Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training.

BACKGROUND: Health care routinely fails Indigenous peoples and anti-Indigenous racism is common in clinical encounters. Clinical training programs aimed to enhance Indigenous cultural safety (ICS) rely on learner reported impact assessment even though clinician self-assessment is poorly correlated with observational or patient outcome reporting. We aimed to compare the clinical impacts of intensive and brief ICS training to control, and to assess the feasibility of ICS training evaluation tools, including unannounced Indigenous standardized patient (UISP) visits. METHOD: Using a prospective parallel group three-arm randomized controlled trial design and masked standardized patients, we compared the clinical impacts of the intensive interactive, professionally facilitated, 8- to10-h Sanyas ICS training; a brief 1-h anti-bias training adapted to address anti-Indigenous bias; and control continuing medical education time-attention matched to the intensive training. Participants included 58 non-Indigenous staff physicians, resident physicians and nurse practitioners from family practice clinics, and one emergency department across four teaching hospitals in Toronto, Canada. Main outcome measures were the quality of care provided during UISP visits including adjusted odds that clinician would be recommended by the UISP to a friend or family member; mean item scores on patient experience of care measure; and clinical practice guideline adherence for NSAID renewal and pain assessment. RESULTS: Clinicians in the intensive or brief ICS groups had higher adjusted odds of being highly recommended to friends and family by standardized patients (OR 6.88, 95% CI 1.17 to 40.45 and OR 7.78, 95% CI 1.05 to 58.03, respectively). Adjusted mean item patient experience scores were 46% (95% CI 12% to 80%) and 40% (95% CI 2% to 78%) higher for clinicians enrolled in the intensive and brief training programs, respectively, compared to control. Small sample size precluded detection of training impacts on clinical practice guideline adherence; 100% of UISP visits were undetected by participating clinicians. CONCLUSIONS: Patient-oriented evaluation design and tools including UISPs were demonstrated as feasible and effective. Results show potential impact of cultural safety training on patient recommendation of clinician and improved patient experience. A larger trial to further ascertain impact on clinical practice is needed. TRIAL REGISTRATION: Clinicaltrials.org NCT05890144. Retrospectively registered on June 5, 2023.

Robust within-session modulations of IAT scores may reveal novel dynamics of rapid change.

The Implicit Association Test (IAT) is employed in the domain of social psychology as a measure of implicit evaluation. Participants in this task complete blocks of trials where they are asked to respond to categories and attributes (e.g., types of faces and types of words). Reaction times in different blocks sharing certain response combinations are averaged and then subtracted from blocks with other response combinations and then normalized, the result of which is taken as a measure indicating implicit evaluation toward or away from the given categories. One assumption of this approach is stationarity of response time distributions, or at a minimum, that temporal dynamics in response times are not theoretically relevant. Here we test these assumptions, examine the extent to which response times change within the IAT blocks and, if so, how trajectories of change are meaningful in relation to external measures. Using multiple data sets we demonstrate within-session changes in IAT scores. Further, we demonstrate that dissociable components in the trajectories of IAT performance may be linked to theoretically distinct processes of cognitive biases as well as behaviors. The present work presents evidence that IAT performance changes within the task, while future work is needed to fully assess the implications of these temporal dynamics.

Untested assumptions perpetuate stereotyping: Learning in the absence of evidence.

In the present work, we set out to assess whether and how much people learn in response to their stereotypic assumptions being confirmed, being disconfirmed, or remaining untested. In Study 1, participants made a series of judgments that could be influenced by stereotypes and received feedback that confirmed stereotypes the majority of the time, feedback that disconfirmed stereotypes the majority of the time, or no feedback on their judgments. Replicating past work on confirmation bias, patterns in the conditions with feedback indicated that pieces of stereotype-confirming evidence exerted more influence than stereotype-disconfirming evidence. Participants in the Stereotype-Confirming condition stereotyped more over time, but rates of stereotyping for participants in the Stereotype-Disconfirming condition remained unchanged. Participants who received no feedback, and thus no evidence, stereotyped more over time, indicating that, matching our core hypothesis, they learned from their own untested assumptions. Study 2 provided a direct replication of Study 1. In Study 3, we extended our assessment to memory. Participants made judgments and received a mix of confirmatory, disconfirmatory, and no feedback and were subsequently asked to remember the feedback they received on each trial, if any. Memory tests for the no feedback trials revealed that participants often misremembered that their untested assumptions were confirmed. Supplementing null hypothesis significance testing, Bayes Factor analyses indicated the data in Studies 1, 2, and 3 provided moderate-to-extreme evidence in favor of our hypotheses. Discussion focuses on the challenges these learning patterns create for efforts to reduce stereotyping.

