1. Understanding Unconscious Bias, Cultural Competence, and Humility

2. I have no conflicts of interest; financial, or otherwise, to disclose.
I have biases like everyone else.

3. Objectives Learn about diversity at IUSM.
Recognize how cultural diversity relates to learning.
Recognize less obvious aspects of cultural diversity.
Identify strategies for overcoming stereotypes and biases.

4. IUSM Statement on Diversity
IUSM believes diversity is a core value that embodies inclusiveness, mutual respect, and multiple perspectives that serves as a catalyst for change resulting in health equity.
At IUSM, diversity includes but is not limited to race, ethnicity, gender, religion, socio-economic status, age, geographic differences, sexual orientation and gender identity, disabilities, differing work styles and more.
Diversity is vital to our success as clinicians, teachers and researchers.

5. Importance of Culturally Competent Health Care
Our world is becoming more diverse
The definition of diversity has evolved
Persistence of health disparities is a problem
Patients do better when their physician looks like them
Patients do better when they feel heard and understood.

6. Diversity Pillars
We are committed to improving and increasing our three pillars of diversity.

7. INDIANA UNIVERSITY
Definitions
Multiculturalism is a situation in which all the different cultural or racial groups in a society have equal rights and opportunities, and none is ignored or regarded as unimportant.
Cultural Competence is the ability to interact effectively with people of different cultures. It means to be respectful and responsive to the health beliefs and practices—and cultural and linguistic needs—of diverse population groups.
Cultural Humility is the ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity that are most important to the other person.

8. INDIANA UNIVERSITY
Cultural Humility
Goes beyond the concept of cultural competence to encourage individuals to identify their own biases and to acknowledge that those biases must be recognized. Cultural competency implies that one can function with a thorough knowledge of the mores and beliefs of another culture.
Cultural humility acknowledges that it is impossible to be adequately knowledgeable about cultures other than one's own.  Humility denotes a willingness to accurately assess oneself and one’s limitations, the ability to acknowledge gaps in knowledge, and an openness to new ideas, contradictory information, and advice. 

9. Why is Cultural Humility Important
INDIANA UNIVERSITY
Why is Cultural Humility Important
Cultural humility means not pigeon-holing people.  Knowledge of different cultures and their assumptions and practices is indeed important, but it only goes so far.
Cultural humility is an important step in helping to “redress” the imbalance of power.
Approaching each encounter with the knowledge that one’s own perspective is full of assumptions and prejudices can help us to keep an open mind and remain respectful of others seeking involvement.

10. Why is it important to address diversity in the academic medicine and research environment?

11. Everyday Bias for the Health Professions Facilitator Guide
Cook Ross Inc. © 2015
May be used only with express permission.
Diversity and Inclusion = Innovation and Productivity
Identity diversity among intelligent people on a team contributes to more effective problem-solving than a team comprised of the best-performing, intelligent people without identity diversity.
NY Times, 2008
Scott E. Page
Studies have shown that companies that achieve diversity in management teams and on corporate boards attain better financial results, on average, than other companies.
TIME: 1 min
SAY: Diversity has been proven to have a tremendous positive impact on our businesses.
SAY: Scott Page is a computational mathematician who has proven that greater diversity in an organization can yield better decisions, given that leaders know how good decision making works. His work in contributed important quantifiable proof that diversity and inclusion can bring tremendous value to our organizations.
SAY: We’ve also known for years that having gender diversity on an executive committee yields greater financial results than companies that don’t. There is a lot of evidence that diversity is important for our business.
Catalyst, 2004, 2007, 2011

12. Raising Awareness = Reducing Bias
Everyday Bias for the Health Professions
Facilitator Guide
Raising Awareness = Reducing Bias
Cook Ross Inc. © 2015
May be used only with express permission.
Workshops and learning experiences for medical professionals that focus on the science and research of bias can reduce its impact.
TIME: 30 sec
SAY: Learning experiences that raise awareness of unconscious or non-conscious bias have been shown to reduce the impact of bias in clinical care. That’s why we’re here today; we’ll be equipping you with the strategies and tools you’ll need to identify and navigate personal and organizational bias to create more conscious, inclusive organizations.
TRANSITION: Let’s try a brief activity.
Moskowitz & Stone, 2011: Non-conscious bias in medical decision making: what can be done to reduce it?

