Podcasts about implicit racial bias

I'm so excited about this podcast episode! Jessica Pryce, MSW, PhD is someone I know in real life. I had the honor of working under her leadership a few years ago. Her career story is awe-inspiring and one I talk about often because it is a true testament that your frontline work can create larger opportunities for you. For the past 10 years, she has worked on multiple levels of the child welfare system (direct practice, teaching, training, policy, research, and consulting).  She has published research on child welfare-related topics, such as training and education, racial disparity, and anti-poverty practices. 

In this episode Dr Jessica Pryce, chats about inclusive, equitable and effective child welfare. After earning her PhD at Harvard University and working in New York state for two years, Dr Jessica Pryce was appointed in 2016 the new Executive Director of the Florida Institute for Child Welfare. Her research has focused on the training and education of the workforce, racial disparity in child welfare decisions, and the disproportionality in the United States foster care system.       This episode was recorded for the Adopt Change National Permanency conference 2020 Supporting Children at Home and School to #THRIVE.      Help us find #aHomeForEveryChild      Get in touch:    Find out more about Dr Pryce at https://jessicaprycephd.com/   You can get in contact with us at www.adoptchange.org.au       Like this episode? Share your thoughts with us on   Instagram    Facebook   TikTok      Show Credits:   Host: Michelle Stacpoole, Adopt Change    Guests: Dr Jessica Pryce   Audio Producer: Fernanda Dedic, Adopt Change   Executive Producer: Lily Allsep, Adopt Change      Adopt Change acknowledges the Traditional Owners of the Land we have recorded and edited this podcast on, the Gadigal people of the Eora Nation. We pay our respect to Elders past and present and extend that respect to all Aboriginal and Torres Strait Islander cultures.      Additional info:   Dr Jessica Pryce  For the past 10 years, Dr. Pryce has been involved at multiple angles of child welfare (direct practice, teaching + training & policy and research). She has published on child welfare related topics, such as, training and education, racial disparity and anti-poverty practices. She has presented her research at 30+ conferences both nationally and internationally. She is the author of several op-eds focused on racial disparity and effective strategies to impact racial disproportionality within child welfare. Her TED Talk on Implicit Racial Bias in Decision Making has since been viewed over 1.2 million times. 

