Reducing unconscious bias in postgraduate specialist assessment in South Africa
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Abstract
Unconscious bias involves making decisions, interpreting situations and forming assumptions about people based on past experiences, stereotypes, ingrained thoughts and deep-seated ideas. In diverse multicultural societies, unconscious bias has been extensively studied for its impact on social inequity including access to quality healthcare. In addition, unconscious bias can influence assessment outcomes in medical practitioner training, potentially hindering advancement towards establishing a diverse health workforce. This paper reflects on perspectives on unconscious bias in postgraduate assessments utilising a South African model as an illustration. The authors propose some practical strategies to address unconscious bias in specialist training and assessment.
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References
1. Greenwald AG, Banaji MR. Implicit social cognition: Attitudes, self-esteem and stereotypes. Psychol Rev 1995;102(1):4-27. https://doi.org/10.1037/0033-295x.102.1.4
2. FitzGerald C, Hurst S. Implicit bias in healthcare professionals: A systematic review. BMC Med Ethics 2017;18(1):19. https://doi.org/10.1186/s12910-017-0179-8
3. Yeo HL, Dolan PT, Mao J, Sosa JA. Association of demographic and program factors with American Board of Surgery qualifying and certifying examinations pass rates. J Am Med Assoc Surg 2020;155(1):22-30. https://doi. org/10.1001/jamasurg.2019.4081
4. Dayal A, O’Connor DM, Qadri U, Arora VM. Comparison of male vs female resident milestone evaluations by faculty during emergency medicine residency training. J Am Med Assoc Intern Med 2017;177(5):651-657. https://doi.org/10.1001/jamainternmed.2016.9616
5. United Nations. Transforming our world: The 2030 agenda for sustainable development. 2015. https://wedocs. unep.org/20.500.11822/9814 (accessed May 2023).
6. Arif SA, Schlotfeldt J. Gaps in measuring and mitigating implicit bias in healthcare. Front Pharmacol 2021;12:633565. https://doi.org/10.3389/fphar.2021.633565
7. Greenwald AG, McGhee DE, Schwartz JL. Measuring individual differences in implicit cognition: The implicit association test. J Pers Soc Psychol 1998;74(6):1464-1480. https://doi.org/10.1037//0022-3514.74.6.1464
8. Schimmack U. The implicit association test: A method in search of a construct. Perspect Psychol Sci 2021;16(2):396-414. https://doi.org/10.1177/1745691619863798
9. Sukhera J, Wodzinski M, Rehman M, Gonzalez CM. The implicit association test in health professions education: A meta-narrative review. Perspect Med Educ 2019;8(5):267-275. https://doi.org/10.1007/s40037-019-00533-8 10. Maina IW, Belton TD, Ginzberg S, Singh A, Johnson TJ. A decade of studying implicit racial/ethnic bias in
healthcare providers using the implicit association test. Soc Sci Med 2018;199:219-229. https://doi.org/10.1016/j.
socscimed.2017.05.009
11. Sukhera J, Wodzinski M, Rehman M, Gonzalez CM. The implicit association test in health professions education: A meta-narrative review. Perspect Med Educ 2019;8(5):267-275. https://doi.org/10.1007/s40037-019-00533-8 12. van der Merwe LJ, van Zyl GJ, St Clair Gibson A, et al. South African medical schools: Current state of selection
criteria and medical students’ demographic profile. S Afr Med J 2015;106(1):76-81. https://doi.org/10.7196/
SAMJ.2016.v106i1.9913
13. Clarke M, Bassett C. The struggle for transformation in South Africa: Unrealised dreams, persistent hopes. J Contemp Afr Stud 2016;34(2):183-189. https://doi.org/10.1080/02589001.2016.1202501
14. Yach D. Health status and its determinants in South Africa. Afr Health 1994;(Spec No):5-8.
15. Kon ZR, Lackan N. Ethnic disparities in access to care in post-apartheid South Africa. Am J Pub Health
2008;98(12):2272-2277. https://doi.org/10.2105/AJPH.2007.127829
16. Emberton M. Unconscious bias is a human condition. Perm J 2021;25(20):199. https://doi.org/10.7812/
TPP/20.199
17. https://www.justice.gov.za/legislation/acts/2000-004.pdf (accessed 29 May 23).