Evidence for Distinct Facial Signals of Reward, Affiliation, and Dominance from Both Perception and Production Tasks.

Smiles are nonverbal signals that convey social information and influence the social behavior of recipients, but the precise form and social function of a smile can be variable. In previous work, we have proposed that there are at least three physically distinct types of smiles associated with specific social functions: reward smiles signal positive affect and reinforce desired behavior; affiliation smiles signal non-threat and promote peaceful social interactions; dominance smiles signal feelings of superiority and are used to negotiate status hierarchies. The present work advances the science of the smile by addressing a number of questions that directly arise from this smile typology. What do perceivers think when they see each type of smile (Study 1)? How do perceivers behave in response to each type of smile (Study 2)? Do people produce three physically distinct smiles in response to contexts related to each of the three social functions of smiles (Study 3)? We then use an online machine learning platform to uncover the labels that lay people use to conceptualize the smile of affiliation, which is a smile that serves its social function but lacks a corresponding lay concept. Taken together, the present findings support the conclusion that reward, affiliation, and dominance smiles are distinct signals with specific social functions. These findings challenge the traditional assumption that smiles merely convey whether and to what extent a smiler is happy and demonstrate the utility of a social-functional approach to the study of facial expression.

Correction to: Evidence for Distinct Facial Signals of Reward, Affiliation, and Dominance from Both Perception and Production Tasks.

[This corrects the article DOI: 10.1007/s42761-020-00024-8.].

Little race or gender bias in an experiment of initial review of NIH R01 grant proposals.

Many granting agencies allow reviewers to know the identity of a proposal's principal investigator (PI), which opens the possibility that reviewers discriminate on the basis of PI race and gender. We investigated this experimentally with 48 NIH R01 grant proposals, representing a broad range of NIH-funded science. We modified PI names to create separate white male, white female, black male and black female versions of each proposal, and 412 scientists each submitted initial reviews for 3 proposals. We find little to no race or gender bias in initial R01 evaluations, and additionally find that any bias that might have been present must be negligible in size. This conclusion was robust to a wide array of statistical model specifications. Pragmatically, important bias may be present in other aspects of the granting process, but our evidence suggests that it is not present in the initial round of R01 reviews.

A Gender Bias Habit-Breaking Intervention Led to Increased Hiring of Female Faculty in STEMM Departments.

Addressing the underrepresentation of women in science is a top priority for many institutions, but the majority of efforts to increase representation of women are neither evidence-based nor rigorously assessed. One exception is the gender bias habit-breaking intervention (Carnes et al., 2015), which, in a cluster-randomized trial involving all but two departmental clusters (N = 92) in the 6 STEMM focused schools/colleges at the University of Wisconsin - Madison, led to increases in gender bias awareness and self-efficacy to promote gender equity in academic science departments. Following this initial success, the present study compares, in a preregistered analysis, hiring rates of new female faculty pre- and post-manipulation. Whereas the proportion of women hired by control departments remained stable over time, the proportion of women hired by intervention departments increased by an estimated 18 percentage points (OR = 2.23, dOR = 0.34). Though the preregistered analysis did not achieve conventional levels of statistical significance (p < 0.07), our study has a hard upper limit on statistical power, as the cluster-randomized trial has a maximum sample size of 92 departmental clusters. These patterns have undeniable practical significance for the advancement of women in science, and provide promising evidence that psychological interventions can facilitate gender equity and diversity.

Breaking the prejudice habit: Mechanisms, timecourse, and longevity.

