This article was authored by Sherry-Ann Brown, MD, PhD, Fellow in Training (FIT) at Mayo Clinic in Rochester, MN.

The ACC Women in Cardiology (WIC) Section Workshop, held last fall in Washington, DC, featured Sharonne Hayes, MD, FACC, as one of the main speakers. She led a workshop on "Advancing Women in Cardiology: Addressing Biases and Barriers Head On," and it involved kindly confronting implicit or unconscious bias in ourselves, others, our fields of practice and society at large.

In preparation for the workshop, I completed a few pre-conference tests on Implicit Bias: Gender-Career, Gender-Science and Race. Like many other workshop attendees, reflecting on the test results was a profound and meaningful experience.

I first completed the Gender-Career test without reading any details beyond the basic step-by-step instructions. The test results suggested that I have a "strong association for male with career and female with family." The results showed that I took longer to complete the section of the test that paired "male" with "family" and "female" with "career," than the section of the text that paired "male" with "career" and "female" with "family," indicating that I found the former unusual and the latter more normal.

I found this result interesting and wondered about the constituent factors underlying the information. I thought back to an initial section of the test in which “male” was associated with “career.” At that early point in the test, I said out loud to myself that the test was "training in" implicit bias by training me to associate the “E” key on the left of my keyboard with “career” and “males,” and the “I” key on the right of my keyboard with “family” and “females.” As the test progressed, switching the left key to “career” and the right key to “family” was confusing for my brain and fingers, regardless of the sex. Could this be “ism-xplaining?”

I also recalled early on in the test that if I went faster, I started making mistakes like calling John or Jeffrey "female" simply because I was answering quickly. I intentionally slowed down as the test progressed in order to focus and think before calling John or Jeffrey "female." In addition, every time I saw “management” or “professional,” I would think of homemakers as professional managers and remind myself to select “career.” Admittedly, when I thought of homemakers, I thought of women; almost every homemaker I know is a woman. I realized that the test results were at least in part reflecting technical mechanics as well as a personal assessment of societal norms, which can both contribute to perception of implicit bias.

To switch gears in my “ism-xplaining,” I pursued the Gender-Science test. This result suggested that I have a "moderate automatic association for male with science and female with liberal arts." I struggled with this outcome since that is what we tend to see around us in society and higher education; however, I do not believe that to be true.

I then turned my attention to a third test: Race. I chose this one because I felt it was timely. It started out with “demographics” and then switched to questions specific to the test. I paused and took a moment to digest when I saw an African-American face on the middle of the screen, on the left "bad" or "African-American," and on the right "good" or "Caucasian." Although society may make these associations, I could not. I realized that the power of these tests is in reflection and recognition that we do not have to embrace or perpetuate social or societal norms, even if we subconsciously them.

The test result suggested I have a "slight automatic preference for European Americans over African Americans." I laughed out loud at that result, as I am an African American myself. Again, I felt like the test was on some subconscious level “training in” fingers and keys with associations. (Was I ism-xplaining?) The pain of it all is that completing tests like these is necessary to uncover the reality in our society and in the furthest parts of our minds in order to heal and move forward healthily together as individuals and health care professionals.

With this backdrop in mind, I was delighted to introduce Hayes as our main speaker to lead a workshop the next day. Others at the workshop commented that "the results made me feel ashamed," "the test results reflected the way I was raised" or "the computer could see deep down how I really think about these things," while others felt reassured. Hayes assured the group that although the old paradigm said, "prejudice is bad," the new paradigm says, "prejudiced thoughts and actions are habits that we all have and breaking these habits requires more than good intentions." This is possible by "doubting our objectivity" and "increasing our motivation to be fair."

Stay tuned for a Part 2 article about the ACC Women in Cardiology (WIC) Section Workshop.