Clinical trials are essential to progress in medicine, but racial and ethnic minorities are frequently underrepresented in such studies. In this ASCO Education podcast episode, we will examine this issue with Dr. Carol Brown, gynecologic cancer surgeon and Chief Health Equity Officer at Memorial Sloan Kettering Cancer Center, Dr. Ana Maria Lopez, Professor and Vice Chair of Medical Oncology at Sidney Kimmel Medical College and former Chair of ASCO's Health Equity Committee and Mr. Ted Bebi, Innovation Manager at Medidata Solutions. They discuss how diversification of clinical trials contributes to health equity (4:03), barriers to participating in clinical trials (14:37), and what clinicians and trial sponsors can do to improve participant diversity in clinical trials (20:25).  Speaker Disclosures Dr. Carol Brown – None Ted Bebi: Employment – Medidata (a Dassault Systèmes company); Stock and Other Ownership Interest – Pfizer, Eli Lily, Abbvie, Merck, BMY        Dr. Ana Lopez - None Resources ASCO-ACCC Initiative to Increase Racial & Ethnic Diversity in Clinical Trials Journal Article: Increasing racial and ethnic diversity in cancer clinical trials Journal Article: Representation of minorities and women in oncology clinical trials Podcast: Impact of Implicit Racial Bias on Oncology Patient Care and Outcomes ASCO-ACCC JustASK Training Program If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT Dr. Carol Brown: Welcome to the ASCO Education podcast. I'm Dr. Carol Brown, a gynecologic cancer surgeon and the Chief Health Equity Officer at Memorial Sloan Kettering Cancer Center. Our guests and I will be exploring the problems and solutions with regards to racial disparities in clinical trials.   A necessary element for conducting clinical trials is, obviously, the enrollees or participants. Racial and ethnic diverse groups are frequently underrepresented in clinical trials, despite having a disproportionate burden for certain cancers. In addition, there is increasing evidence that a person's individual genetic makeup may determine the level of toxicity or efficacy of a new cancer drug specifically. Therefore, when we don't have enough diversity in our cancer clinical trials, it can really undermine the generalizability of our results. And so, to address this gap, in its recent updated guidance to industry, the US Food and Drug Administration stated that enrollment in clinical trials should reflect the diversity of the population who ultimately use a treatment.   In 2022, ASCO and the Association of Community Cancer Centers issued a joint statement recommending that anyone designing or conducting trials should complete recurring education, training, and evaluation to demonstrate and maintain cross-cultural competencies, mitigation of bias, effective communication, and a commitment to achieving equity, diversity, and inclusion.   Joining me to discuss this important topic today is Dr. Ana Maria Lopez, who's the Professor and Vice Chair of Medical Oncology at the Sidney Kimmel Medical College. And she's the former Chair of ASCO's Health Equity Committee. Our second guest is Mr. Ted Bebi, Innovation Manager at Medidata Solutions. His research explores underrepresentation of black patients at clinical trials and how diversity impacts clinical trials.  Participant disclosures for this episode are listed on the podcast page.  So why should we care about improving diversity in clinical trials? Dr. Lopez? Dr. Ana Maria Lopez: We are clinicians. We are wanting to take care of our patients as best as possible, and we can only do that if our studies include everyone. An example that I often think about is the concept of airbags began in 1953, and in 2008, the National Highway Traffic Safety Administration came out and said, “You know what? We should be testing airbags on small female crash test dummies because otherwise, we don't know that these airbags will be safe.” And in fact, there were data that the airbags that existed put women and children at a much higher risk for injury or death. So, we want to be ahead of that curve, and we want to allow the best possible treatment. Dr. Carol Brown: So, Mr. Bebi, what would you say about how we could improve diversity in clinical trials? Ted Bebi: So I really like the example of the airbags that Dr. Lopez brought up because it makes it clear when building a product it's important to test the product in a representative sample of the population that will ultimately end up using it. It's the same with products like medications. If you want an efficacious drug, you should test it in the appropriate population. It's what constitutes good science. Additionally, adequate diversity in clinical trials is also important because it's ultimately an issue of health equity and providing fair access. Dr. Carol Brown: Could you kind of go on from there and talk about, specifically, how does diversifying the group of people that participate in clinical trials actually translate into increasing health equity?  Ted Bebi: Well, participating in a clinical trial is a form of receiving health care. Often, we are talking about patients for which a clinical trial might be their last resort. And even if not, participating in a clinical trial means gaining early access to potentially life-changing drugs that could become the new industry standard and doing so at no cost. So, you're receiving care and follow-up from some of the best specialists in the field. So having fair access to this opportunity for all patients is definitely a health equity issue. Dr. Carol Brown: Great. Dr. Lopez, how would you answer that question about how does diversifying clinical trials contribute to health equity? Dr. Ana Maria Lopez: Yeah, no, I think I agree with everything that Mr. Bebi said. In addition, I think we have to remember that diversity is more than race. Race is truly a social construct. We need to think about gender. We need to think about age, the whole lifespan, and people are living longer. How we metabolize medications at different time points in our life may vary. So, lots of different factors that we can consider when we think of diversity. But the gold standard is really: Are folks getting the best outcome possible? And as long as that metric is not being reached, we need to be thinking of how can we facilitate that. Dr. Carol Brown: So, Dr. Lopez, you brought up this concept that health equity is really the best outcome possible. Could you comment a little bit about how do we know, particularly in cancer, what is the best outcome possible? So how do we determine what the reference is for that, so we can figure out whether our patients are actually getting health equity? Dr. Ana Maria Lopez: Sure. So, we use different time points. We can look at relapse rates, survival rates, and of course, part of that may be comorbidities. Certain comorbidities that people have may impact their cancer treatment outcomes. So, it is complex, but it is important for us to take a look contextually at what the patient's risk is and what the patient's outcome would be. Dr. Carol Brown: We can kind of all agree that when we're talking about equity, it's getting the best outcome for everybody, no matter what they're bringing to it. And I really like your comment, Dr. Lopez, about race being not only the only factor but remembering that it is a social construct. If you could add to that, Mr. Bebi. Ted Bebi: We're talking a lot about diversity in clinical trials in terms of race and ethnicity, and that is something that is ultimately very important. But we're talking about diversity in all sorts of aspects. We're talking about diversity with age. We're talking about diversity with sex, with socioeconomic aspects because we often use race as a proxy for other things that might be going on in patients' lives. And we need to consider all of this part of diversity in clinical trials because once the drug is out in the market, it will be an intersection of potentially all of those identities and many things going on in their life that might affect how they respond. So, when we're thinking about race as a diversity point, we might be using it as a proxy for a specific type of individual, a specific patient journey that we want to make sure to include. It's not necessarily that race is the end-all, be-all measure of diversity; it's that we want to capture the true patient experience for that disease. Dr. Ana Maria Lopez: What I think is also really interesting is how we collect the data. And some of what the last couple of years have taught us is that folks may not trust our healthcare systems, and so folks may not be willing to say, ‘I am X, Y, or Z,' which certainly puts us a little bit in the void. So how important it is for us as clinicians, as researchers, to be part of creating an environment where patients can feel that ‘Yes, I can trust and I can share, and I can say, this is who I am,' because that could impact clinical care. Dr. Carol Brown: So, acknowledging that race is a social construct and that it really is used as a surrogate for other social determinants of health and other factors that affect health, and again, really acknowledging what you said, Dr. Lopez, that even asking people to identify their race is extremely problematic. But given what we do know and what our experience has been in the clinical trial world, first, Mr. Bebi, could you comment about what has been your experience and your research with the current state of participation by diverse racial and ethnic groups in clinical trials in the United States? What have you found in your research?  Ted Bebi: Recently, at Metidata, we published a paper where we looked at the state of black participation in clinical trials. We found the level at which you look at the data really matters. For example, when we looked at racial diversity across all US trials, black representation actually matched the proportion of black people represented in the 2020 US National Census, which is about 14%. But looking deeper, there were actually huge differences by therapeutic and disease area. And specifically, we saw that in oncology, black participation was only at around 8.5%, so far below the representation of black people in the United States.   Another interesting story is that when we were looking at the central nervous system therapeutic area, overall, we saw a pretty high rate of black participation at around 20%. But when we looked at one of the largest central nervous system indications, Alzheimer's, we saw only 5% black participation, so much, much lower. What we discovered is that within this therapeutic area, there were actually a lot of psychiatric trials that were driving the rate up. So, the main takeaway from this research is that you cannot take a general level of diversity as adequate for all diseases. You really have to zoom in on the specific indication to understand what constitutes good diversity or representative diversity for that disease.  