The prejudice habit-breaking intervention (Devine et al., 2012) and its offshoots (e.g., Carnes et al., 2012) have shown promise in effecting long-term change in key outcomes related to intergroup bias, including increases in awareness, concern about discrimination, and, in one study, long-term decreases in implicit bias. This intervention is based on the premise that unintentional bias is like a habit that can be broken with sufficient motivation, awareness, and effort. We conducted replication of the original habit-breaking intervention experiment in a sample more than three times the size of the original (N = 292). We also measured all outcomes every other day for 14 days and measured potential mechanisms for the intervention's effects. Consistent with previous results, the habit-breaking intervention produced a change in concern that endured two weeks post-intervention. These effects were associated with increased sensitivity to the biases of others and an increased tendency to label biases as wrong. Contrasting with the original work, both control and intervention participants decreased in implicit bias, and the effects of the habit-breaking intervention on awareness declined in the second week of the study. In a subsample recruited two years later, intervention participants were more likely than control participants to object on a public online forum to an essay endorsing racial stereotyping. Our results suggest that the habit-breaking intervention produces enduring changes in peoples' knowledge of and beliefs about race-related issues, and we argue that these changes are even more important for promoting long-term behavioral change than are changes in implicit bias.

Ecological Invalidity of Existing Gaydar Research: In-Lab Accuracy Translates to Real-World Inaccuracy: Response to Rule, Johnson, & Freeman (2016).

In recent years, several empirical studies have claimed to provide evidence in support of the popular folk notion that people possess "gaydar" that enables them to accurately identify who is gay or lesbian (Rule, Johnson, & Freeman, 2016). This conclusion is limited to artificial lab settings, however, and when translated to real-world settings this work itself provides evidence that people's judgments about who is gay/lesbian are not pragmatically accurate. We also briefly review evidence related to the consequences of perpetuating the idea of gaydar (i.e., "the gaydar myth"). Although past claims about accurate orientation perception are misleading, the work that gave rise to those claims can nevertheless inform the literature in meaningful ways. We offer some recommendations for how the evidence in past "gaydar" research can be reappraised to inform our understanding of social perception and group similarities/differences.

Inferences About Sexual Orientation: The Roles of Stereotypes, Faces, and The Gaydar Myth.

In the present work, we investigated the pop cultural idea that people have a sixth sense, called "gaydar," to detect who is gay. We propose that "gaydar" is an alternate label for using stereotypes to infer orientation (e.g., inferring that fashionable men are gay). Another account, however, argues that people possess a facial perception process that enables them to identify sexual orientation from facial structure. We report five experiments testing these accounts. Participants made gay-or-straight judgments about fictional targets that were constructed using experimentally manipulated stereotypic cues and real gay/straight people's face cues. These studies revealed that orientation is not visible from the face-purportedly "face-based" gaydar arises from a third-variable confound. People do, however, readily infer orientation from stereotypic attributes (e.g., fashion, career). Furthermore, the folk concept of gaydar serves as a legitimizing myth: Compared to a control group, people stereotyped more often when led to believe in gaydar, whereas people stereotyped less when told gaydar is an alternate label for stereotyping. Discussion focuses on the implications of the gaydar myth and why, contrary to some prior claims, stereotyping is highly unlikely to result in accurate judgments about orientation.

The motivation to express prejudice.

Contemporary prejudice research focuses primarily on people who are motivated to respond without prejudice and the ways in which unintentional bias can cause these people to act in a manner inconsistent with this motivation. However, some real-world phenomena (e.g., hate speech, hate crimes) and experimental findings (e.g., Plant & Devine, 2001, 2009) suggest that some prejudice is intentional. These phenomena and findings are difficult to explain solely from the motivations to respond without prejudice. We argue that some people are motivated to express prejudice, and we develop the Motivation to Express Prejudice Scale (MP) to measure this motivation. In 7 studies involving more than 6,000 participants, we demonstrate that, across scale versions targeted at Black people and gay men, the MP has good reliability and convergent, discriminant, and predictive validity. In normative climates that prohibit prejudice, the internal and external motivations to express prejudice are functionally nonindependent, but they become more independent when normative climates permit more prejudice toward a target group. People high in the motivation to express prejudice are relatively likely to resist pressure to support programs promoting intergroup contact and to vote for political candidates who support oppressive policies. The motivation to express prejudice predicted these outcomes even when controlling for attitudes and the motivations to respond without prejudice. This work encourages contemporary prejudice researchers to give greater consideration to the intentional aspects of negative intergroup behavior and to broaden the range of phenomena, target groups, and samples that they study.

