Eliminating Explicit and Implicit Biases in Health Care: Evidence and Research Needs

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• Evidence has shown that implicit attitudes are malleable and that such attitudes are learned and strengthened through repeated observation of particular classes of people in valued or devalued circumstances. For example, individuals exposed to less favorable exemplars from a given identity demonstrate increased implicit bias and stereotypes with respect to that entire group

• stereotype replacement (replacing stereotypical responses to bias with nonstereotypical ones), counter-stereotypic imaging (imagining known counter-stereotypical people), individuation (learning personal attributes of persons present rather than identifying group attributes), perspective taking (taking the perspective of persons present), and increasing opportunities for contact

• biases permeate the health care system and affect patients via patient–clinician communication, clinical decision making, and institutionalized practices