Like other forms of education and awareness-raising that focus on socially sensitive topics, it is important to recognize that change will not occur instantaneously but rather as a developmental process.
Teal et al. articulated one such model in which education may facilitate individuals’ progression along a spectrum ranging from denial/unawareness of implicit bias to recognizing and acting to mitigate one’s own implicit biases . The following approaches can help move individuals along this spectrum toward embracing active bias mitigation strategies.
Using the Implicit Association Test – Because implicit biases operate unconsciously, bringing these unconscious associations to conscious awareness is critical for helping individuals become self-aware of their biases. The Implicit Association Test (IAT) is a free and publicly-available tool that is useful for surfacing implicit biases. For example, clinical educators have used the IAT as way to spark discussions and reflections among their students regarding the presence of and their responses to bias [1-3].
Fostering reflections on bias – Whether the approach is small group discussions, written reflections, or other forms of engagement, individual reflections on implicit bias have been used with respect to both future and current health care professionals [2-4]. Given that learners may resist this bias education to varying degrees, other scholars recommend that any activity of this nature should be actively framed as “an exercise in personal development” [1, 3]. The effectiveness of this approach can have significant meaning, as one study suggests that group-based reflections on implicit bias may not only benefit individuals but may also affect their willingness to discuss bias with their colleagues .
Implicit Bias Mitigation Strategies:
Fostering and increasing motivation toward egalitarian goals – Some scholars believe that tapping into clinicians’ intrinsic motivation toward egalitarianism may offset implicit bias in clinical decision-making. For instance,work by Byrne & Tanesini suggests that the strategy of encouraging students to “approach every encounter with patients who are members of underprivileged or stereotyped social groups as an opportunity to re-enforce and act out their avowed commitment to these [egalitarian] values” can be a successful strategy for mitigating the influence of implicit bias [5, p. 125?]. This can be particularly effective when those egalitarian intentions become chronically accessible and automatically activated .
Perspective taking and empathy building – Referring to the ability to consider a situation from another’s position, perspective taking not only has been shown to reduce implicit bias, but it also can also increase empathy between clinician and patient [6-8].
Mindfulness – In the context of health care, mindfulness encourages clinicians to “pay attention to the details of the process of clinical care rather than falling back on habits and shortcuts such as stereotypes and [unconscious biases]” . This approach can be incorporated into clinician education as well as professional development opportunities for practicing clinicians.
Building new associations – Another approach for mitigating implicit bias is to replace existing associations with new ones that better align with one’s egalitarian intentions. There are several approaches to altering one’s associations.
Counter-stereotypes: Studies suggest that exposure to and interaction with counter-stereotypical exemplars — individuals whose traits contrast with the stereotypes usually associated with a group or category  — may reduce levels of unwanted biases [1, 5 & 9]. In a clinical education setting this may occur through the use of immersion experiences with undeserved communities and those they are biased against .
Inter-group Contact: Under the right conditions, cross-cultural inter-group contact is an effective way to alter one’s associations [1, 6-7, & 10]. In particular, if the contact takes place with two individuals of equal group status within the situation, common goals, inter-group cooperation and authority support .
Fostering “teamness” among doctors and patients: “Whether people perceive another as a partner on the ‘same team’ (i.e., as part of the same group, the ‘ingroup’) or as a member of a different groups [sic] (‘outgroup’) has profound implications on their reactions to the other” [6, p. 884]. Given this reality, fostering feelings of cooperation and “teamness” between clinicians and their patients is a critical way to override one’s implicit biases .
Self Evaluation Tools for Bias Mitigation:
The following forms are intended to help clinicians and health educators evaluate their susceptibility toward relying on implicit bias as well as their orientation toward bias mitigation practices. Please answer each question honestly to allow for a holistic evaluation. In no way is this self-evaluation tool intended for use as a formal metric of performance; instead, it is created for individual use by educators seeking to mitigate implicit bias in their teaching practices and increase their capacity for introspection and reflection.
Download the Clinician Self-Evaluation Tool
Download the Health Educator Self-Evaluation Tool
 Teal, C.R., et al., Helping Medical Learners Recognize and Manage Unconscious Bias Toward Certain Patient Groups. Medical Education, 2012. 46(1): p. 80-88.
 Teal, C.R., et al., When Best Intentions Aren’t Enough: Helping Medical Students Develop Strategies for Managing Bias about Patients. Journal of General Internal Medicine, 2010. 25(Suppl 2): p. 115-118.
 Hernandez, R.A., et al., Fostering Students’ Reflection About Bias in Healthcare: Cognitive Dissonance and the Role of Personal and Normative Standards. Medical Teacher, 2013. 35(4): p. e1082-e1089.
 Hannah, S.D. and E. Carpenter-Song, Patrolling Your Blind Spots: Introspection and Public Catharsis in a Medical School Faculty Development Course to Reduce Unconscious Bias in Medicine. Culture, Medicine, and Psychiatry, 2013. 37(2): p. 314-339.
 Byrne, A. and A. Tanesini, Instilling New Habits: Addressing Implicit Bias in Healthcare Professionals. Advances in Health Sciences Education, 2015. 20: p. 1255-1262.
 Burgess, D., et al., Reducing Racial Bias Among Health Care Providers: Lessons from Social-Cognitive Psychology. Journal of General Internal Medicine, 2007. 22(6): p. 882-887.
 Boscardin, C.K., Reducing Implicit Bias Through Curricular Interventions. General Internal Medicine, 2015.
 Stone, J. and G.B. Moskowitz, Non-Conscious Bias in Medical Decision Making: What Can Be Done to Reduce It? Medical Education, 2011. 45(8): p. 768-776..
 Kang, J. and M. Banaji, Fair Measures: A Behavioral Realist Revision of ‘Affirmative Action’. California Law Review, 2006. 94: p. 1063-1118.
 Allport, G.W., The Nature of Prejudice. 1954, Cambridge, MA: Addison-Wesley.