About the BRIM Initiative
The BRIM Initiative was an NIH clinical study designed and conducted by Dr. Molly Carnes and colleagues at the University of Wisconsin-Madison (UW) and offered the opportunity to help our DOM faculty “break the bias habit” and align their judgments and behaviors with their explicit commitments to be fair and objective. The John T. Milliken Department of Medicine at the Washington University School of Medicine was one of several institutions nationwide that participated in the BRIM study.
Over the course of 2 years, all divisions in the Department of Medicine completed a 3-hour interactive workshop with 3 modules:
- Implicit bias as a habit
- Becoming bias literate: If you name it, you can tame it
- Evidence-based strategies to break the bias habit
What is the goal of the BRIM Initiative?
The overall goal was to study and facilitate the implementation of an effective pro-diversity intervention throughout academic medicine. To achieve this, a team from the University of Wisconsin-Madison (UW) presented the workshop to approximately half of your divisions and trained DOM implementers who presented the workshop to the remaining divisions.
Background
Professional interactions, performance evaluations, and hiring decisions can be inadvertently influenced by cultural stereotypes about race, gender, age, sexual preference, and weight. As a result, faculty from some groups experience a more positive and supportive work environment than faculty from other groups.1-7 These same stereotypes can unwittingly affect physicians’ perceptions and decisions about their patients. The Association of American Medical Colleges (AAMC), National Academies of Sciences (NAS), and National Institutes of Health (NIH) affirm that reducing stereotype-based bias will benefit medical education, patient care, population health, and scientific discovery.
Unlike most diversity trainings that can be time consuming and ineffective, the BRIM Initiative drew on decades of research on behavioral change in approaching stereotype-based bias as a “habit of mind” that can be changed like any other unwanted habit by increasing awareness, motivation, and self-efficacy to practice evidence-based strategies.8,9 The BRIM Initiative also incorporated principles of implementation science to build capacity for continuing this approach at collaborating institutions and to help ensure sustainability.
There are 3 phases of activities in the BRIM Initiative:
- Phase I – Site visit by the UW team members and launch of BRIM initiative in the Department of Medicine.
- Phase II – Presentation of virtual workshops to group 1 by the UW team members followed by training of DOM BRIM Implementers.
- Phase III – Presentation of virtual workshops to group 2 by DOM BRIM Implementers
- Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. Nov 2013;28(11):1504-1510.
- Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Review. Apr 2015;16(4):319-326.
- Sabin JA, Greenwald AG. The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma. American Journal of Public Health. May 2012;102(5):988-995.
- van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians’ perceptions of patients. Social Science in Medicine. Mar 2000;50(6):813-828.
- Sabin J, Riskind R, Nosek B. Health care providers’ implicit and explicit attitudes toward lesbain women and gay men. American Journal of Public Health. 2015;105:1831-1841.
- Williams R, Romney C, Kano M, et al. Racial, gender, and socialeconomic status bias in senior medical student clinical decision-making: A national survey. J Gen Intern Med. 2015;6:758-767.
- Ruiz J, Andrade A, Anam R, et al. Group-based differences in anti-aging bias among medical students. Gerontology and Geriatrics Education. 2015;36:58-78.
- Carnes M, Devine PG, Baier Manwell L, et al. The effect of an intervention to break the gender bias habit for faculty at one institution: a cluster randomized, controlled trial. Academic Medicine. Feb 2015;90(2):221-230.
- Carnes M, Devine PG, Isaac C, et al. Promoting institutional change through bias literacy. Journal of diversity in higher education. Jun 2012;5(2):63-77.
Molly Carnes, MD, MS
Director
Center for Women’s Health Research Co-Director, Women in Science and Engineering Leadership Institute (WISELI)
BRIM Initiative PI
University of Wisconsin-Madison
Jennifer Sheridan, PhD
Executive & Research Director
Women in Science and Engineering Leadership Institute (WISELI)
BRIM Initiative Co-investigator
University of Wisconsin-Madison
Eve Fine, PhD
Associate Scientist and Director
Curriculum Development and Implementation for Women in Science and Engineering Leadership Institute (WISELI)
University of Wisconsin-Madison
Sharon Topp
BRIM Initiative Coordinator
University of Wisconsin-Madison
Lynn Cornelius, MD – PI
Winfred A. and Emma R. Showman Professor of Dermatology
Chief, Division of Dermatology, Department of Medicine
Joe Pangelinan, PhD, LPC, NCC – Lead
Assistant Professor
Director of Cultural Awareness & Diversity, Equity, and Inclusion
Department of Orthopaedic Surgery
Maya Jerath, MD, PhD
Professor
Division of Allergy & Immunology
Sharon Cresci, MD
Associate Professor
Division of Cardiology, Department of Medicine
Lisa de las Fuentes, MD, MS
Professor
Division of Cardiology, Department of Medicine
Kara Sternhell-Blackwell, MD
Associate Professor
Division of Dermatology, Department of Medicine
Cristina Strong, PhD
Assistant Professor
Division of Dermatology, Department of Medicine
Anne Goldberg, MD, FACP, FAHA
Professor
Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine
Deborah Rubin, MD, AGAF
William B. Kountz Professor of Medicine
Division of Gastroenterology, Department of Medicine
Jane Garbutt, MB, ChB
Professor
Division of General Medical Sciences, Department of Medicine
Lenise Cummings-Vaughn, MD, CMD
Associate Professor
Division of Geriatrics and Nutritional Science, Department of Medicine
Amy Zhao, MD
Assistant Professor
Division of Hematology, Department of Medicine
Wenners Ballard III, MD
Instructor
Division of Hospital Medicine, Department of Medicine
Hilary Babcock, MD, MPH
Professor
Division of Infectious Diseases, Department of Medicine
Rakhee Bhayani, MD
Professor
Division of General Medicine, Department of Medicine
Will Ross, MD, MPH
Professor
Division of Nephrology, Department of Medicine
George Ansstas, MD
Assistant Professor
Division of Oncology, Department of Medicine
Maria Dans, MD
Associate Professor
Division of Palliative Care, Department of Medicine
Chad Witt, MD
Assistant Professor
Division of Pulmonary and Critical Care, Department of Medicine Christine Pham, MD
Professor
Division of Rheumatology, Department of Medicine
Angeline DeiSanti, MD