| A Health Disparities Reduction Project of the American Academy of Physician Assistants, the Physician Assistant Foundation, and Physician Assistants for Health Equity |
| Heads Up! |
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In November 2007, the American Academy of Physician Assistants' (AAPA) Committee on Diversity launched "Heads Up!," an
awareness campaign aimed at reducing racial and ethnic disparities in health care. For three months, signage addressing the
issues of racial health care disparities, unconscious racial stereotyping, and implicit racial bias by clinicians was placed on
University of Washington Health Sciences Express shuttle busses. The buses are used by thousands of medical and health
care students and clinicians who travel daily between Seattle's University of Washington School of Medicine and its teaching
partner institution, Harborview Medical Center.
The campaign consisted of three bus signs, each of which addressed a different health disparities issue. The signs were
displayed on a rotating basis over the next three months. After the conclusion of the project, the AAPA Committee on Diversity
worked with AAPA to develop this CME module, with an assessment available at no charge to AAPA members on the AAPA
website. One hour of Category I CME credit may be earned by reading this introduction, three additional articles and
completing a post-test with a minimum score of 70% correct.
The project is among the first to address new evidence about the role of unconscious racial stereotyping in racial health
disparities. In 2007, Alexander Green, MD, of the Disparities Solutions Center at Massachusetts General Hospital, released a
study that connected implicit and unconscious stereotyping with unequal treatment of patients. It is one of the first studies to
connect these two issues. Green and the Disparities Solutions Center provided consultation and input on the Heads Up!"
campaign.
One "Heads Up!" sign featured photos of two males, one Caucasian and one African American, with the words: "Chest Pain,
Identical Symptoms, Matching Histories: Which Patient Doesn't Get the Appropriate Tests?" This refers to Green's study,
published in the Journal of General Internal Medicine, which had resident physicians direct treatment for hypothetical
patients. The residents based treatment decisions on a picture of the patient's face, accompanied by a written description of
the patient's chest pain. All of the hypothetical descriptions were identical, differing only in the race of the patients. Results
revealed more physicians prescribing thrombolysis for the white patients than for the black patients.
The study used an assessment tool from Project Implicit at Harvard University, measuring unconscious bias against black
patients on the part of providers. As the study clinician's unconscious biases against blacks increased, their likelihood of
giving thrombolysis treatment decreased. Green noted in an interview, "It's not a matter of you being a racist. It's really a
matter of the way your brain processes information is influenced by things you've seen, things you've experienced, the way
media has presented things." Green recommends that the best way to combat those impulses is by acknowledging them, and
suggests that medical personnel take an assessment measuring unconscious bias, which can be found at implicit.harvard.
edu.
Recent research about the issue of stereotyping and disparities in care offer some novel suggestions for ways to address
and decrease these problems. Diana Burgess and Michelle Van Ryn of the University of Minnesota have proposed an
intervention called "priming," putting basic information about unequal treatment and implicit/unconscious bias and
stereotyping in front of clinicians and allied health providers. This technique presupposes that racial gaps in care are based
on unconscious stereotyping, not on conscious efforts, as echoed by Green.
Van Ryn and Burgess describe the mechanism of using unconscious stereotyping to allow clinicians to "fill in the gaps" to
facilitate making complex decisions in a short period of time. They note that unconscious stereotyping, while helping
clinicians arrive at decisions quickly, can lead to unequal treatment.
Pain care persists as an area with well-studied and documented disparities in care. Todd's work has indicated evidence of
unequal treatment of pain, focusing on disparities in pain care for trauma and emergency departments.
It is widely and inaccurately believed by many clinicians that unequal treatment based on race and ethnicity is a matter of
unequal access. While access to care is known to impact a variety of populations, data indicates that even when access is
factored out of studies, treatment of pain and other problems frequently varies simply based on the race of patients, even
when patients present to the same facilities with similar injuries.
The federal government's Institute of Medicine released the congressionally mandated book Unequal Treatment in 2003.
Widely acclaimed for its comprehensive look at data related to racial disparities to care, Unequal Treatment made several
recommendations to health professionals. One of the foremost recommendations directs health professionals to share
information about racial disparities in care with colleagues, increasing awareness within the medical community about this
ongoing problem. The AAPA "Heads Up!" project was a response to this recommendation, as well as an effort to integrate the
Burgess and Van Ryn "priming" concept. This effort promotes awareness about racial disparities to PAs and other
colleagues, while framing the issue by describing the shared human tendency to use implicit and unconscious stereotyping in
daily practice.
Green and the Disparities Solutions Center also recommend developing "equity reports" in practice sites. These reports are
ways to examine specific practices for disparities in care, and creating specific action plans to address these disparities.
Their guide to creating equity reports is available at www.massgeneral.org/disparitiessolutions.
The AAPA is the only national organization to represent physician assistants in all medical and surgical specialties. Founded
in 1968, the Academy works to promote quality, cost-effective health care and the professional and personal growth of PAs.
