The Bias Checklist was designed for educators to use when developing or reviewing content for learners in medicine and the health professions. The intent is that the tool be self-explanatory and suitable for self-assessment. That is, it neither requires nor replaces other approaches to faculty development and continuing education, including the hard work of confronting our own biases.

The Bias Checklist was also intended to avoid burdening learners—especially learners of color and those from other minoritized backgrounds—with the responsibility to call attention to biased material, although it can and has been used by learners themselves to provide feedback on content and educational experiences.

It is expressly not intended to be punitive toward educators, but instead to promote self-reflection, educator development and quality improvement in education, while also preventing the harm that comes when biased content reaches learners—harm that not only impacts our learners but also impacts their and our future patients.

Anyone can complete the Bias Checklist, including content creators (e.g., educators 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. At the start of the Checklist, you will be asked to identify your role relative to the content you are assessing.

Although the Checklist was originally intended for self-assessment of material, having multiple individuals assess the same content can be very useful.

The Checklist can be applied to any type of prepared 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 can be used in any health profession and at all levels of training. As of January 2023, the Bias Checklist 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, veterinary education, and law schools.

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”) and also available in the Moving Beyond the Checklist section of the website.

The Bias 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.

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 recommending you consider making a change. Changes might include:

1. Removing the content entirely (e.g., an image that promotes stereotypes of certain patient groups or an inappropriate joke)

2. 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)

3. 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)

4. 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. Please feel free to reach out to colleagues, expert faculty at your own institution, including your Office of Diversity, Equity and Inclusion, and/or to email biaschecklist@gmail.com for additional assistance.

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.

For more information, please check out the Video Library.

By utilizing the public-facing version of the Bias Checklist that is accessible through this website (hosted on REDCap), you are agreeing to allow the Bias Checklist Collaborative to retain your responses for analysis, possible publication and continuous quality improvement of the Checklist. Identifying information is not collected.

If you are using a version made available through your institution, you should contact your local Bias Checklist Collaborative leader for further information. (A list of Bias Checklist Collaborative member institutions and contacts is available here.) At SUNY Upstate, for example, individual Checklists and pooled data on Bias Checklist utilization (proportion of checklists completed relative to the number of hours of content taught and proportion of changes mind relative to the frequency of changes recommended) for each unit, course and clerkship are provided to the directors prior to the annual review each year.

The Bias 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 Medical University, and is regularly revised to include new material. The current version of Bias 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. More information regarding each domain is available here.

More information regarding the history of the Bias Checklist is available here.

The Bias Checklist was first published as a brief report in the journal Medical Education.

Caruso AB, Hobart TR, Botash AS, Germain LJ. Can a checklist ameliorate implicit bias in medical education? Medical Education. 2019;53(5):510.

A complete list of publications and presentations related to the Bias Checklist is available here.

The Upstate Bias Checklist is available for download and modification through the REDCap Shared Library. If your institution does not participate in REDCap, please email biaschecklist@gmail.com about creating a Friends of Upstate REDCap account and a REDCap project with the checklist for your institution, which will give you both the ability to edit the checklist and access to data from your own faculty.

Members of the Bias Checklist Collaborative are also available to lead faculty development workshops and can provide additional information regarding institution- or program-wide implementation and monitoring.

More information regarding support for implementation of the Bias Checklist at the program or institutional level is available here.

Yes. Yes, it is. And yet, despite robust literature on topics like racial essentialism, we continue to hear from students who are taught misinformation and harmed by offensive jokes. The Bias Checklist offers concrete actions that educators can take right now to do better. It is a beginning. It is not an end.