Dr. Carol Brown: I'd like to ask both of you what do you think about that - what the bar should be. Because Mr. Bebi, you mentioned using the census distribution of races in the population, but I think a lot of us in the cancer field feel like that maybe isn't the right bar. Maybe the bar should really be what is the cancer burden distributed according to self-identified race, ethnicity, or other categories. And when you look at that, I think you find some different statistics. So, Dr. Lopez, could you comment about what your work has shown you about the current state of representation of diverse people affected by cancer in cancer clinical trials, and maybe get a little bit more into what you were saying earlier about the definition of race and the challenge of determining race, etc. Dr. Ana Maria Lopez: We really need to look closely at the data, and that looking at therapeutic trials and at specific populations can be really important. Now, we're a big country, so there can be - what is the catchment area that you serve? And in that catchment area, what are the cancers you're treating, and in which populations are at greatest risk? But right, sometimes it may not be - let's say the population is 10%x, but if that population is at higher risk for a certain disease, to really get granular about the understanding, I need to recruit more people that are from that greater-risk population. So that's where I think it's so important to know the population, to have connections with the community. And actually, the community can say, “Hey, this is what you may want to be studying because this is what impacts us.” Ted Bebi: If I can speak on the research side as well, the best way to ensure representative diversity is to have a very solid understanding of the natural prevalence of a disease. We need to be able to understand what the risk populations are and, even further, what does the mortality look like? Are there differences in how different patients are experiencing the disease further on, not just how they're getting the disease and how often they're getting the disease? So it needs to look different for every single indication. And even with the oncology, for example, the two largest indications in clinical trials for oncology, lung cancer and breast cancer, they also look slightly different. With lung cancer, and our research showing at 8% black participation and breast cancer being a little bit higher at around 11%. So, we always need to take into consideration that incidents include prevalence, include mortality. And yes, the golden standard should be can we build a clinical trial that reflects the actual representative diversity of the disease in the real world? That is what we're striving for. Dr. Carol Brown: I would agree with that. I would also add, though, that there may be some specific cancers for which you want to have an even greater representation of a particular group because it might be directly related to the question you're trying to answer. So, for example, you mentioned breast cancer, so I think most of the audience is probably aware that young women who self-identify as black tend to have a higher mortality from breast cancer. And this is believed to be because they are more likely to get triple-negative breast cancer. And so one of the strategies we've looked at at our cancer center is for trials specifically for triple-negative breast cancer, trying to overrepresent women who self-identify as black or have African ancestry in those trials because we're specifically trying to make sure that we do something to narrow that gap in survival from breast cancer that they experience. So, I think that, as you all mentioned, I think what we can take from this is it's really important to look closely that there are different layers and subtleties that we have to take into account.  So, I think we've clearly established that there is underrepresentation of diverse groups. But let's talk about why. So why do we think that different self-identified races and ethnicities or age groups or socioeconomic status background people are underrepresented in clinical trials? What are some of the reasons in your experience for this, Dr. Lopez? Is it funding outreach? What are the main barriers that you've experienced in terms of getting diverse populations to participate in clinical trials? Dr. Ana Maria Lopez: Maybe all of the above. But one of the things, and one of the things that we're working on, is when a person comes in and you have the trauma of the diagnosis. And they're offered a study, and there may be suspicion of the health care system, that may not be the best time to really talk and educate around a clinical trial. So, if people receive the education, learn about clinical trials before that acute event, then they can come in more prepared. So, one is just the concepts of randomization, double blind in the setting where there may be distrust of the healthcare system may be difficult. Also, some of the clinical trials, and I'm sure everyone has studies where the person needs to be at the clinic for about 12 hours getting blood draws. And people have other responsibilities, and they may not have the support mechanisms for transportation, for childcare, for elder care. And if you're taking two to three buses and, you know, here I am in Center City, Philadelphia, and you need to take two to three buses to get home at 07:00, that could be a deterrent to getting on a clinical trial.   So, there are lots of clinical factors, social factors, experience with the studies, and also how we design the studies. Can we design studies so that we are more inclusive in the criteria? So, I think lots of questions, and then certainly there are clinician factors. There could be bias that we all have that maybe we don't offer studies to certain people, so something for us to be very introspective about as well. Dr. Carol Brown: So, Mr. Bebi, could you comment specifically on, with the research that you've done, are there some barriers on the side of the sponsors of the trials or in terms of industry that you found and that you found in your work at Medidata, maybe really affecting the ability of diverse people to participate in clinical trials? Ted Bebi: Dr. Lopez did a really good job at presenting what we consider patient-level barriers, such as mistrust in the healthcare system. Logistical issues such as taking time off from work, transportation, or feeling that the investigators running the trials don't fully represent the patient. But the industry-level barriers are just as important. A lot of companies are making decisions on what good diversity should look like and where they can find more diverse patients based on incomplete data sources such as disconnected external data, or they might be limited to data from the companies.  Dr. Carol Brown: Great. So, Dr. Lopez, what do you think individual physicians can do, or individual investigators can do to improve the diversity of representation in cancer clinical trials? Dr. Ana Maria Lopez: Certainly, being circumspect, being aware of our own biases, our own approaches. But as a health system, I think we need to think about: How can we make it easy to enroll people into trials? So are there ways, if this is, for example, a study for people at this stage of cancer, that all of those patients could be screened in the electronic record? Let's have our electronic tools work for us so that we identify patients that are meeting the study criteria and then connecting the patients, the study, and the investigators together. So, this way, by having our systems identify potential participants, there's a less chance of there being that personal bias. The research team can come to the doctor, to the oncologist, let's say, and say these are folks that are eligible. What do you think? So, in a way, setting up systems to help with the recruitment would be very helpful. Dr. Carol Brown: Mr. Bebi, can you comment from the standpoint of specifically– because you focus on this– the importance of data, the data, how to capture the data about race or ethnicity or whatever the demographic diversity variable is, what can individual investigators do to really address the challenges around collecting this data and sharing it? Ted Bebi: Often, race and ethnicity data is not even captured at all. So, if we want to understand this issue better and improve upon it, we need better data inputs in order to produce this large-scale research that will help us ultimately advance the issue and not just rely on anecdotal information. Dr. Carol Brown: Are there any technologies or things that you came across in your specific work that can help with this ability to capture this type of data and to share it? Ted Bebi: I think it has more to do with the awareness and the clinician relationship with the patient. And I also think it has to do with sponsors and the way that they design the trial, to begin with, whether or not the race and ethnicity entry is something that they're asking in their electronic health forms. Because if that is not included in the clinical trial, to begin with, then there won't be any incentive to capture that information. Dr. Carol Brown: Dr. Lopez, do you have any specific tips that you would recommend to clinicians who want to improve recruitment of underrepresented groups in their clinical trials? Dr. Ana Maria Lopez: I think one thing that's really important is to be able to have the time. Now, that may not mean that it's all the clinicians' time. It may mean that you have a research coordinator. It may mean that you have a research nurse. It may mean that you give the patient a video that explains the study that they can take home. There can be different ways. Something that I often ask a patient is, “How do you make decisions?” People tell me, “You know, I always go over this with my wife,” let's say, or, “I always discuss this in our family, and then we come to a conclusion.” Because that really helps me to think about how should I best deliver the information so that the patient can really feel I made a good decision and I made a value-congruent decision. So, I think time is critical and to set up our patient experience to really facilitate that type of experience for the patient.  Also, as a reference, I would urge people to take a look at the recent recommendations put out by ASCO and ACCC that talk specifically about increasing racial and ethnic diversity in cancer clinical trials. So, there are lots more strategies, a lot more ideas, and ways to really support clinicians and researchers. Dr. Carol Brown: Mr. Bebi, do you have any specific tips, particularly for trial sponsors, about how they can improve diversity in their clinical trials? Ted Bebi: In terms of companies and sponsors, what they can do if they want to improve diversity in their trials is they need to find and include the right sites that serve the populations that they are looking for. We published research that shows that there is high variability of diverse recruitment based on which sites you are looking at, with some sites providing the highest concentration of diverse patients. So, if diversity is not woven into trial design off the bat and you're not selecting the right sites, you run the risk of not reaching these populations. Companies also need to be willing to put in work to educate and develop sites into clinical trial sites. A clinical trial site is about building trust and relationships and knowing how to be culturally adept at talking to diverse communities.   Dr. Carol Brown: Great. Thank you so much. Well, I want to thank both of you, Dr. Lopez and Mr. Bebi, for a lively discussion on this ASCO Education podcast about diversity in clinical trials.   The ASCO Podcast is where we explore topics ranging from implementing new cancer treatments and improving patient care to oncologist well-being and professional development. If you have an idea for a topic or a guest you'd like to see on the ASCO Education Podcast, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content, please visit education.asco.org.  Speaker Disclosures Dr. Carol Brown – None Ted Bebi: Employment – Medidata (a Dassault Systèmes company); Stock and Other Ownership Interest – Pfizer, Eli Lily, Abbvie, Merck, BMY       Dr. Ana Lopez – None The purpose of this Podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this Podcast express their own opinions, experience, and conclusions. Guest statements on the Podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.    

