Bias-Free Curriculum Checklist

A Checklist for Assessing Bias in Health Professions Education Content

We are often unaware of the limiting mindsets and structures that hold us back from meaningfully engaging diverse populations of learners. Taking a closer look at the content we present is a crucial first step in creating more positive health science education outcomes. When creating or reviewing curriculum consider using the Bias Checklist.

How to Use

The Upstate Bias Checklist* is designed for faculty to use when developing or assessing content for medical and health professions students and trainees. The questions within the checklist encourage reflection on how race, gender, and other socioeconomic factors are represented in your content. The tool is intended to be self-explanatory and suitable for self-assessment.

The checklist is applicable to a variety of types of content, including but not limited to:

Depending on the type of content you are reviewing, the checklist can take up to an hour or more to complete. Once complete, you are able to save a PDF copy of your assessment which can be a useful addition to your teaching portfolio. 

If you are unable to complete the checklist assessment in one sitting, you are able to save your work and continue at a later time. To do so, you will need both the survey link and your return code. Complete the following steps:

  1. Click Save and Return Later
  2. Copy or write down the Return Code (without the code you will NOT be able to return that particular session).
  3. Return to the survey page, then click returning-checklist.pngin the upper right-hand corner and enter the Return Code.
  4. OR you can have the survey link emailed to you by providing your email address. For security purposes, the return code will NOT be included in the email, please be sure to write it down or copy/save it

*This checklist was developed by Dr. Amy Caruso Brown at SUNY Upstate Medical University. Access to the checklist has been granted to the University of Nebraska Medical Center by Dr. Caruso Brown. 

Why It's Important

Checking curriculum for bias is undoubtedly an uncomfortable process. It is, however, a critically important process for advancing health science education. The factors used within the checklist are often associated with marginalization and inequality within health care. In preventing the harm that comes when biased content reaches learners, we are also preventing the harm that impacts patients and health outcomes. Utilizing the checklist also avoids burdening the learner with the responsibility of calling attention to the biased material.

 

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Frequently Asked Questions

Who should use the checklist?  

Anyone can complete the checklist, including content creators (e.g., faculty writing and giving lectures, designing case-, team- or problem-based learning sessions, etc.); curriculum supervisors (e.g., unit, course or clerkship directors; evaluation and assessment leaders; deans); session facilitators (e.g., small group facilitators); and learners themselves. 

The more frequently both the content creator and unit, course or clerkship director (or other supervisor) complete a checklist for the same content, the better the checklist validation. Learner feedback extremely useful. 

What types of health professions education content can I review with the checklist?  

It is applicable to a variety of types of health professions education content, including but not limited to: lecture slides or notes, clinical vignettes, multiple-choice questions, case-based learning materials, objective structured clinical examinations (OSCE), and standardized patient encounter (SPE) scripts. 

It is also applicable to all health professions, at all levels of training, and has been utilized in undergraduate, graduate and continuing medical education, nursing education, and physician assistant programs, and has even been adapted for use in clinical laboratory sciences and veterinary education. 

Can I use the checklist to review more than one educational session at once?  

Faculty who teach multiple sessions (including multiple lectures) can choose whether to submit one checklist or separate checklists. The checklist does ask whether the user is evaluating one session or multiple sessions, and how many contact-hours are covered. 

We recommend a single checklist only if the lectures or sessions are closely related; a lecturer who gives two lectures on very different topics within the same unit (for instance, one that is very biochemistry-heavy and one that is a clinical correlation) would be better served by completing two checklists. 

Multiple cases should be evaluated individually, using the checklist, and collectively using the “Clinical Case Tracker” grid embedded in the checklist (under “Clinical Vignettes”).  

When should I complete the checklist?  
The checklist is most effective when completed in advance of the educational session, with enough time allotted to allow for changes to be made to the content. However, it can also be completed retrospectively, as part of a review prior to the next iteration of the unit, course or clerkship.
What happens if the checklist picks up bias in my content?  

Congratulations! You used the checklist successfully.

If the possibility of bias is detected, you will see a box telling you that your content is at risk for bias and recommend you consider making a change. The checklist does NOT tell you HOW to change your content. Changes might include:

  • Removing the content entirely (e.g., an image that promotes stereotypes of certain patient groups or an inappropriate joke)
  • Replacing the content (e.g., replacing some slides of white skin with more representative slides of many skin colors, replacing outdated or offensive terminology with more appropriate language)
  • Adding additional material to the content (e.g., including women and people of color in a lecture on the history of medicine, discussing why a race-based disease association might exist)
  • Attaching an apology or disclaimer to the content (e.g., acknowledging that race-based GFR corrections are not based in science but may appear on standardized tests—please note that this is a last resort if none of the other approaches can be applied).

You may not be sure what type of change to make or even if a change is definitely needed. That is completely understandable and expected. We recommend reaching out to curriculum or teaching experts within your college. For additional assistance, contact facdev@unmc.edu, or inclusion@unmc.edu.

Why should I use the checklist?  
Bias in health professions negatively impacts learners by creating a learning environment that is unsupportive and even hostile to learners from traditionally underrepresented backgrounds, hindering their success. However, it has an even greater effect on learners’ future patients. Health professions students and trainees who learn biased material (for instance, suggesting that race is a biological, rather than social, construct) are more likely to treat their patients differently based upon their social identities—missing diagnoses that don’t fit stereotypes, under-managing pain and other symptoms, leaving patients feeling unheard and disrespected, and increasing mistrust in the healthcare system. Every interaction between health professions educators and learners is an opportunity to begin to dismantle the bias and structural oppression embedded in our society. What you teach today—even if it seems very far removed from clinical care—may change a patient’s life tomorrow.
Some of the terms in the checklist are confusing. Where can I find more information?  
Some definitions are embedded into the checklist, below the answer choices. A glossary is also available here.
What happens to the data submitted through the checklist?  

By utilizing the REDCap version of the checklist, you are agreeing to allow Dr. Caruso Brown and the Upstate Bias Checklist team to retain your responses for further refinement of the checklist. Identifying information is not collected.

How was the checklist developed?  

The checklist was designed by Dr. Amy Caruso Brown at SUNY Upstate Medical University, and she holds the copyright to this tool. Please feel free to contact Dr. Caruso Brown (brownamy@upstate.edu) with any questions or feedback.

It was informed by a review of the literature, synthesized with three years of student evaluation data from SUNY Upstate, and is regularly revised to include new material. The current checklist includes 13 domains identified as being at risk for bias or promotion of shame, stereotype or stigma: Race and Ethnicity, Gender, Sexual Orientation and Sexuality, Disability, Mental Health Including Substance Use, Weight, Immigration Status, Poverty, Religion, Prisoners, and Interprofessional Communication; and two types of content which are especially prone to bias: visual images and clinical vignettes.

Has the checklist been published?  
Caruso AB, Hobart TR, Botash AS, Germain LJ. Can a checklist ameliorate implicit bias in medical education? Medical Education. 2019;53(5):510. https://europepmc.org/article/med/30856280