Michigan: Implicit (Unconscious) BiasPage 2 of 11

1. Bias: Implicit and Explicit

People have a tendency and need to classify individuals into categories, allowing us to quickly process information and make sense of the world. This mostly occurs below the level of consciousness using information developed from our life experiences.

Processing information in this way is efficient, requiring few mental resources and little conscious thought. Although efficient, automatic processing can lead to implicit and explicit biases.

Test Your Knowledge

You may find it helpful to try these 10 “True or False” questions first before reading the course. The answers are at the end of the question list.

  1. Implicit bias is a conscious process based on intentional mental associations.
  2. Health equity means that everyone has a fair and just opportunity to be as healthy as possible.
  3. Structural racism refers to ideologies, practices, processes, and institutions that produce and reproduce differential access to power and to life opportunities along racial and ethnic lines.
  4. Cultural sensitivity is a respect for another person’s strengths, culture, and knowledge.
  5. A type of unconscious bias that occurs when our perception is skewed based on inaccurate and overly simplistic assumptions about a group or person is called perception bias.
  6. Evidence shows that interventions focusing on social determinants of health rarely lead to better health outcomes.
  7. Perception bias is a type of unconscious or implicit bias that occurs when our perception is skewed based on inaccurate and overly simplistic assumptions about a group a person “belongs” to.
  8. Historically embedded structural racism is a fundamental cause of health inequities in the United States.
  9. Measures of implicit bias rely on the assumption that automatic associations between two concepts will influence behavior in a measurable way.
  10. Bias training has been shown to be more effective when the approach is multipronged, designed with context and professional identity in mind, and when people work and train together.

Answers: Questions 1 and 6 are False; all the others are True.

What is Implicit Bias?

Implicit bias is an attitude or internalized stereotype that affects an individual’s perception, action, or decision-making in an unconscious manner. It can contribute to unequal treatment based on characteristics such as race, ethnicity, nationality, gender, gender identity, sexual orientation, religion, socioeconomic status, age, or disability (Michigan.gov, 2021, September 24).

Implicit biases influence our thinking and behaviors and can negatively affect clinical interactions and outcomes. Decades of research has demonstrated that discrimination, driven by implicit bias, impacts healthcare access, trust in clinicians, care quality, and patient outcomes (Dirks et al, 2022).

Implicit bias is widespread, even among individuals who explicitly reject prejudice. It persists through structural and historical inequalities that have been slow to change (Payne et al., 2019).

Although everyone has implicit biases, negative biases toward a particular group can be reduced through positive contacts with members of that group. Once recognized, individuals can control the likelihood that these biases will affect their behavior (DOJ, Nd).

What is Explicit Bias?

Explicit or conscious bias occurs when we are aware of our prejudices and attitudes toward certain groups. Positive or negative preferences for a particular group are conscious. Overt racism and racist comments are examples of explicit biases.

Explicit forms of bias include preferences, beliefs, and attitudes of which people are generally consciously aware, personally endorse, and can identify and communicate. Discrimination, directly related to bias, is the unequal treatment of individuals and communities related to general policies, practices, and norms (Vela et al., 2022).

Implicit Stereotypes, Attitudes, and Prejudices

Stereotypes are fixed, oversimplified beliefs about a particular group or culture. They occur when we categorize people by age, gender, race, or other criteria.

Stereotypes develop early in life and once established, can shape a person’s attitudes and behaviors (Brusa et al., 2021). Stereotyping can lead to conventional, formulaic, and oversimplified conceptions and opinions. In the healthcare setting, it allows providers to categorize someone in a certain way, making no further effort to learn whether the individual in question fits the stereotype (Galanti, 2019).

Unconscious stereotypes can lead to implicit bias. This highlights what can be troubling for healthcare professionals: the possibility of biased judgment and biased behavior can affect patient care (FitzGerald et al., 2019).

Recognizing stereotypical thoughts can have a powerful impact on bias. Putting yourself in the shoes of the other person, creating a non-stereotypical alternative to a particular stereotype, and seeing the person as an individual help reduce bias.

Case Example

Jamie recently visited the dog park with her young dog. As she was watching her dog run around, she noticed a woman of Asian descent standing alone. All the other people in the park were White (including Jamie) and were clustered in small groups talking—mostly about their dogs. Jamie wondered why the woman was alone and decided to approach her.

Jamie immediately began to categorize the woman according to what she thinks she knows about various Asian cultures. She assumed the woman was of Japanese descent based on the woman’s appearance. Jamie has a positive view of Japanese people and assumed the woman would be friendly, educated, liberal, and well-off. Based on the woman’s age, Jamie wondered if the woman’s parents had been taken to U.S. concentration camps during WW2. She wondered if the woman was born in Japan or spoke Japanese. She wondered if she was local or not.

Jamie struck up a conversation with the woman and noticed she didn’t have an accent—most likely born in the United States, Jamie thought. She thought the woman’s dog might be a purebred because she assumed people of Japanese descent were successful, status-conscious, and wealthy.

During their conversation, the woman mentioned she was born in Switzerland, spoke German as a child, and has always wanted to visit Japan because it reminded her of Switzerland. Her dog was a mutt, rescued from a dog shelter in Massachusetts. She had only recently moved to the area from Massachusetts and didn’t know many people.

Jamie realized she had used stereotypes to place the woman into a recognizable category. She wondered what stereotypes the other woman assigned to Jamie. She wondered if she had made the woman uncomfortable or if she had successfully hidden her own unconscious stereotypes. Mostly, she wondered if her stereotyping was bad or wrong.

Can you identify some of the ways Jamie categorized and stereotyped this woman? Imagine Jamie (a nurse practitioner) meeting the woman in the healthcare setting. Do you think any of the characteristics Jamie attributed to the woman at the dog park would affect her clinical judgment? If so, how. Do you think Jamie being aware of her stereotyping would help her overcome any preconceptions she has about people of Japanese descent (or people from Switzerland)?


  • Bias: the unintended influence of factors that are not meant to be considered; a tendency to prefer one person or thing to another.
  • Diversity: the ways in which people differ; encompasses all the characteristics that make one individual or group different from another.
  • Equality: when every individual has the same rights, resources, and opportunities, regardless of their circumstance.
  • Equity: being fair and impartial; providing resources and opportunities to create equal outcomes for all community members.
  • Explicit (conscious) bias: a conscious attitude or belief about a person or a group.
  • Implicit (unconscious or hidden) bias: a bias that is outside a person’s consciousness; may directly contradict a person’s stated beliefs and values. Expressed automatically, without conscious awareness.
  • Inclusion: when the inherent worth and dignity of all people is recognized. Promotes and sustains a sense of belonging, values and practices respect for the talents, beliefs, backgrounds, and ways of living of its members.
  • Prejudice: a bias or preconceived opinion, idea, or belief about something; an assumption, unfair feeling, or dislike for a person or group simply based on the person’s membership in a particular social group.
  • Racial discrimination: treating a person adversely due to that individual’s race or characteristics associated with that race, such as hair texture, facial features, or skin color. National origin discrimination involves treating people unfavorably due to where they are from or their ethnicity or accent.
  • Structural racism: Encompasses a history and current reality of institutional racism across all institutions combining to create a system that negatively impacts communities of color.
  • Stereotype: beliefs and opinions about the characteristics, attributes, and behaviors of members of a group; a generalization, often exaggerated, or untrue.