"What exactly is implicit racial bias? How does it manifest in physician-patient interactions and what is the potential impact of such bias on oncology patient outcomes? In this ASCO Education Podcast episode, Dr. Lauren M. Hamel (Wayne State University) and Dr. Nimish Mohile (University of Rochester) share their insights and perspectives on these topics with host Alissa A. Thomas (University of Vermont). If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at education@asco.org. Resources: Blindspot: The Hidden Biases of Good People by Mahzarin R. R. Banaji and Anthony G. Greenwald Implicit Associations Test 21-Day Racial Equity Challenge   TRANSCRIPT Dr. Nimish Mohile: We had a patient a few years ago who had presented to our clinic, who ended up having a diagnosis of primary central nervous system lymphoma, and she was a young black woman, and it took about nine months for her to get that diagnosis. She had gone into multiple emergency rooms, she was only 22, had not had prior interaction with the medical system, but based on some of her socioeconomic demographics, her skin color, she was never given the kinds of testing that any other patient I think should have gotten at that time.   Dr. Alissa Thomas: Hello, and welcome to another episode of ASCO Education podcast. Today's topic is, 'Implicit racial bias and its impact on patient care.' My name is Alissa Thomas, and I'm a Neurologist and Neuro-Oncologist at the University of Vermont College of Medicine. I'm delighted to introduce our two guest speakers; Dr. Lauren Hamel, who is an Associate Professor of Communication and Behavioral Oncology at Wayne State University, and the Co-program Leader of the Population Studies and Disparities Research Program of the Karmanos Cancer Institute. Her ongoing research explores racial attitudes in non-verbal behavior of oncology patients and physicians, and how those behaviors influence treatment decisions. Dr. Nimish Mohile is a Professor of Neurology and Oncology at The University of Rochester. He also serves as the Diversity Officer, Associate Chair for Career Development and Leadership, and Neuro-Oncology Division Chief. I'll get us started with the first question, really a definition. What do we mean by the term, ‘implicit racial bias'? Dr. Lauren Hamel: I'm happy to go first. I think understanding what the definition of what implicit racial bias is is really important. You know, for good or for ill, over the last few years, it's gotten a lot more attention. And I think what's important to remember about it is that it's not a cognizant or a conscious bias, and it really is implicit, and it really is more of an association than it is anything else. It's sort of like the built-up associations that we have for anything. You know, could be race, could be gender, any number of demographics, or other factors that make our lives as humans. So, you know, associating certain aspects of people with positive or negative valuations. I think when we're talking about implicit racial bias, it's kind of like the gut associations we have for members of different racial groups. So often, it's kind of paired with "white is good, black is bad." It's a very rudimentary description of it, but that's a real kind of basic association that this kind of definition is built around. Dr. Nimish Mohile: Yeah, I would agree with that. I think that's a great discussion of what this is. I think it's really important for us to remember that these are really ingrained behaviors. It's, based on, you know, how we've been socialized and conditioned. And I think it's helpful to also put it in the framework of knowing that we all have some biases, we all probably have racial biases, and age biases, and other kinds of biases, and there's no sort of good or bad about having these biases. And the important part of this is, how do we recognize some of the biases that we have so that we can be more conscious about how we might fix those or think differently about the patients that we're seeing so that it doesn't result in actions that can be harmful. Dr. Lauren Hamel: Yeah, I agree with everything that Dr. Mohile just added. It is these ingrained associations. Really, it isn't about blaming ourselves for them because it's kind of the result of how our brains are structured. But to his point, it's once we know that we have them, and you know, we have data showing how they affect our behavior, it's then on us to identify them and then work to mitigate them. Dr. Alissa Thomas: Thank you. How do racial biases in patients and physicians influence treatment decisions or ultimately, how does this affect patient outcomes in Oncology? Dr. Lauren Hamel: You know, I think the direct relationship between certain biases and outcomes is still kind of being uncovered and investigated. But there are some interesting patterns that have been uncovered in data, specifically in the Oncology context too, because as you can imagine, a variety of professional organizations and groups examine the influence of bias. But just within Oncology, we see physicians who have higher levels of implicit bias who tend to see their patients who are black as less trustworthy, less educated, and less adherent to treatment recommendations. We also know that higher levels of implicit bias may be associated with less aggressive treatment programs recommended for black patients. We see some associations between levels of implicit bias and verbal dominance. But what was I think, especially interesting, is that we also see patterns of kind of perceptions from the patients that these physicians are communicating with. So, we see some manifestations in behavior, but we also see patients kind of “picking up” on some of these, whether or not they can identify them as bias necessarily. But for example, we see that patients who are seeing a physician with higher levels of implicit bias tend to see their physicians as less patient-centered, and less trustworthy. And I think that's a really important piece to identify because these biases are by definition kind of operating outside of our own consciousness, but they're manifesting themselves in a way that the people that we're communicating with are noticing. Dr. Nimish Mohile: We had a patient a few years ago who had presented to our clinic, who ended up having a diagnosis of primary central nervous system lymphoma, and she was a young black woman, and it took about nine months for her to get that diagnosis. She had gone into multiple emergency rooms, she was only 22, had not had prior interaction with the medical system, but based on some of her socioeconomic demographics, her skin color, she was never given the kinds of testing that any other patient I think should have gotten at that time. That was a real sort of wake-up call for our clinic, because as some of you know, this is a disease that we can really treat, especially in younger patients. So, there's real consequences to these kinds of biases. And some of them are personal, the ways they're ingrained in us, but some of them are built into our systems, and it's based on; what our ERs are designed like, where our hospital systems are, what kind of relationships we have with primary care physicians in different communities, what kind of access some of our patients have to primary care physicians. This patient in particular didn't have great access to primary care, so she didn't have this other team of people to advocate for her and to say, "Hey, you know, this is something really different in this patient, and we need to take this seriously." So, I think it can get complicated as we think about biases in ourselves, in other people, in the whole health system, and then also as we get out of our health system, some of these things are so influenced by what's going on in our communities. Dr. Lauren Hamel: Yeah, I think that's a really important point. At least with my work, I examine kind of at the interpersonal level, but these biases, as Dr. Mohile points out, exist in all levels of our society, and they interact, and they're-- I don't want to say additive, it's probably much more exponential. But yeah, it's a layer, on top of layer, on top of layer problem. Dr. Alissa Thomas: So, Dr. Mohile, you commented earlier that part of it is recognizing these biases in ourselves. Can you discuss how we might approach this with the impact of an anti-racism education program has been in your department and applications for that? Dr. Nimish Mohile: So, we've worked on anti-racism in our department on a couple of levels. One of the main levels is just building awareness for individuals to understand that they have biases, that they have racial biases, and starting to understand why they have those. So, we've gone through exercises like book clubs and talks, for people to really do some of that self-reflective work to understand how they've been conditioned as they grew up. I've personally done that and have found it very revealing and understood some of the biases that I grew up with based on people I was around, and based on my schools, and based on segregation within my school systems. So, I think that that's one piece of it. I think another piece is we don't often get taught about the history of racism in the United States, and how widespread it is. It's a very small part of our curriculums, and I think we have to take it upon ourselves now in