BREAKING THE BIAS HABIT

The Bias Reduction in Internal Medicine (BRIM) initiative was developed at the University of Wisconsin-Madison to “break the bias habit” and challenge cultural stereotypes that impact interactions with others even unconsciously.

“Nobody thinks that their thoughts or actions are based on internalized stereotypes or biases, but the truth is that these ideas can be so ingrained that even the most sensitive person can be influenced by them in their behavior at work, towards colleagues, patients, or towards students,” said Dr. Patricia Finn. “BRIM has been shown in early trials to help faculty recognize and reduce biased thoughts and behavior. I knew immediately after I saw the results presented at a conference that I wanted our department of medicine to participate in the next phase of evaluating the program.”

The Department of Medicine (DOM) was the first to enroll in the 2017 nationwide study of BRIM developed by Dr. Molly Carnes, professor of medicine, psychiatry and industrial and systems engineering at the University of Wisconsin-Madison and her colleagues. The NIH-funded study included 20 departments of medicine and lasted approximately two years at each institution. The DOM initially selected four local leads for the study: Drs. Waddah Alrefai, Alana Biggers, Geri Donenberg, and Andrew Trotter.

“Ensuring a positive departmental climate by reducing racial/ethnic, gender, and other biases will improve faculty retention,” explained Dr. Carnes. “The average cost of losing a faculty member exceeds $400,000, so climate is also important regarding cost-savings,” said Dr. Carnes. “UI Health — our health enterprise comprised of UIC’s seven health science colleges and the University of Illinois Hospital and Clinics — is dedicated to advancing health equity for all. That commitment is rooted in a faculty and staff who are aware of and can recognize biases and inequities they themselves might hold,” said Dr. Robert Barish, vice chancellor for health affairs at the University of Illinois at Chicago. “Engaging in the BRIM program is one way we can foster this mission in interactions with fellow faculty, staff, patients and students.”

“Research indicates that professional interactions, performance evaluations and hiring decisions are often inadvertently influenced by opinions people hold about others, like where they’re from or the language they speak, without getting to know the individual, Dr. Carnes explained. Race/ethnicity, gender, age, sexual preference, and even weight can drive biases. At the heart of BRIM is a three-hour workshop designed to “break the bias habit” in Internal Medicine. Participants are taught to recognize their implicit biases and identify strategies to reduce them. For example, participants are encouraged to take the other person’s perspective — or put themselves in another’s shoes and replace a stereotypical perception with real information based on the individual. At the end of the workshop, participants indicate “commitments to action;” the most common ones were challenging microaggressions, practicing perspective-taking, and recognizing and challenging stereotypes. Ten DOM faculty were initially trained by Dr. Carnes’ team to deliver the workshops and are now certified BRIM implementers.

As part of the research study, half of the DOM divisions received the workshops led by the team at the University of Wisconsin-Madison, and half of the divisions received the workshop delivered by UIC-trained implementers. Prior to workshop delivery, DOM faculty completed a baseline survey on the departmental climate. Three months after the workshops, participants completed a follow-up survey about the department climate, the BRIM workshop, and changes in their behavior. A final survey was completed by participants at the conclusion of the study.

The UIC-DOM-BRIM team modified the original workshop to create a two-hour version. The BRIM team has delivered several sessions of this modified version of the workshop to all members of DOM including faculty, internal medicine residents, fellows, post-docs, and administrators during the last four years. Last year, the BRIM team began a collaborative initiative with the College of Medicine (COM) to provide BRIM training to all members of the college on all three campuses. The BRIM team trained new facilitators and the group now includes 20 certified implementers from different departments and from the three campuses. In 2022, 55 sessions were held; 50 of the sessions were for the College of Medicine, three for residents, and two sessions for family medicine and MSTP students. The DOM-BRIM team will continue to collaborate with other departments in the COM at UIC to expand the program and explore options for scholarly activities centered around best practices to promote equity.