Reducing Medical Students’ Ethnic Bias Toward Indigenous Population (Māori) Using Digital Training

What is it about?

In our study, we developed and tested a novel digital bias training called cognitive bias modification for stereotype (CBM-S), a tool designed to address interpretation bias in medical students. CBM-S targets biases at the unconscious level by using a word task designed to force a less biased interpretation of Māori patients (a New Zealand indigenous population) in common healthcare scenarios. An example scenario reads: “You explain to Miss Ropata your selected treatment. They ask you many questions about this decision. You imagine they are…” This scenario could be interpreted in various ways, including (1) Miss Ropata is uneducated about western medicine or (2) Miss Ropata is worried about her health condition and related treatment. A student who holds stereotypical biased beliefs that Māori patients are generally from a low socioeconomic background may be more likely to endorse the former interpretation. In CBM-S, medical students are presented with a series of these types of common health care scenarios involving Māori. Similar to a CAPTCHA-type mechanism, the final word of each scenario is presented with missing letters (“…w-rr-ed”), and students are prompted to enter the first letter of that word to complete the word task. The final word invites a constructive resolution of the ambiguity (“You imagine they are worried.”), which is followed by a yes/no question to reinforce this constructive interpretation (“Is it likely that Miss Ropata is worried about the treatment?” YES). Using this type of prompted word task is an effective way to navigate the training task, but more importantly, to force a less biased response at the unconscious level. In our study, we tested the effectiveness of a single session 59-item CBM-S training against control and found promising results. We showed that following CBM-S training, there was a reduction in students' interpretation bias of scenarios involving Māori patients.

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Photo by Ani Kolleshi on Unsplash

Photo by Ani Kolleshi on Unsplash

Why is it important?

Health inequity is commonly experienced by marginalized populations and is a risk factor for developing health problems, in part due to unconscious bias. Unconscious bias is defined as the tendency to automatically focus on and interpret everyday events in a particular manner. For example, thinking that older people are physically incompetent and unproductive or that indigenous communities are lazy and poor. Many existing bias trainings aim to shift these unconscious stereotype beliefs by "pulling" them into conscious level through naming, examining, and analyzing beliefs and biases. This has proved to be difficult and time consuming as stereotypes are often developed early in life and therefore deeply rooted in one's belief system. CBM-S targets biases at the unconscious level and has already shown promising and effective results in other areas of application (e.g., in clinical application as a mental health intervention). This is the first time that this type of bias modification technique has been introduced in targeting ethnic stereotype bias and would be valuable to many readers.

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