Interventions to Mitigate Implicit Racial Bias in Graduate Medical Education Trainees: A Systematic Review

Implicit racial bias contributes to racial health inequity. Graduate medical education (GME) trainees may be a key target audience for effectively intervening upon implicit racial bias. We systematically reviewed the literature on interventions seeking to mitigate implicit racial bias in GME trainees.

We searched PubMed, Embase, and Academic Search Premier for peer-reviewed, English language articles assessing interventions aiming to mitigate implicit racial bias in GME trainees published between January 2003 and August 2024. We extracted details of the study design and training intervention. Each stage of screening and data extraction was conducted by two independent reviewers. We used the Medical Education Research Study Quality Instrument to assess methodological quality and conducted a framework synthesis guided by a transformative learning theory framework for implicit bias instruction and the Kirkpatrick Model of Learning Evaluation.

Of 6455 bibliographic records, 23 were eligible. Interventions most frequently utilized critical reflection (87%, n = 20) and instructional activities (65%, n = 15) as educational strategies. Half included disorienting experiences (43%, n = 10); five (22%) involved skill-acquisition activities. Most (74%) assessed trainee knowledge, attitudes, and skills through self-report (Kirkpatrick Level 2A), with positive outcomes. Three studies measured trainee knowledge and behaviors directly (Kirkpatrick Level 2B) through pre- and post-intervention assessments, two of which demonstrated short-term bias reduction.

There remains a need for rigorous research to design, evaluate, and implement evidence-based interventions that reduce the impact of implicit racial biases on patient-centered health outcomes.