13. Everyday Bias for the Health Professions Facilitator Guide
Cook Ross Inc. © 2015
May be used only with express permission.
As you look at each slide, note your feelings, judgments, and reactions that emerge.
TIME: 10 min
SAY: I’m going to show you a series of pictures. As you view each slide, watch your own thinking and immediate assumptions about the individual pictured. What do you find yourself thinking about them? Two particular assessments you may wish to keep in mind are: 1) how warm you think they are and 2) how competent you think they are. Research from Amy Cuddy and colleagues at Harvard discovered that the these tend to be two of the key traits we evaluate people based upon.
DO: Advance the slides through the series of pictures, lingering for about 15 seconds on each one.

14. Everyday Bias for the Health Professions Facilitator Guide
Cook Ross Inc. © 2015
May be used only with express permission.
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15. Everyday Bias for the Health Professions Facilitator Guide
Cook Ross Inc. © 2015
May be used only with express permission.
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16. Everyday Bias for the Health Professions Facilitator Guide
Cook Ross Inc. © 2015
May be used only with express permission.
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Copyright Cook Ross Inc. - Unconscious Bias Learning Lab

18. Everyday Bias for the Health Professions Facilitator Guide
Cook Ross Inc. © 2015
May be used only with express permission.
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19. Everyday Bias for the Health Professions Facilitator Guide
Cook Ross Inc. © 2015
May be used only with express permission.
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20. SAY: Here is everyone together.

21. What do you notice first or focus on?
This is a pre-existing work of Cook Ross Inc. and may be used outside of this training session only with the express prior written permission of Cook Ross Inc.
Gender
Skin tone
Ethnicity
What do you notice first or focus on?
Age
Setting
Facial expression
Body posture
TIME: 2 min
SAY: What patterns did you notice when you were watching your own perceptions?
DO: Ask 3-4 participants to share what they reacted to when they saw the pictures, and comment appropriately.
SAY: Now I’m going to share with you a little bit about who each of these individuals are.
Body type
Clothing

22. Everyday Bias for the Health Professions Facilitator Guide
Cook Ross Inc. © 2015
May be used only with express permission.
John Fetterman
Mayor of Braddock, PA (a suburb of Pittsburgh) – the tattoo on his arm is the zip code!
Has a Master’s degree in Public Policy from Harvard
Served in the AmeriCorps
Received international media attention for the economic revitalization programming he started in his community
DO: Introduce each individual using the some of the key points about them on each slide. Know that some of them may provoke strong reactions from the audience!
ASK the group every now and then: did you perceive them to be warm, competent? Why or why not? What other feelings or assumptions did you have about them?
John Fetterman
Mayor of Braddock, PA (a suburb of Pittsburgh) – the tattoo on his arm is the zip code!
Has a Master’s degree in Public Policy from Harvard
Served in the Americorps
Received international media attention for the economic revitalization programming he started in his community

23. First female president of India, 2007-2012
Pratibha Patil
Economist
Attorney
First female president of India,
Pratibha Patil
President of India from
First female president of India
Copyright Cook Ross Inc. - Unconscious Bias Learning Lab

24. Everyday Bias for the Health Professions Facilitator Guide
Cook Ross Inc. © 2015
May be used only with express permission.
Ted Bundy
American serial killer and rapist
Confessed to killing 30 women
Ted Bundy
American serial killer and rapist
Confessed to killing 30 women

25. Russian police captain and fashion model PhD in civil law
Oxana Federova
Miss Universe 2002
Russian police captain and fashion model
PhD in civil law
Oxana Federova
Miss Universe 2002
Russian police captain, fashion model
Phd in civil law
Copyright Cook Ross Inc. - Unconscious Bias Learning Lab