Stereotypes possess heterogeneous directionality: a theoretical and empirical exploration of stereotype structure and content.

We advance a theory-driven approach to stereotype structure, informed by connectionist theories of cognition. Whereas traditional models define or tacitly assume that stereotypes possess inherently Group → Attribute activation directionality (e.g., Black activates criminal), our model predicts heterogeneous stereotype directionality. Alongside the classically studied Group → Attribute stereotypes, some stereotypes should be bidirectional (i.e., Group ⇄ Attribute) and others should have Attribute → Group unidirectionality (e.g., fashionable activates gay). We tested this prediction in several large-scale studies with human participants (NCombined = 4,817), assessing stereotypic inferences among various groups and attributes. Supporting predictions, we found heterogeneous directionality both among the stereotype links related to a given social group and also between the links of different social groups. These efforts yield rich datasets that map the networks of stereotype links related to several social groups. We make these datasets publicly available, enabling other researchers to explore a number of questions related to stereotypes and stereotyping. Stereotype directionality is an understudied feature of stereotypes and stereotyping with widespread implications for the development, measurement, maintenance, expression, and change of stereotypes, stereotyping, prejudice, and discrimination.

Stereotyping to infer group membership creates plausible deniability for prejudice-based aggression.

In the present study, participants administered painful electric shocks to an unseen male opponent who was either explicitly labeled as gay or stereotypically implied to be gay. Identifying the opponent with a gay-stereotypic attribute produced a situation in which the target's group status was privately inferred but plausibly deniable to others. To test the plausible deniability hypothesis, we examined aggression levels as a function of internal (personal) and external (social) motivation to respond without prejudice. Whether plausible deniability was present or absent, participants high in internal motivation aggressed at low levels, and participants low in both internal and external motivation aggressed at high levels. The behavior of participants low in internal and high in external motivation, however, depended on experimental condition. They aggressed at low levels when observers could plausibly attribute their behavior to prejudice and aggressed at high levels when the situation granted plausible deniability. This work has implications for both obstacles to and potential avenues for prejudice-reduction efforts.

Long-term reduction in implicit race bias: A prejudice habit-breaking intervention.

We developed a multi-faceted prejudice habit-breaking intervention to produce long-term reductions in implicit race bias. The intervention is based on the premise that implicit bias is like a habit that can be reduced through a combination of awareness of implicit bias, concern about the effects of that bias, and the application of strategies to reduce bias. In a 12-week longitudinal study, people who received the intervention showed dramatic reductions in implicit race bias. People who were concerned about discrimination or who reported using the strategies showed the greatest reductions. The intervention also led to increases in concern about discrimination and personal awareness of bias over the duration of the study. People in the control group showed none of the above effects. Our results raise the hope of reducing persistent and unintentional forms of discrimination that arise from implicit bias.

Stereotypes, Prejudice, and Depression: The Integrated Perspective.

Social psychologists fighting prejudice and clinical psychologists fighting depression have long been separated by the social-clinical divide, unaware that they were facing a common enemy. Stereotypes about others leading to prejudice (e.g., Devine, 1989) and schemas about the self leading to depression (e.g., A. T. Beck, 1967) are fundamentally the same type of cognitive structure. According to the integrated perspective on prejudice and depression, negative stereotypes (i.e., schemas) are activated in a Source, who expresses prejudice toward the Target, causing the Target to experience depression. This linking of prejudice and depression (i.e., "comorbid" prejudice and depression) can occur at the societal level (e.g., Nazis' prejudice causing Jews' depression), the interpersonal level (e.g., an abuser's prejudice causing an abusee's depression), and the intrapersonal level (e.g., a person's self-prejudice causing his or her depression). The integrated perspective addresses several longstanding paradoxes, controversies, and questions; generates new areas of inquiry; and spotlights specific methods and findings that have direct cross-disciplinary applications in the battle against prejudice and depression. Ironically, some interventions developed by depression researchers may be especially useful against prejudice, and some interventions developed by prejudice researchers may be especially useful against depression.