our medical systems to go through that education. Education that we probably should have had all through elementary school, high school, college, we have to do that learning now because then we can really start seeing that impact of race on our society. And I think for physicians specifically, what is that impact of racism on patient care in our medical systems and how it's been ingrained in US healthcare. Understanding that we had segregated hospitals right until the 1960s, those are all things that were in the lifetimes of still practicing Oncologists. One of the things we did for our other professional society that I belong to, The American Academy of Neurology, is we did develop an anti-racism education program that focused on understanding this history and this historical lens in healthcare, reviewing the impact that anti-racism has on our colleagues. So, what does that mean for black physicians or physicians from other underrepresented groups and how they interact with our health systems, how they're treated, what does it mean for their roles in academic departments? Then talking about how we can connect being anti-racist with the goals of health equity. So, how can we change the systems that we have control of to have healthcare that's more fair? And then finally, how do we engage trainees and physicians in really developing anti-racism action plans? One of the important things about anti-racism is that you really have to be active, it's not a passive experience. You have to take action to change all these systems around us that are embedded with racism. Dr. Alissa Thomas: Thank you. Along the same line, Dr. Hamel, you recently co-authored a study of a longitudinal implicit bias training curriculum. And can you tell us something about this project and what's come of it? Dr. Lauren Hamel: Yeah, so it came about a little more than a year ago and kind of coincided happily with an executive directive made by our state's governor requiring implicit bias training, so we were able to kind of design it so it met those requirements. But really what the goal is, is to approach implicit bias with a 360 view. So, what are all of the issues related to it? What are the scientific underpinnings? What are the measurements? What are the pros and cons of those measurements and what we've used, and what they've shown in terms of influence on our individual behavior, our decision-making, kind of how we relate to people who might be different than us. And certainly, expanding beyond racial groups — we've looked at gender, we're looking at age, things like structural racism. So, we're trying to kind of have a comprehensive view of it. And I think, you know, one thing, and it sounds like Dr. Mohile and his group have done a really nice job of tracking what happens after those. Because, you know, I think one-off sessions are better than nothing, certainly. Awareness is critical, but also, tracking like, what does this do for our attitudes, perceptions, and behavior? And that's not easy. And so really, you know, trying to invest in tracking how things change. So, we've had a full year of assessments, we've seen some improvements in people's attitudes and perceptions. But now what we really need to start doing is tracking certain behavioral aspects, and I think that's where the next step needs to be. Our next year is just about to kick off in a couple of weeks. So, I think that that's where we need to start putting our effort where it's—okay, we've gotten kind of institutional support, the leaders of both the University's School of Medicine and also the Cancer Institute have been encouraging this, which I think is really critical, because even though it's a lot of individual work if you want these changes, you really have to have the support and buy-in from the leaders of the institution. So, we've got that, we have interest, you know, we've established a really consistent and impressive participation in terms of each session. We've had upwards of 200 people attending each session, so people want this information. Now, according to the state, they also are required to have it. So, I think building up on that now, we've established a lot of good pieces of it, but now let's start doing a better job of tracking how does this affect long-term perceptions, attitudes, and behavior. Dr. Nimish Mohile: Every cancer center and department should be doing what Dr. Hamel is doing. The risk of the one-off trainings is that people come out of an implicit bias workshop and think, “Well, I'm fixed. I don't need this anymore, now I can go on and take care of patients without bias.” And you really need that time to really work on those things and start to fix some of those attitudes that we have. Dr. Lauren Hamel: Yeah. Because the associations get built up over a lifetime. You know, that's not something you're going to fix in an hour. It's a campaign, it's a marathon, to be sure. Dr. Alissa Thomas: So, you've both touched on something that a lot of this is about perception, and it's not just what we say verbally, but non-verbal behavior. It plays into implicit racial bias. Dr. Hamel, can you talk a little about your study of non-verbal synchrony, and can you describe differences between non-verbal behavior with doctors and patients of the same race compared to those of different races? Dr. Lauren Hamel: Yeah, absolutely. And you know, a lot of my work focuses on nonverbal behaviors. On the study you referenced, we were looking at something a little bit more kind of in line with how implicit bias acts. It sort of manifested unconsciously. So, this whole idea of non-verbal synchrony is kind of this non-conscious coordination of movement that happens between two people. And this is a construct that's been studied for decades in a number of settings, but we were the first to be able to examine it in an oncology setting, and also comparing diads of different racial makeup. We were able to take like real video-recorded data of naturally-occurring treatment discussions. We had a set of videos that included black patients in a similar set with white patients. And we used automated software to track their behavior and determine how coordinated they were over time. We actually observed more coordinated behavior between black patients and their physicians compared to white patients and their physicians. Some literature is non-verbal synchrony is sort of seen as always good, and there's also some new data showing that maybe it could be evidence of trying to repair a relationship. We're very early phases, I'm not in a position to offer kind of a best practice with this, but I think the point is, is that we do see differences. There is a coordinated behavioral difference between dyads. We're also starting to look at how that level of coordination is influenced by attitudes including implicit bias. So, I think identifying a difference is important, but now I think it's on us to now figure it out. Like, what is that the result of? And then, what does that do for the patient in terms of short and long-term outcomes? So, does that affect their perceptions of their physician? Does it affect their perceptions of the recommended treatment? Does it affect adherence to that treatment? Dr. Alissa Thomas: How can we do better? How can doctors improve non-verbal and verbal communication methods with our patients? Dr. Nimish Mohile: I can speak a little bit about verbal communication. I think this work on non-verbal communication is fascinating. I'd love to hear where that comes out because it's something I think we're not really thinking about very much, and I'm not surprised that there's differences there. I think sometimes with communication, just having an awareness in that you might be communicating differently with someone can be helpful. In many of our institutions, we sometimes go through coaching with our communication, particularly with Oncology patients, where you have someone witnessing how you're interacting with that patient, and what kind of verbal and non-verbal cues you're giving, how you make eye contact. I think there's models there that we could really be thinking about, not just focused on some of the stuff that oncology has been focused on, like, delivering bad news or end-of-life discussions, but also on these issues of racial bias or age bias, and see what we could do differently in those areas. Dr. Lauren Hamel: Yeah, I completely agree. And I think decades of research have shown that patient-centered communication skills are something that can be taught, learned, and improved upon. Maybe not just regarding the issues related to racial bias and other racial attitudes, but you know, for helping to improve a number of outcomes for patients. So, I think, that kind of focus, I mean there are very clear, well-established frameworks and methods around that, I think that was just, you know, something we already have in our toolbox that we can use. But I think also things like building up trust within a community, I think is critical, for really any kind of medical institution that operates within a community should be, you know, trusted by the community it's in. And there's a number of strategies that can be implemented to build up that level of trust. So, you're kind of looking at like the outside going in. A lot of these the data that I'm referring to right now are coming out of the