26. Everyday Bias for the Health Professions Facilitator Guide
Cook Ross Inc. © 2015
May be used only with express permission.
Mae Jemison
Engineer
Physician
Professor
U.S. Astronaut
First African American woman in space
Mae Jemison
Physician
Professor
U.S. Astronaut

27. Everyday Bias for the Health Professions Facilitator Guide
Cook Ross Inc. © 2015
May be used only with express permission.
Guru Ganesha Khalsa
Sikh devotional musician
One of the world’s leading sales training experts in tech/software industry
GuruGanesha Khalsa
Sikh devotional musician
One of the world’s leading sales training experts

28. Everyday Bias for the Health Professions Facilitator Guide
What is bias?
Everyday Bias for the Health Professions
Facilitator Guide
Cook Ross Inc. © 2015
May be used only with express permission.
A tendency or inclination that results in judgment without question.
A shortcut to interact with our world
An automatic response
TIME: 1 min
SAY: Bias refers quite simply to the mechanism of the brain that operates on associations; it is an automatic response. Our brain operates with short-cuts that allow us to quickly interpret and respond to the world around us. Bias is a decision we make so quickly that it simply occurs to us as data; we don’t know that we’ve actually taken in data points, interpreted them, and made meaning out of them. It all happens so fast that judgments such as ‘He’s stand-offish’ or ‘She’s charming’ in a first impression simply appear as though they were facts. However, we’re really just associating this new person with someone or something we’ve experienced before and creating a judgment based on that. This is a normal human function, but often it has consequences that are unintended.
TRANSITION: Some of our biases are conscious. For instance, you might be aware that you have a preference for working with people from your own culture or with people your age, rather than younger employees. Most of our biases, however, are unconscious to us.

29. Everyday Bias for the Health Professions Facilitator Guide
What is Unconscious Bias?
Cook Ross Inc. © 2015
May be used only with express permission.
Mental associations that are made without:
Awareness
Intention
Control
These often conflict with our conscious attitudes, behaviors, and intentions.
TIME: 2 min
SAY: So what is unconscious bias?
DO: Read what is on the slide.
SAY: My assumption from being with you is that everyone has an intention to be inclusive, and yet, when we look at our results we don’t always see the fruits of our labor. (Click to reveal “These often conflict with our conscious attitudes and intentions”). Unconscious bias often conflicts with our conscious attitudes, behaviors, and intentions. This explains the fact that even though we have consciously worked on increasing diversity and inclusion, we have not been as successful as we hoped we would be, like we discussed earlier.
NOTE: If you have time, ask people in large group popcorn style or in pairs, and see if they can identify some of these discrepancies between intention and outcome.

30. Everyday Bias for the Health Professions Facilitator Guide
Cook Ross Inc. © 2015
May be used only with express permission.
What we see…
Scary
Fun
Nauseating
Exciting
TIME: 7 min
ASK:
What is this picture? (A roller coaster)
What do we say about them? (DO: Click to reveal Fun, Exciting, Exhilarating)
Who doesn't like roller coasters (DO: Click to reveal Scary, Nauseating, Dangerous)
Exhilarating
Dangerous

31. Everyday Bias for the Health Professions Facilitator Guide
What is there…
Cook Ross Inc. © 2015
May be used only with express permission.
Nuts and Bolts
Welded steel
Bright paint
Curved design
ASK: Are roller coasters fun or scary? (pause for answers from learners)
NOTE: You’ll get many examples of interpretation: It’s a journey, lots of ups and downs, a ride, a metaphor for life, etc. Keep asking the question “What is it?,” until someone notes that it’s a thing: a tall, mechanical, inanimate structure made of metal and wood.
SAY: The objective truth is that it’s a machine, a thing, made up of welded steel, nuts and bolts, and in this case bright paint and a curved design. All the rest is interpretation. A roller coaster is not really scary or fun on its own; either of these, and the other descriptions you gave, are our INTERPRETATION . Those all come from the past, given by our experience of the world. This is a simple example of how our minds work. Our experiences, our backgrounds, shape the lens through which we see the world.
ASK: What determines whether a roller coaster is scary or fun? If we have a background of excitement about roller coasters, either directly or indirectly—or perhaps something else that reminds us of them—they are more likely to look fun. If we have a background of fear, either from our own experience or something you’ve heard from someone else, they probably look scary.
SAY: Our backgrounds and experiences shape our perspectives, points of view, and expectations. Background is what stays with us and shapes our perceptual lenses. It lives in our unconscious. Consider how that plays out when we deal with people.

