Dr. Cristina Gonzalez Receives AAMC New Investigator Award
In November 2019, Dr. Cristina Gonzalez will travel to the Association of American Medical Colleges’ “Learn Serve Lead” meeting in Phoenix, AZ to accept its 2018 New Investigator Award. The honor, which is offered by the AAMC’s Research in Medical Education Committee, touts her paper, “How to Make or Break Implicit Bias Instruction: Implications for Curriculum Development.” The award included publication in a November 2018 online supplement to the journal Academic Medicine.
Dr. Gonzalez, who is associate professor of medicine and a 2004 Einstein graduate, is an activist in the fight against health disparities. These preventable differences in the burden borne by disadvantaged populations in terms of disease, injury, violence, or opportunities to achieve optimal health, stem in part from care disparities that happen for many reasons, among them clinicians’ racial and ethnic implicit bias—their subconscious, unintentional assumptions about other people.
She gave a hypothetical example: “We sent Mr. Stern to the catheterization lab, but we sent Mr. Rodriguez home, although both presented with the same symptoms. Was there a good medical reason for that?” Dr. Gonzalez’ approach is matter-of-fact and non-threatening. “Bias is human nature,” she explained. “It’s hard to eliminate but possible to manage. You say to yourself, ‘Oops, wait, something is off, did I ask the standard questions? Did my patient perceive what I said differently from what I intended?’ Then you can make a correction.”
Teaching the Teachers
Many medical schools offer bias instruction for medical students, and Dr. Gonzalez has made significant contributions to such programming at Einstein. Teachers, however, have not been on the receiving end of this instruction themselves, and in her paper she explores needs and obstacles.
Interviews of 21 Einstein faculty members revealed discomfort and hesitancy. One participant said, “As the speaker, you’re so anxious that you’re going to say something wrong that you may not want to talk about it at all.”
Faculty also were not sure how their own race, ethnicity, gender, age, or degree would affect their ability to deliver the message. And they were uncertain about handling resistant students who responded to the training with anger, denial, or criticism of the Implicit Association Test, a validated online measure of reaction time to images and value-laden words.
The same interviewees offered solutions. One commented that “the easiest way to approach faculty is by saying, ‘We need to teach this to our students.’ You speak to the educator in them more than to the clinician in them.”
Other participants suggested faculty development sessions and providing clinicians with key phrases to help them recognize bias. Dr. Gonzalez has submitted a grant proposal to fund the development of simulated scenarios, outcome metrics, and validation measures. Her ultimate goals are: to help faculty feel more comfortable and confident in giving implicit bias instruction, to see the topic recognized as a faculty development priority, and change the culture around implicit bias in medical education and healthcare.
A Collaborative Effort
While Dr. Gonzalez will be recognized with the AAMC honor as lead author of the paper, she worked with colleagues at Einstein and other institutions. Her co-authors were Ms. Ramya Garba, of the University of Texas at Austin; Ms. Alyssa Liguori, who was an Einstein student at the time; Einstein’s Drs., Paul Marantz and Diane McKee; and Dr. Monica Lypson, of the United States Department of Veterans Affairs in Washington, DC.
Posted on: Thursday, September 19, 2019