18. Thackwell, N, Swartz L, Dlamini S, et al. Race trouble: Experiences of black medical specialist trainees in South
Africa. BMC Int Health Hum Rights 2016;16:1-6. https://doi.org/10.1186/s12914-016-0108-9
19. Tiwari R, Chikte U, Chu KM. Estimating the specialist surgical workforce density in South Africa. Ann Glob
Health 2021;87(1):83. https://doi.org/10.5334/aogh.348
20. Rantloane A (Medical and Dental Board, Health Professions Council of South Africa (HPCSA)) personal
communication. Register of medical specialists, with permission from HPCSA. 23 January 2024.
21. The Colleges of Medicine of South Africa. https://www.cmsa.co.za (accessed 1 April 2024).
22. Hyde S, Fessey C, Boursicot K, MacKenzie R, McGrath D. OSCE rater cognition - an international multi-centre
qualitative study. BMC Med Educ 2022;22(1):6. https://doi.org/10.1186/s12909-021-03077-w
23. Zimmermann P, Kadmon M. Standardised examinees: Development of a new tool to evaluate factors influencing
OSCE scores and to train examiners. GMS J Med Educ 2020;37(4):Doc40. https://doi.org/10.3205/zma001333 24. Bapuji H, Chrispal S, Vissa B, et al. Local, yet global: Implications of caste for MNEs and international business.
J Int Bus Policy 2023;6(2):201-234. https://doi.org/10.1057/s42214-022-00146-9
25. Padalia D. Conformity bias: A fact or an experimental artifact?. Psychol Stud 2014:59;223-230. https://doi.
org/10.1007/s12646-014-0272-8
26. Yeates P, O’Neill P, Mann K, Eva KW. ‘You’re certainly relatively competent’: Assessor bias due to recent experiences. Med Educ 2013;47:910-922. https://doi.org/10.1111/medu.12254
27. McClintock AH, Fainstad T, Jauregui J, Yarris LM. Countering bias in assessment. J Grad Med Educ 2021;13(5):725-726. https://doi.org/10.4300/JGME-D-21-00722.1
28. Devine PG, Ash TL. Diversity training goals, limitations and promise: A review of the multidisciplinary literature. Annu Rev Psychol 2022;73:403-429. https://doi.org/10.1146/annurev-psych-060221-122215
29. Woreta FA, Gordon LK, Knight OJ, Randolph JD, Zebardast N, Pérez-González CE. Enhancing diversity in the ophthalmology workforce. Ophthal 2022;129(10):e127-e136. https://doi.org/10.1016/j.ophtha.2022.06.033
30. Gandhi M, Johnson M. Creating more effective mentors: Mentoring the mentor. AIDS Behav 2016;20
(Suppl 2):294-303. https://doi.org/10.1007/s10461-016-1364-3
31. Matava CT, Alam F, Kealey A, Bahrey LA, McCreath GA, Walsh CM. The influence of resident and faculty gender
on assessments in anesthesia competency-based medical education. Can J Anaesth 2023;70(6):978-987. https://
doi.org/10.1007/s12630-023-02454-x
32. Kozato A, Patel N, Shikino K. A randomised controlled pilot trial of the influence of non-native English accents on examiners’ scores in OSCEs. BMC Med Educ 2020;20(1):268. https://doi.org/10.1186/s12909-020-02198-y 33. Royce CS, Morgan HK, Baecher-Lind L, et al. The time is now: addressing implicit bias in obstetrics and gynecology education. Am J Obstet Gynecol 2023;228(4):369-381. https://doi.org/10.1016/j.ajog.2022.12.016