For more information about the Academy and the PA profession, visit AAPA’s Web site, www.aapa.org.
awareness campaign aimed at reducing racial and ethnic disparities in health care. For three months, signage addressing the
issues of racial health care disparities, unconscious racial stereotyping, and implicit racial bias by clinicians was placed on
University of Washington Health Sciences Express shuttle busses. The buses are used by thousands of medical and health
care students and clinicians who travel daily between Seattle's University of Washington School of Medicine and its teaching
partner institution, Harborview Medical Center.
The campaign consisted of three bus signs, each of which addressed a different health disparities issue. The signs were
displayed on a rotating basis over the next three months. After the conclusion of the project, the AAPA Committee on Diversity
worked with AAPA to develop this CME module, with an assessment available at no charge to AAPA members on the AAPA
website. One hour of Category I CME credit may be earned by reading this introduction, three additional articles and
completing a post-test with a minimum score of 70% correct.
The project is among the first to address new evidence about the role of unconscious racial stereotyping in racial health
disparities. In 2007, Alexander Green, MD, of the Disparities Solutions Center at Massachusetts General Hospital, released a
study that connected implicit and unconscious stereotyping with unequal treatment of patients. It is one of the first studies to
connect these two issues. Green and the Disparities Solutions Center provided consultation and input on the Heads Up!"
campaign.
One "Heads Up!" sign featured photos of two males, one Caucasian and one African American, with the words: "Chest Pain,
Identical Symptoms, Matching Histories: Which Patient Doesn't Get the Appropriate Tests?" This refers to Green's study,
published in the Journal of General Internal Medicine, which had resident physicians direct treatment for hypothetical
patients. The residents based treatment decisions on a picture of the patient's face, accompanied by a written description of
the patient's chest pain. All of the hypothetical descriptions were identical, differing only in the race of the patients. Results
revealed more physicians prescribing thrombolysis for the white patients than for the black patients.
The study used an assessment tool from Project Implicit at Harvard University, measuring unconscious bias against black
patients on the part of providers. As the study clinician's unconscious biases against blacks increased, their likelihood of
giving thrombolysis treatment decreased. Green noted in an interview, "It's not a matter of you being a racist. It's really a
matter of the way your brain processes information is influenced by things you've seen, things you've experienced, the way
media has presented things." Green recommends that the best way to combat those impulses is by acknowledging them, and
suggests that medical personnel take an assessment measuring unconscious bias, which can be found at implicit.harvard.
edu.
Recent research about the issue of stereotyping and disparities in care offer some novel suggestions for ways to address
and decrease these problems. Diana Burgess and Michelle Van Ryn of the University of Minnesota have proposed an
intervention called "priming," putting basic information about unequal treatment and implicit/unconscious bias and
stereotyping in front of clinicians and allied health providers. This technique presupposes that racial gaps in care are based
on unconscious stereotyping, not on conscious efforts, as echoed by Green.
Van Ryn and Burgess describe the mechanism of using unconscious stereotyping to allow clinicians to "fill in the gaps" to
facilitate making complex decisions in a short period of time. They note that unconscious stereotyping, while helping
clinicians arrive at decisions quickly, can lead to unequal treatment.
Pain care persists as an area with well-studied and documented disparities in care. Todd's work has indicated evidence of
unequal treatment of pain, focusing on disparities in pain care for trauma and emergency departments.
It is widely and inaccurately believed by many clinicians that unequal treatment based on race and ethnicity is a matter of
unequal access. While access to care is known to impact a variety of populations, data indicates that even when access is
factored out of studies, treatment of pain and other problems frequently varies simply based on the race of patients, even
when patients present to the same facilities with similar injuries.
The federal government's Institute of Medicine released the congressionally mandated book Unequal Treatment in 2003.
Widely acclaimed for its comprehensive look at data related to racial disparities to care, Unequal Treatment made several
recommendations to health professionals. One of the foremost recommendations directs health professionals to share
information about racial disparities in care with colleagues, increasing awareness within the medical community about this
ongoing problem. The AAPA "Heads Up!" project was a response to this recommendation, as well as an effort to integrate the
Burgess and Van Ryn "priming" concept. This effort promotes awareness about racial disparities to PAs and other
colleagues, while framing the issue by describing the shared human tendency to use implicit and unconscious stereotyping in
daily practice.
Green and the Disparities Solutions Center also recommend developing "equity reports" in practice sites. These reports are
ways to examine specific practices for disparities in care, and creating specific action plans to address these disparities.
Their guide to creating equity reports is available at www.massgeneral.org/disparitiessolutions.
The AAPA is the only national organization to represent physician assistants in all medical and surgical specialties. Founded
in 1968, the Academy works to promote quality, cost-effective health care and the professional and personal growth of PAs.
For more information about the Academy and the PA profession, visit AAPA’s Web site, www.aapa.org.
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