in the forum for allowing me to present and thanks to all of you for sticking around. So implicit bias, how to recognize it and how to fight it, and I don't expect to tell you all this in 10 minutes because this is a very long topic, but we're going to try and raise awareness. I have no disclosures. So just to review the definitions, while aware of bias, prejudice in favor of or against one thing, person or group compared to another, and the verb we're all familiar with as we look at our medical research, statistical bias, method sampling bias. Explicit bias is a conscious bias that we all have and we're all very aware of, but what we're talking about is implicit bias, and implicit bias is a subconscious favoritism toward or prejudiced against people of a particular ethnicity, gender, or social group that can influence your actions or perceptions. So I did some extensive training at my hospital and I saw this video and I think it will really demonstrate both implicit bias and microaggressions. So we'll watch this real quickly. Wake everyone up. Hi there. Hi. Nice day, huh? Yeah. Finally, right? Where are you from? Your English is perfect. San Diego. We speak English there. Oh, no. Where are you from? Well, I was born in Orange County, but I never actually lived there. I mean before that. Before I was born. Yeah, like where are your people from? Well, my great grandma was from Seoul. Korean. I knew it. I was like, she's either Japanese or Korean, but I was leaning more towards Korean. Amazing. I'm Shastina. There's a really good teriyaki barbecue place near my apartment, so I actually really like kimchi. Cool. What about you? Where are you from? San Francisco. But where are you from? Oh, I'm just American. Really? You're Native American? No, just regular American. Oh, well, I guess my grandparents are from England. Oh, well. Hello, Gangnam! What's all this then? Top of the mornin' to ya! Let's get a small tea, small tea! Double, double toil and trouble! Mind the gap! Beware Jack the Ripper! Bloody hell! Pip, pip! Cheerio! I think your people's fish and chips are amazing. You're weird. Really? I'm weird? Must be a Korean thing. So, very demonstrative of both microaggressions on both sides, I think that you can tell. Hi there. So, think of implicit bias as your fight or flight response. Human beings have a rapid hardwire response into their being based on their life experiences, how they were raised, what they've been exposed to. And these responses have attitudes and behaviors associated with them. So, I encourage you all to take the Harvard Implicit Bias Test if you haven't. And you can find that online if you just Google it. And consider your privilege, not only how you were raised or how you grew up, which is how many of us identify ourselves, but what privileges do you have now? And how did you get those privileges? And think about how others perceive those privileges that you currently have. Because that might be different than how you perceive it. Recognize implicit bias in yourself. But this really requires significant introspection. We all know what we're supposed to say and do, but how do you instinctively act at a moment? And this really requires a thoughtful look into your response and actions. A questioning curiosity that you ask yourself at the end of the day or the end of an encounter, why you said what you said, or how others perceived what you said. Because frequently, with implicit bias, it's not an intent to harm, but it can be very harmful. So, learned responses. We learn all the time. We learn new skills, we learn new communication skills. We try to get our patients to learn. So, consider your athletes that have poor lower extremity control and you're trying to prevent ACL injuries. We tell them over and over, practice, practice, practice. Look in the mirror if you can't get how to do your control, your lower extremity control. And the same with the shoulder blade and the shoulder problems with the scapular control. So, this really takes repetitive practice for our athletes to get it right. So, we need to all look in the mirror and figure out, we need to do the same. We need to look in the mirror and understand how our behaviors are interpreted by others. So, there's been many, many articles published. So, this just isn't my opinion. Implicit bias in healthcare professionals is a systemic review. This was in 2017 that said, healthcare workers exhibit the same level of implicit bias as the wider population. And that should be really no surprise. We think we're a little better than everyone else, but studies show that we're really not. And that this study highlights the need for instruction for implicit bias and disparities in healthcare delivery. An article from 2020, Too Male, Too Pale, Too Stale, a qualitative exploration of student experiences of gender bias within medical education. And it says, despite progress having been made regarding overt gender discrimination, implicit bias persists with existing positive action inadequate to promote the advancement of women. An institution should mandate participation in implicit bias education. An article by Bohl, inappropriate questions asked of female orthopedic surgery applicants from 1971 to 2015. And the important thing here, I think, for us all to realize is this proportion either increased or decreased from 1971 to 2015. So questions are still being asked. And with, nowadays, the men get paternity leave almost as long as the women do. Do people ask the men, do you plan on getting married and having children during your residency? So I think we need to level the playing field. This was a study, a decade of studying implicit racial, ethnic bias in healthcare providers using the implicit association test. And the interesting thing about this is if the providers were told that they were part of a study on implicit bias, they answered the questions differently. They answered the way they were supposed to answer, the way they were taught to answer. But if they weren't told that, they answered the questions differently. So I would be amiss in not pointing out the studies that were just published in J-OS by Tammy Skripala and many women up here and in the forum advocating for women in orthopedic surgery and showing that orthopedic surgery is the least diverse of all medical specialties by both sex and race and that diversity among orthopedic trainees is the lowest in medicine. So we do have more women residents now than we have board-certified orthopedic surgeons and that's a step in the right direction, but we need to be very supportive of them. And this just published in Medscape in January of this year by Dr. Augustus White, the whitest specialty revisited. And he said, what seems to be distinctive about orthopedics is that the mindset which perpetuated and still perpetuates the old lily-white male predominance in medicine seems stronger, more ingrained, and more resistant to change than it is among physicians of other specialties. Orthopedic surgery needs an enhanced campaign to raise awareness and redouble persuasion. So microaggressions, and I think you saw that in that video, it's a comment or action that is subtly and often unintentionally hostile or demeaning to a number of a minority or marginalized group. So reflect on comments that you make, not only to your patients, athletes that you care for, things that you see happen in a training room. Be supportive of someone who speaks out because it takes courage to speak out. So be supportive. Reflect on your patient encounters. Do you have a preconceived notion when someone's seeing you for a fourth opinion or maybe a patient has a mental illness or they're houseless? So try before you go in those rooms to address those in your mind so that you can get rid of that implicit bias that just instinctively pops up when we see these marginalized groups. So microaggressions are named for acting out implicit bias and, on the reverse, for response to multiple implicit bias comments that have just built up over time and then people lash out. And I think also you saw that demonstrated in the video where she was getting a little more upset with all the comments he was making and then she kind of made this ridiculous backlash to him and then he just thought she was weird because of it all. So, you know, that's... And sometimes, especially in our society today, if people have guns and other things, it can get very ugly, and we've all seen that. So implicit bias, in summary, is built into our hardwiring. Think of it as your fight-or-flight response. Critically reflect on your day, your actions, and how those actions have been interpreted. With any habit or instinct, you must recognize it, make a sincere and very conscious effort to change your behavior, and everyone will be better for it. Thank you very much.

implicit bias

recognize

introspection

microaggressions

combat