Innovative Ideas Fight Bias in Medicine

An IDEAS grant expands a novel training program for Tufts University School of Medicine faculty

Vision without action, Nelson Mandela observed, is just daydreaming. For a decade, the Innovations in Diversity Education Awards (IDEAS) program at Tufts University School of Medicine has kept the focus on action, by helping faculty turn new concepts for advancing diversity, health care equity, and cultural competency into successful initiatives that often inspire further innovation. 

Case in point: the 2019 IDEAS grant awarded to Karen Freund to further the school’s anti-bias training. Freund, physician-in-chief at Tufts Medical Center (Tufts MC) and Sheldon M. Wolff Professor and chair of the Department of Medicine at the School of Medicine, focuses her research on improving care to under-resourced communities and understanding barriers facing groups traditionally underrepresented in medicine. After she brought novel anti-bias training to all divisions of the Tufts MC Department of Medicine, Freund envisioned extending that training to all School of Medicine and Tufts MC faculty. “The IDEAS grant provided a great opportunity for us to expand something unique and important to all departments,” Freund said.

Damian Archer, Clinical Assistant Professor

Damian Archer

The training, called Bias Reduction in Medicine (BRIM), developed and taught by the University of Wisconsin-Madison, is unique in that it was created by academic physicians for other physicians and applies decades of research on behavioral change strategies. The program trains facilitators who can then teach their peers, tailoring the program for different audiences. When leading training sessions, Robert Sege, a clinical professor of medicine and co-director of stakeholder and community engagement at Tufts Clinical and Translational Science Institute, often points to data showing clear bias in medical research.

For example, medical researchers from under-represented groups take years longer to secure career-building federal grants. When it comes to research areas, cystic fibrosis, which affects about 30,000 Americans, most of them white, receives $10,000 in funding per affected person, while sickle cell disease, which disproportionately affects Black people, receives about $943 for each of the 90,000 Americans who have it.

Such data is compelling, Sege said, as is the evidence that the program itself has been effective at other medical schools. “Doctors are scientists,” said Sege, “If you give them research to validate themselves, they will find it convincing.” 

“This training encourages us to engage and be courageous. It really is a prototype of what we should be supporting at the medical school." 

Damian Archer, assistant dean for multicultural affairs and clinical assistant professor in family medicine

The anti-bias training urges medical educators to pay attention to the words they use in teaching, hiring and promotion, and patient care. Whether writing a job description, letter of reference to support a student’s residency application, or a vignette about a patient, “language matters,” said Damian Archer, assistant dean for multicultural affairs and clinical assistant professor in family medicine. For example, research shows that recruiting for a department “chairman” rather than a “chair” or “chairperson” reinforces the stereotype that a department chair is male and skews evaluation of candidates. “We are teaching our community to recognize this, call it what it is—bias—and interrupt it with effective techniques,” said Archer, who believes training has better equipped him to identify problems and made him more confident in addressing them. “This training encourages us to engage and be courageous. It really is a prototype of what we should be supporting at the medical school.” 

The original program was designed for internal medicine, Archer said, but the School of Medicine innovated by expanding its reach. “We intentionally planned that people from other departments, such as pediatrics, family medicine, and anesthesiology, would also be trained as facilitators, so we were quickly able to deploy that training across Tufts and also sites where our faculty teach.” 

The initial cadre of 14 facilitators represented 10 different departments and sites, and subsequent trainings have included the School of Medicine’s admissions committees as well as medical faculty. Pre- and post-training surveys show a substantial increase in knowledge of key anti-bias concepts and techniques. While Freund’s IDEAS grant has concluded, the school and Tufts MC continue to train additional facilitators, expand the work to affiliate organizations, and develop content to involve non-clinical team members.

The initiative has also inspired wider innovation. It reinforced the importance of offering more explicit anti-racism education within the medical school. Archer and Assistant Professor of Family Medicine Sarah Rosenberg-Scott are developing a proposal to further educate faculty about race and inequity in medicine. For example, built into the software of modern spirometers (devices that measure lung function and are used to diagnose and treat diseases such as asthma and COVID-19) is a formula that assumes lower lung capacity for Black patients; the formula is based on flawed data and racist assumptions that go back centuries. “We need to have deeper conversations about how to acknowledge such problems and prepare faculty to talk about them with students,” said Rosenberg-Scott.

Amy Lee, associate professor and vice chair for academic affairs in the Department of Family Medicine, believes that bias reduction training can set the stage for further change. “Karen Freund’s program has been a great first step,” she said. “Anti-bias training can help us think about things in new ways and consider more broadly about how bias might be affecting the educational environment. This can move the university much closer to its goal of becoming an anti-racist institution.”

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