32. Everyday Bias for the Health Professions Facilitator Guide
What is there…
Everyday Bias for the Health Professions
Facilitator Guide
Cook Ross Inc. © 2015
May be used only with express permission.
Hair
Glasses
Earrings
Neutral expression
SAY: When we see somebody, particularly for the first time, we are interpreting a multitude of visual cues through our background. So while what is there is hair, earrings, glasses, and a neutral expression…

33. Everyday Bias for the Health Professions Facilitator Guide
What we see…
Everyday Bias for the Health Professions
Facilitator Guide
Cook Ross Inc. © 2015
May be used only with express permission.
Well Groomed
One of “those people”
Intelligent
Socially Inept
Expressive
Rebellious
Stoic
Unfriendly
SAY: What we see is our own interpretation of those cues. If our interpretation is positive, we might deem his hair to be well-groomed, his glasses as intelligent, and his expression as expressive, or stoic. If our interpretation is negative, we might recognize him as an “other” from ourselves or one of “those people”, we might see glasses as indicative of social ineptitude, and his expression as one of rebelliousness or unfriendliness. Our assessment doesn’t necessarily occur as entirely positive or entirely negative, but it is 100% interpretation!
DO: Give a brief personal example of how your background impacted how you perceived someone. Use yourself as an example if you wish (Am I familiar to you in any way? Who do I remind you of? ). If there are some responses to ask if they liked the person you remind them of. This gives you extra points to start if there is a positive projection.
SAY: Our background gives us linguistic interpretation, perceptual interpretation, and even structures our consciousness (John Searle).
NOTE: The main emphasis here is getting people to see that “we see the world not as it is, but as we are.” Background experiences, beliefs, etc., that we have developed during our lifetimes shape what we see. This in turn creates our judgments and interpretations.
SAY: So let’s explore our own background and how it creates the way we see the world.

34. The Unconscious is Malleable
Everyday Bias for the Health Professions
Facilitator Guide
The Unconscious is Malleable
Cook Ross Inc. © 2015
May be used only with express permission.
TIME: 1 min
SAY: One of the more important learnings that we’ve had from the research is that the unconscious is malleable; we can work with it. The brain has a high level of plasticity and flexibility, which means that it constantly makes new connections and re-wires itself. We can also re-wire and redefine our relationship to bias. I’ll talk about some of the strategies now.

35. General Guidelines for Reducing Biases
Recognize any biases or stereotypes you may have absorbed.
Treat each learner as an individual, and respect each one for whom he or she is.
Rectify any language patterns or case examples that exclude or demean any groups.
Do your best to be sensitive to terminology.
Introduce discussions of diversity at department meetings.

36. General Guidelines for Reducing Biases
Become more informed about the history and culture of groups other than your own.
Convey the same level of respect and confidence in the abilities of all your learners.
Don’t try to “protect” any group of learners.
Be evenhanded in how you acknowledge students’ good work.
Recognize the complexity of diversity.

37. Take a P.A.U.S.E. A quick way to check your reaction.
Everyday Bias for the Health Professions
Facilitator Guide
Cook Ross Inc. © 2015
May be used only with express permission.
Take a P.A.U.S.E. A quick way to check your reaction.
Pay attention to what’s actually happening, beneath the judgments and assessments P
Acknowledge your own reactions, interpretations and judgments A
Understand the other possible reactions, interpretations and judgments that may be possible U
Search for the most empowering, productive way to deal with the situation S
Execute your action plan E
TIME: 3 min
SAY: The first important thing to do in any situation, is to quickly check your reaction by taking a pause.
DO: Click to reveal each step as you are reading what is on each section. Provide a personal example of when you did or could have applied this model, demonstrating how you would perform each step.