Reimagining Bias: Making Strange With Disclosure

Academic presentations in health professions continuing professional development (CPD) often begin with a declaration of real or potential conflicts utilizing a three-slide template or a similar standardized display. These declarations are required in some constituencies. The three-slide template and similar protocols exist to assure learners that the content that follows has been screened, is notionally bias free, and without financial or other influence that might negatively affect health provider behavior. We suggest that there is a potential problem with this type of process that typically focusses in on a narrow definition of conflict of interest. There is the possibility that it does little to confront the issue that bias is a much larger concept and that many forms of bias beyond financial conflict of interest can have devastating effects on patient care and the health of communities. In this article, we hope to open a dialogue around this issue by "making the familiar strange," by asking education organizers and providers to question these standard disclosures. We argue that other forms of bias, arising from the perspectives of the presenter, can also potentially change provider behavior. Implicit biases, for example, affect relationships with patients and can lead to negative health outcomes. We propose that CPD reimagine the process of disclosure of conflicts of interest. We seek to expand reflection on, and disclosure of, perspectives and biases that could affect CPD learners as one dimension of harnessing the power of education to decrease structural inequities.