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Implicit Bias and the Feedback Paradox: Exploring How Health Professionals Engage With Feedback While Questioning Its Credibility

Sukhera, Javeed MD, PhD, DABPN, FRCPC; Wodzinski, Michael; Milne, Alexandra RN; Teunissen, Pim W. MD, PhD; Lingard, Lorelei PhD; Watling, Chris MD, PhD, FRCPC

doi: 10.1097/ACM.0000000000002782
Research Reports

Purpose Learners and practicing health professionals may dismiss emotionally charged feedback related to self, yet little research has examined how to address feedback that threatens an individual’s identity. The implicit association test (IAT) provides feedback to individuals regarding their implicit biases. Anticipating feedback about implicit bias might be emotionally charged for mental health professionals, this study explored their experience of taking the IAT and receiving their results, to better understand the challenges of identity-threatening feedback.

Method The researchers sampled 32 psychiatry nurses, psychiatrists, and psychiatric residents at Western University in Ontario, Canada, after they completed the mental illness IAT and received their results. Using constructivist grounded theory, semistructured interviews were conducted from April to October 2017 regarding participants’ experience of taking the IAT. Using constant comparative analysis, transcripts were iteratively coded and analyzed for results.

Results While most participants critiqued the IAT and questioned its credibility, many also described the experience of receiving feedback about their implicit biases as positive or neutral. Most justified their implicit biases while acknowledging the need to better manage them.

Conclusions These findings highlight a feedback paradox, calling into question assumptions regarding self-related feedback. Participants’ reactions to the IAT suggest that potentially threatening self-related feedback may still be useful to participants who question its credibility. Further exploration of how the feedback conversation influences engagement with self-related feedback is needed.

J. Sukhera is assistant professor of psychiatry and pediatrics and fellow, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.

M. Wodzinski is an MD candidate, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.

A. Milne is a registered nurse in paediatrics, London Health Sciences Centre, London, Ontario, Canada, and master of nursing and nurse practitioner candidate, Ryerson University, Toronto, Ontario, Canada.

P.W. Teunissen is professor of workplace learning in healthcare, Faculty of Health Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands, and gynecologist, Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, the Netherlands.

L. Lingard is professor, Department of Medicine, and director, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.

C. Watling is professor and associate dean for postgraduate medical education, Schulich School of Medicine and Dentistry, Western University, and scientist, Centre for Education Research and Innovation, London, Ontario, Canada.

Funding/Support: This work was supported by grants from Associated Medical Services–Phoenix Fellowship and the London Health Sciences Centre Children’s Health Foundation.

Other disclosures: None reported.

Ethical approval: Approval was obtained from the Western University Research Ethics Board to conduct the study.

Correspondence should be addressed to Javeed Sukhera, LHSC VH 800 Commissioners Rd. E., Suite B8-176, London, Ontario, Canada, N6A 5W9; telephone: (519) 685-8500, ext. 74968; email:

Copyright © 2019 by the Association of American Medical Colleges