Centering Justice in Health Professions Education by Owning Limitations of Anti-Bias Checklists

This article examines the reliance on anti-bias checklists in clinical settings and the education of health professionals, noting a lack of focus on a justice-oriented clinical curriculum.

Introduction

Wyatt and Randall examine the limitations of using anti-bias checklists which are intended to address and mitigate health inequities in the education of health professionals. Inequities can be defined as a difference in diagnosis and in outcome on the basis of race and gender. While these checklists represent progress for antiracist frameworks, the authors argue these checklists fall short of their intended purpose of identifying instances of racism and structural disparities that exist within medical education and diagnosis of the condition. The authors argue that anti-bias checklists alone are insufficient for dismantling entrenched systems of oppression and that substantive changes are needed to move beyond superficial metrics and solutions. Therefore, they advocate for comprehensive reform to health professionals’ education, emphasizing the need for a justice-oriented framework that addresses structural racism and existing disparities. 

They also express that there is a need to scrutinize how whiteness as the norm, particularly its use as the dominant illustration in medical education, shapes the education of health professionals. The authors contend that health education pedagogy must shift to de-center whiteness and prioritize justice.

Dr. Tasha R. Wyatt is an Associate Professor at the Uniformed Services University’s Center for Health Professions Education, where she examines how race, culture, and oppression shape professional identity formation and develop acts of resistance among minoritized physicians. Her work uses decolonization frameworks. Dr. Jennifer Randall is a psychometrician and the Dunn Family Chair at the University of Michigan. Her work focuses on developing antiracist, culturally sustaining assessments by disrupting white supremacist logics and centering the voices of Black, Brown, and Indigenous students in test design.

Methods and Findings

Wyatt and Randall have three methods for examining and re-framing the use of anti-bias checklists in health professionals’ education. 

1. What’s Wrong with Anti-Bias Checklists?
   
   Although anti-bias checklists are designed for ease of implementation and scalability, their standardization approach lacks nuance in the context of health professional education. 
   
   The historical underpinnings of racism that might infiltrate these checklists are rarely examined, which leads to an absence of critical examination of checklists’ existence and intended use. 
   
   The authors also show that the checklists primarily serve to assuage clinical providers that they are not biased, rather than meeting the needs of marginalized patients. 
   
2. Interrogating Whiteness in Education
   
   Whiteness is often treated as the default standard in health profession education, as evidenced by the lack of diversity within case studies in medical diagnosis and training. The use of whiteness as a framework reifies “white normativity,” which overlooks the significance of race in medicine. Centering whiteness in medical education racializes other groups while positioning whiteness as the norm. When clinicians disregard or misdiagnose the unique needs and health outcomes of racially minoritized communities, it further marginalizes and harms BIPOC individuals. 
   
   Since these anti-bias checklists are standardized, they cannot detach themselves from the prevailing norm of whiteness, which further underscores the need to reframe both the health professional educational framework and the use of these checklists. 
   
3. Justice-Oriented Approach and Critical Consciousness 
   
   The authors recommend adopting a justice-oriented approach that focuses on equitably diagnosing patients in medical education and allows for a better understanding of marginalized populations. 
   
   They also argue that health professionals must shift towards a practice of critical consciousness, which encourages examining personal biases, power, and privilege. This type of self-interrogation, along with a critical reckoning of whiteness in the field, can lead to more equitable outcomes for the development and assessment of patient diagnosis and health education. 

Conclusions

There is good reason in the health professional education space to move beyond the use of anti-bias checklists and adopt a pedagogy that directly confronts whiteness. This shift can be done by fostering critical consciousness and a deeper understanding of the historical underpinnings of oppression and racism that educators might unknowingly perpetuate.