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Am J Perinatol 2024; 41(12): 1634-1644
DOI: 10.1055/a-2240-1979
Original Article

Implicit Bias and Health Disparities Education in the Neonatal Intensive Care Unit

Nicolle Fernández Dyess  ‡   *
1   Section of Neonatology, Department of Pediatrics, University of Colorado, Aurora, Colorado
,
Cara Beth Carr‡   *
2   Division of Neonatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Stephanie C. Mavis
3   Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
,
Catherine G. Caruso 
4   Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
,
Susan Izatt
5   Division of Neonatology, Department of Pediatrics, Duke University, Durham, North Carolina
,
Heather French
6   Division of Neonatology, Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
,
Rita Dadiz
7   Division of Neonatology, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
,
Elizabeth M. Bonachea
8   Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
,
Megan M. Gray 
9   Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
› Author Affiliations Funding This work was supported by a 2020 American Academy of Pediatrics Section of Neonatal-Perinatal Medicine Strategic Grant. The funding agency had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
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Abstract

Objective This study aimed to characterize implicit bias (IB) and health disparities (HD) education in neonatal–perinatal medicine (NPM), including current educational opportunities, resources, and barriers.

Study Design A national web-based survey was sent to NPM fellows, neonatologists, and frontline providers after iterative review by education experts from the National Neonatology Curriculum Committee. Quantitative data were analyzed with chi-square and Fisher's exact tests. Qualitative data were evaluated using thematic analysis.

Results Of the 452 NPM survey respondents, most desired additional IB (76%) and HD (83%) education. A greater proportion of neonatologists than fellows received IB (83 vs. 57%) and HD (87 vs. 74%) education. Only 41% of neonatologists reported that their institution requires IB training. A greater proportion of fellows than neonatologists expressed dissatisfaction with the current approaches for IB (51 vs. 25%, p < 0.001) and HD (43 vs. 25%, p = 0.015) education. The leading drivers of dissatisfaction included insufficient time spent on the topics, lack of specificity to NPM, inadequate curricular scope or depth, and lack of local educator expertise. A minority of faculty who were tasked to educate others have received specific educator training on IB (21%) and HD (16%). Thematic analysis of survey free-text responses identified three main themes on the facilitators and barriers to successful IB and HD education: individual, environmental, and curricular design variables.

Conclusion NPM trainees and neonatologists desire tailored, active, and expert-guided IB and HD education. Identified barriers are important to address in developing an effective IB/HD curriculum for the NPM community.

Key Points

  • There is a gap between the current delivery of IB/HD education and the needs of the NPM community.

  • NPM trainees and neonatologists desire tailored, active, and expert-guided IB and HD education.

  • A successful curriculum should be widely accessible, NPM-specific, and include facilitator training.

Keywords

implicit bias - health disparities - neonatal–perinatal medicine - curriculum development

Data Availability Statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.


Authors' Contributions

N.F.D. and C.B.C. contributed to the methodology, investigation, data curation, visualization, formal analysis, and writing (of the original draft) of the study. As corresponding author, N.F.D. has full access to the data in the study and final responsibility for the decision to submit for publication. S.C.M. and C.G.C. contributed to the study's methodology, investigation, formal analysis, and writing (review and editing). S.I., H.F., R.D., and E.M.B. contributed to the study's conceptualization, methodology, review, and editing. M.M.G. contributed to the study's conceptualization, methodology, supervision, formal analysis, and writing (review and editing). All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.


* These authors contributed equally to this work as cofirst authors.


Supplementary Material



Publication History

Received: 04 November 2023

Accepted: 05 January 2024

Accepted Manuscript online:
08 January 2024

Article published online:
06 February 2024

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