Extensive research over the past two decades indicates racial inequities in patient-provider communication stem largely from implicit prejudice among health care providers. This implicit prejudice manifests during medical interactions with Black patients through a wide range of communication behaviors. These include nonverbal behaviors, or how people move their bodies – such as eye contact and hand movements – and paraverbal behaviors, or how people deliver speech – such as their tone and volume. Both of these behaviors typically occur spontaneously.

For example, providers with higher levels of implicit prejudice tend to talk more and spend less time evaluating Black patients. They also display less positive and more negative affect and more frequently use anxiety-related words like “worry,” “afraid” and “nervous.”

Importantly, Black patients are adept at discerning these subtle negative communication behaviors. “It’s petty, little things,” a Black patient told the Kaiser Family Foundation. “When they call the nurse, they rush to come see the white people. They don’t rush to see the Black people. I think it’s racist.” Consequently, Black patients report lower levels of satisfaction after interacting with providers with higher levels of implicit prejudice.

A common misconception is that implicit prejudice is a key driver of racial disparities in medical treatment. However, current research does not support the idea that providers with higher levels of implicit prejudice treat Black patients worse than white patients. Additionally, more research is needed to determine whether implicit stereotyping from providers – such as automatically associating the idea of being “medically uncooperative” with Black people – would also lead to negative communication behaviors or sub-optimal treatment decisions for Black patients.

Many researchers and clinicians see implicit bias training as an essential component of medical education. However, current programs have shortcomings that undermine their effectiveness.

To understand what typical implicit bias training is like, our ongoing systematic review looks at 77 studies on implicit bias training programs in U.S. health care institutions. Although the majority of the programs were designed to address implicit racial bias, a significant number also addressed other forms of bias including gender identity, sexual orientation and socioeconomic status. Most programs aim to educate health care workers and trainees on implicit bias and how it may affect their patient care, as well as increase awareness about their own biases. Most are single sessions that last about 5.5 hours on average.

However, the design of these training programs does not align with current scientific knowledge about implicit bias.

First, while awareness of one’s biases is a necessary first step to mitigating implicit bias, it alone is not sufficient. Providers must also be personally invested in and have the mental capacity to address their biases.

Second, mitigating implicit bias requires repeated and consistent practice. Implicit bias is like a habit: it is deeply ingrained and operates without intentional control, making it challenging to recognize and change.

Third, training effectiveness is more accurately assessed through patient outcomes, such as care satisfaction, rather than self-reflection or implicit bias scores. Because providers may be concerned about how program facilitators will judge them, they may not provide honest feedback. Furthermore, changes in implicit bias scores do not necessarily result in decreased discriminatory behaviors, making it unclear how these programs can change the quality of care that Black patients experience.

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