primary care setting. But I think people like us that are in an Oncology setting are certainly well poised to start testing these in Outpatient Oncology clinics. And I think just like what we're doing right now, making the topic of race, racism, implicit bias, something that we can have in a number of settings. And I think Dr. Mohile made a really good point. Like, we're not taught this like we're taught like grammar, and, you know, math. This is a part of our lives too, and you know, it's having big effects on huge swaths of our population. So, I think normalizing these conversations is a really important step, too. Dr. Nimish Mohile: In the United States, we're particularly uncomfortable talking about racism. Even within our medical teams, we don't know how to do that. So, what do you do if you're on rounds and you see another provider have some kind of verbal or non-verbal communication that, you know, might not be appropriate, or you think that there's a racial bias in the way we're treating or talking to a patient? That's not something we know how to deal with. We don't know how to bring that up. And so, I think that that's something that within health systems, we need to start working on. We have great models for this. When we think about the transitions we've made over the last 20 years in patient safety, we have elevated these conversations about patient safety. If there's a medical error by anyone on a team, it's something we're open to discussing, not blaming, and then really having a conversation about how can we fix this next time. You know, can we work towards doing that with something like racial bias? One of the things we've started doing in our department is that one of our mortality and morbidity conferences each year is focused on racism. So, a scenario where we think that there might have been differing treatment to a patient based on race, and then having an open discussion about that, going through some of the literature about that, and just practicing some of those conversations with each other as faculty, and medical providers, physicians, nurses, advanced practice providers, of being able to name racism as one of these problems. And then we really try to model that behavior on teaching rounds, so that with our medical students and residents, and fellows, we're also having these conversations about how could racism be at play in this patient's story, and how they got to their diagnosis, and in their outcomes, and an acknowledgement that racism is having some effect on this patient's ability to get screened for cancer, and potentially, their ability to have the same survival as another patient. Dr. Alissa Thomas: Thank you. That's so helpful to think about how to elevate this through departments and people who may be less aware of the issue and raising awareness. You both have touched a lot on communication between patients and providers, and there's a theme here that it's not just the doctor-patient relationship, but also the patient's community, and the medical team, that support that physician. Can you elaborate a little bit more about that, about how we communicate to the patient and the community they represent, and the provider and the team that they represent? Dr. Lauren Hamel: Having active, mature, genuine involvement of community members within a cancer hospital or cancer institute, I think is really important. I know my work has benefited from those who have come before me that established really strong connections with people who are, either survivors, care caregivers, advocates, you know, people who are very devoted to their particular neighborhood, community, that work really closely with us and provide feedback on a lot of the interventions that we design. So, one thing that I work in with all of my research is, as I'm developing an intervention that I think will improve either communication with a physician or another care provider, I certainly would never implement that without getting that thoroughly vetted by the people who it's going to affect. My clinician colleagues are always really generous with their time. It's a little bit more challenging to get community member feedback, but I do believe that it is, I mean, not just worth it for my own research success, but also for the mission and the purpose of what we're trying to do here. So, if you seek out feedback from a community group or community members who are willing to give you their honest opinion, and you know, you have to be in a position to receive that feedback with grace and professionalism, I think that's an important piece of it. Like, you want to have that connection, you don't want to just kind of have a checkbox. You know, you really want them involved in what you're doing. I'm using my own personal experience, but I'm sure there's far greater levels of, you know, system-level issues where something similar could be implemented. Dr. Nimish Mohile: I agree with that. I think this is really hard, and I think our medical systems are just starting to learn how to do some of this work. So, I'd echo what Dr. Hamel said about really getting input from members of those communities. I think many cancer centers are trying to do more outreach into communities, and that's not that easy. We have to really start by kind of building that trust, and building a philosophy where it's really about helping that community, as opposed to getting more patients from that community, or getting more trial participants from that community, or being able to check off boxes for our NIH grants from those communities. It really needs to be a genuine approach of, what does this community need? Because we don't often know that answer. And so, we have to start with that curiosity, and then determine how can we help those communities with the resources that we have. And I think cancer centers can do this optimally if the entire health system does that, that's where you can really start building some of that trust. Dr. Alissa Thomas: Thank you. For those of us that want to know more, would you be able to share some practical tools or resources that are available for healthcare professionals who want to learn more about implicit racial bias, either on an individual or institutional level? Dr. Lauren Hamel: I think one of the first things someone can do is take an Implicit Association Test, or an IAT, as it's often referred to. They're all housed at Project Implicit, at Harvard's website - google IAT, it'll take you right there. No identifiable data are collected from the individual test taker, but it gives people a sense of what's being measured. You know, it's not a character assessment, it's a measure that's designed to test your associations. And I think just having that experience makes you a much more informed consumer of this kind of science because I think it's important to keep a critical eye. You know, if we're scientists, we have to be critical. And I think this really helps people kind of get to a point where they can understand the science a little bit more effectively, but maybe also can reduce a little defensiveness that inevitably comes up when these kinds of data are discussed. So, I would do that. And then the second thing would be, there's a wonderful book called, Blindspot: Hidden Biases of Good People, it's written by Doctors Greenwald and Banaji, and they are basically credited for creating the Implicit Association Test, as we know it. It's a relatively easy read, and it can really give you a sense of how these kinds of associations affect our decision-making and communications. I would take those two, as a way to start. Dr. Nimish Mohile: I agree with both of those. I'd say that many of our health systems have implicit bias workshops and trainings, and sometimes they're online, sometimes they're in person. They do have varying sort of quality. I encourage people to just look at those trainings a little bit differently than they look at all of the other trainings that we're forced to do. To go into those with a little bit of an open mind and a learning experience, rather than one to just sort of check boxes and move on. I think you can learn some things about yourself from them. One of the things I encourage folks to do if they're interested in more information about anti-racism is to do something like the 21-day Racial Equity Challenge - you can Google that. Kind of small bite-size openings, and then there's talks about biases, but also helps you sort of understand some of the foundations of racial inequity in this country. Dr. Alissa Thomas: Thank you so much. That's all the time we have for today. I really want to say thank you to Dr. Hamel, and Dr. Mohile for sharing your perspectives on addressing implicit racial bias in oncology, and tips for improving communication with patients and providing culturally-sensitive care. And thank you to ASCO for providing this platform for us to discuss. Thank you to all of our listeners, we appreciate you turning into this episode of ASCO Education podcast.   Thank you for listening to the ASCO Education podcast. To stay up to date with the latest episodes, please click," Subscribe." Let us know what you think by leaving a review. For more information, visit the Comprehensive Education Center, at: education.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy, should not be construed as an ASCO endorsement.  

