Another review, also published last year, analyzed 42 studies since 2014 and concluded that racial biases and structural racism contributed to maternal health complications for Black women. And a 2020 study found Black infants were twice as likely to survive when cared for by Black doctors.

Research by Hardeman and others has found that clinicians are more likely to describe Black patients as “not compliant,” “agitated” or “aggressive.” When such descriptions are included in a patient’s medical record, it can color the perceptions of other providers who consult it, influencing their interactions with the patient.

Hardeman’s courses include patient anecdotes that illustrate bias as well as strategies for curbing assumptions and practicing more empathy. The courses also include a history of racism in medicine, such as the gynecological experiments by J. Marion Sims, often called the father of modern gynecology, on Black enslaved people.

Given that history, many Black, Indigenous and Hispanic patients are wary of health care systems.

“We’re talking about the fact that our medical education system has been built within this history of racism, and so we have to be aware of it to undo it,” Hardeman said.

“We wanted to make sure that people walked away understanding that we all have a role in dismantling these systems, and it starts with educating ourselves, and then making sure that what we’re learning and what we’ve been educated on, we’re applying it to the way that we are interacting with different patients and their families.”

Stalled legislation

But passage of a law doesn’t always lead to immediate change.

A year and half after California’s law took effect in 2020, a California Department of Justice investigation found just 17% of providers surveyed had trained their entire staff. Nearly a year after the probe began and more outreach was conducted, completed training rates rose to 81%. New legislation introduced this year aims to strengthen the law by fining health care centers that fail to train their staff, and would extend training requirements to nursing staff.

In many states, implicit bias legislation has stalled before reaching the governor’s desk.

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