Thank you, Chair Farías and for holding this hearing today. I am providing this testimony on behalf of Brooklyn Borough President Antonio Reynoso. Our office supports Resolution 208, which asks the NYS legislature to amend the public health law to mandate anti-bias training for medical students and residents.
It has been well established that implicit bias among healthcare providers can affect the way they administer care to patients, leading to deviations from standards of care for medical testing, diagnosis, and treatment. This contributes to the persistent health disparities that we see among affected populations.i,ii,iii As a local example of this, in their latest five-year report, DOHMH’s Maternal Mortality Review Committee identified discrimination as a contributing factor in half of the pregnancy-associated deaths they reviewed.iv
In spite of these findings, the effects that implicit bias can have on clinical decision-making and interactions with patients are not typically addressed in a standardized way during medical education and training.v While medical students and residents may receive one or a few lectures on recognizing biases as part of required coursework on cultural competence, ethics, and health disparities, this level of instruction is not adequate to affect significant changes in their implicit biases, and consequently, not in their subsequent patient care.
Healthcare educational institutions are becoming increasingly aware of the need to address students’ implicit biases early in their careers; however, instructional guidelines for this training are lacking and lesson content can be misaligned with what is known about how implicit bias specifically affects patient care. For instance, there may be a focus on the effects bias has on clinical decision-making, rather than on the more consistent role that implicit bias has on eroding patient-provider communication.vi
In 2021, the NIH hosted a seminar to discuss the effectiveness of implicit bias training in the scientific workforce. Among the points made in this seminar was that these trainings will be markedly less effective in sustainably reducing bias if they are one-time sessions rather than part of a broader institutional strategy that is committed to fundamental change, if they fail to convey messages to which participants are receptive, and if they are merely didactic regarding the concept of bias rather than instructive regarding needed behavioral changes.vii It was also noted that trainings should take into account the contextual nature of bias and how it varies situationally.
Consequently, there needs to be a more structured, focused, incremental and continuous approach to implicit bias training for healthcare providers in order to achieve desired improvements in equitable health practices and outcomes. This is why we urge the City Council to pass Resolution 208-2026 and to call upon the New York State Department of Health to work with the State Education Department to assess how implicit bias instruction is currently being conducted during medical and graduate medical education and to develop a comprehensive, required training curricula for medical students and residents as a first step toward addressing this problem.
While this training will be valuable, we acknowledge that it is only a small part of what is needed to ensure that our local healthcare is competent, inclusive and compassionate.
Thank you again for the opportunity to testify today. The Brooklyn Borough President’s Office will continue to work with the Council to find meaningful ways to eliminate health disparities among the residents of our city.
i FitzGerald, C., and Hurst, S. Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics. 2017 Mar 1; 18(1):19. https://doi.org/10.1186/s12910-017-0179-
ii Hall WJ, Chapman MV, Lee KM, Merino YM, Thomas TW, Payne BK, Eng E, Day SH, Coyne-Beasley T. Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. Am J Public Health. Dec 2015;105(12): e60-76. https://doi.org/10.2105/ajph.2015.302903
iii Saluja B, Bryant Z. How Implicit Bias Contributes to Racial Disparities in Maternal Morbidity and Mortality in the United States. J Womens Health (Larchmt). Feb 2021;30(2):270-273. https://doi.org/10.1089/jwh.2020.8874
iv Maternal Mortality Review Committee, New York City Department of Health and Mental Hygiene. Pregnancy-Associated Mortality in New York City, 2016-2020. September 2024. https://www.nyc.gov/assets/doh/downloads/pdf/ms/pregnancy-associated-mortality-report-2016-2020.pdf
v Morris, M. C., Cooper, R. L., Ramesh, A., Tabatabai, M., Arcury, T. A., Shinn, M., and Matthews-Juarez, P. Preparing medical students to address the needs of vulnerable patient populations: implicit bias training in US medical schools. Medical Science Educator. Feb 2020;30(1), 123-127. https://doi.org/10.1007/s40670-020-00930-3
vi Hagiwara N, Duffy C, Cyrus J, Harika N, Watson GS, Green TL. The nature and validity of implicit bias training for health care providers and trainees: A systematic review. Sci Adv. 2024 Aug 16;10(33): eado5957. https://doi.org/10.1126/sciadv.ado5957
vii National Institutes of Health (US), Office of the Director (OD), Chief Officer for Scientific Workforce Diversity (COSWD). Is Implicit Bias Training Effective? Bethesda (MD): National Institutes of Health (NIH); 2021. https://www.ncbi.nlm.nih.gov/books/n/coswdimplicitbias/pdf/