Teachers' unconscious racial bias in the classroom can significantly affect how different students are taught — and what they learn. Portland State University Math Education professor Eva Thanheiser has just won a $640,000 grant to preemptively reduce bias among K-12 math teachers. The effort does not develop a curriculum. Instead, it takes a professional development approach for teachers to bring in the experience of students from all racial backgrounds into what and how they're teaching. We learn more from Thanheiser about how she uses this basic approach in her college classes and the broader effort to excite and engage all students in math and boost their achievement.

In Part III of the series on "Implicit Racial Bias, Identity, Development, and Trauma," Dr. Dolores Tarver and Attorney A.D. Winters are joined by scholar, researcher, professor, advocate Dr. D'Andra Orey to unpackage "What is the cost of racism?" We are discussing racial battle fatigue, the power of the almighty dollar, and the effect of the confederate flag on recruiting and maintaining talent in Mississippi.

Pulling mainly from a CBS article, Chris and Tyler take a look at how the United States approaches teaching about Black history in the current school system.The dynamic-duo begin by trying another Black is Beautiful beer from Lickinghole Creek and by playing another round of the sample game.We would like to thank Oakbrook Brewing company for their continued support! If you are in the Reading/Berks region and are looking for great beer, great food, and a great environment please make sure to check them out!To support our show you can support us on Patreon or reach out directly through Instagram.If you are interested in reading any of the works cited for this episode feel free to check out the links below!US History: How teaching America's past varies... (CBS article)The Humanity of BlacknessHow to Improve How Black History is Taught in AmericaTo read even further on the topic here are some articles provided by Annadore!Texas State Monopoly Over School Approved TextsWhite Children Show Signs of Implicit Racial Bias by Age FiveIf you are interested in joining the team as a producer, intern, videographer, editor, etc, please contact us at alternativeblackspod@gmail.com

