UMMS Affiliation

Clinical and Population Health Research; Office of Student Affairs; Department of Psychiatry; Department of Population and Quantitative Health Sciences; Department of Family Medicine and Community Health; School of Medicine; Senior Scholars Program

Publication Date


Document Type



Health Services Administration | Health Services Research | Medical Education | Social Psychology | Social Psychology and Interaction


CONTEXT: Implicit bias affects health professionals' clinical decision-making; nevertheless, published reports of medical education curricula exploring this concept have been limited. This research documents a recent approach to teaching implicit bias.

METHODS: Medical students matriculating during 2014 and 2015 participated in a determinants of health course including instruction about implicit bias. Each submitted a reflective essay discussing implicit bias, the experience of taking the Implicit Association Test (IAT), and other course content. Using grounded theory methodology, student essays that discussed reactions to the IAT were analyzed for content themes based on specific statements mapping to each theme. Twenty-five percent of essays underwent a second review to calculate agreement between raters regarding identification of statements mapping to themes.

OUTCOME: Of 250 essays, three-quarters discussed students' results on the IAT. Theme comments related to: a) experience taking the IAT, b) bias in medicine, and c) prescriptive comments. Most of the comments (84%) related to students' acknowledging the importance of recognizing implicit bias. More than one-half (60%) noted that bias affects clinical decision-making, and one-fifth (19%) stated that they believe it is the physician's responsibility to advocate for dismantling bias.

CONCLUSIONS: Through taking the IAT and developing an understanding of implicit bias, medical students can gain insight into the effect it may have on clinical decision-making. Having pre-clinical medical students explore implicit bias through the IAT can lay a foundation for discussing this very human tendency.


Medical education, Physicians, Reflection, Medicine and health sciences, Patients, Decision making, Patient advocacy, Professions

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Copyright: © 2019 Motzkus et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

DOI of Published Version



PLoS One. 2019 Nov 15;14(11):e0225058. doi: 10.1371/journal.pone.0225058. eCollection 2019. Link to article on publisher's site

Journal/Book/Conference Title

PloS one


Racquel Wells participated in this study as a medical student in the Senior Scholars research program at the University of Massachusetts Medical School.

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Link to Article in PubMed

PubMed ID


Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.