The Gang and guest **** explore Child Development, Homeschooling, Un-Learning, and Implicit (Racial) Bias in children. We are also anti-Tinitis. Links and Resources mentioned: Linktr.ee/censoriouspodcast --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/censorious/support

Implicit racial bias, asking questions and DOING something with @toddkharris. "Be open to knowing you don't know something... the only wrong thing you can do right now is nothing" - Todd Harris References discuss in this episode: Here are the books: White Fragility White Rage The New Jim Crow Viola Davis - systemic racism short animated video via instagram People/organizations to follow on social media: NAACP Grassroots Law The Conscious Kid Black Lives Matter Layla Saad

“Implicit Racial Bias” refers to subconscious preferences for members of our own group.  This “otherizing” has loud and lasting effects, from perpetuating racial prejudices inside society to reinforcing personal hidden biases. David Bailey talks about how diversity within the Kingdom is a reason for cultural celebration, not separation.

"Implicit Racial Bias" refers to subconscious preferences for members of our own group. This silent and subtle tendency to "otherize" has loud and lasting effects, from perpetuating racial prejudices inside society to reinforcing personal hidden biases. David Bailey talks about how diversity within the Kingdom is a reason for cultural celebration not separation. His ministry, Arrabon, a word that means "a foretaste of things to come." inspires Christ-centered reconciliation in worshipping communities.

April Tith, LMFT, explores the growing research that exists about implicit racial bias and its effect on clinical care, particularly in the service of communities of color.

  Natalie Salmanowitz: How Virtual Reality Can Help Mitigate Implicit Bias (Ep. 146) Bio Natalie Salmanowitz (@nsalmanowitz) is a rising 3L at Harvard Law School and is originally from the San Francisco Bay Area. After studying neuroscience at Dartmouth College, she went to Duke University for a master’s degree in Bioethics and Science Policy before spending a year at Stanford Law School as a fellow in the Neuroscience and Society Program. Resources The Impact of Virtual Reality on Implicit Racial Bias and Mock Legal Decisions by Natalie Salmanowitz (Journal of Law and the Biosciences, 2018) What Money Can’t Buy by Michael J. Sandel News Roundup FBI indicted 12 Russians in connection with 2016 DNC Hack Deputy Attorney General Rod Rosenstein announced a DC Grand Jury indictment of 12 Russians charged with hacking the Democratic National Committee (DNC) in 2016. They’re all GRU members, which is Russia’s intelligence agency. And one of the defendants is accused of hacking into state election systems themselves. Intelligence officials say Russia intended for the hacks to help Donald Trump. But during a presser following his closed-door meeting with Russian president Vladimir Putin in Helsinki on Monday, the President sided with Russia. This was met with strong rebukes from U.S. intelligence officials and Republicans. Meanwhile, U.S. Director of National Intelligence Dan Coates warns of an imminent “crippling cyber attack on our critical infrastructure”. He names Russia as “the most aggressive foreign actor, no question.” And CNN reports that a Kremlin-linked internet company, Mail.Ru, had access to a Facebook app that collected user data without their consent. FCC changes consumer complaint rules The Republican-led Federal Communications Commission passed a new rule last week that will require consumers to pay a $225 fee to file formal complaints with the agency. Democrats were livid, with Democratic Commissioner Jessica Rosenworcel calling the rule change “bonkers”, and FCC Chairman Pai passed the rules over the objections of Democratic representatives Frank Pallone and Mike Doyle. They’re concerned the rule change will dilute the impact of informal complaints. Purdue study: Airbnb benefits local economies in white neighborhoods. Black and Latino neighborhoods? Not so much. A new study of Purdue University, that looks at Bureau of Labor Statistics and Yelp data, has found that Airbnb’s economic benefits local economies—with one wrinkle: it’s mainly neighborhoods that are predominantly white. The study specifically looked at the spillover effect to local economies when Airbnb guests stay there by evaluating how many new jobs were created in area restaurants. Apparently, Airbnb guests are less likely to eat at restaurants surrounding Airbnbs in neighborhoods where the black or Latino population exceeds 50%, than they are in predominantly white neighborhoods. U.S. Lifts Ban on ZTE The Trump administration lifted its ban against ZTE on Friday. The ban required U.S. companies to refrain from contracting with Chinese telecom manufacturer ZTE because U.S. intelligence officials accused ZTE of lying about how it was handling sanctions against Iran and North Korea. Justice Department to appeal AT&T/Time Warner Finally, The Justice Department announced that it would be appealing the DC Court of Appeals decision approving AT&T’s acquisition of Time Warner. This re-opens litigation that could have major implications for how courts and the federal government will consider vertical mergers.

Host Nancy Kahn talks with guest Jair Valley, a dynamic 21-year-old African American artist and full-time professional​. Jair talks about ​a​ recent experience of implicit racial bias in his workplace and the process he is actively engaged in to reclaim his dearly held values for wholeness and compassion. Starbucks recently shared materials with the public on the nationwide training they provided to all employees and defined Implicit Bias as the automatic association of stereotypes or attitudes with particular social groups, and they referenced the source Banaji & Greenwald, 2013. Patricia Devine, a psychology professor and director of the Prejudice Lab said, “ There are a lot of people who are very sincere in their renunciation of prejudice, yet they are vulnerable to habits of mind. Intentions aren't good enough.”  (Nordell, “Is This How Discrimination Ends”, atlanticmonthly.com)​. A sample of Jair's art: his self-portrait This show ​offers insights and practices into how to recover from the impact of racial implicit bias, and how to connect to the range of choices we have about what conversations we want and need to pursue after an incident. Listeners are invited to call in​ to the show (1-800-958-9008) at 7:30 pm  to ask focused questions about how to navigate experiences related to racial implicit bias in the workplace and are encouraged to request coaching on how to support their own​ resilience. Jair Valley, 21-year-old artist born and raised in Oakland, is aspiring to be a public figure. He enjoys life and he loves each experience and lesson that comes with every moment. Jair is motivated by growth, focuses on keeping an open mind, and pours his body and soul into bettering himself and the world around him. Jair is employed full-time at a national corporation and intends to open his own art-based business in the future.​ The post Surviving the Impact of Implicit Racial Bias in the Workplace and the Journey Back to Wholeness​ and Compassion appeared first on KPFA.

"Implicit Racial Bias" refers to subconscious preferences for members of our own group. This silent and subtle tendency to "otherize" has loud and lasting effects, from perpetuating racial prejudices inside society to reinforcing personal hidden biases.

"Implicit Racial Bias" refers to subconscious preferences for members of our own group. This silent and subtle tendency to "otherize" has loud and lasting effects, from perpetuating racial prejudices inside society to reinforcing personal hidden biases.

Implicit bias affects oncologists and their patients -  a few steps can help

"Implicit Racial Bias" refers to subconscious preferences for members of our own group. This silent and subtle tendency to "otherize" has loud and lasting effects, from perpetuating racial prejudices inside society to reinforcing personal hidden biases.