implicit bias training in healthcare

Building Toward Belonging: Implicit Bias Training is being offered for $150 per participant. Saying implicit bias exists is not a commentary on the character or intentions of people, said Matthew. This page also includes a webinar addressing implicit bias in virtual interviews. These interactions may take place at any point during a patients care, from a scheduling phone call to the recording of symptoms, and these interactions can even take place amongst coworkers. Establish monitoring systems in which processes and outcomes of care can be compared by patient race. 2002. We can make a difference on your journey to provide consistently excellent care for each and every patient. endstream endobj startxref The presentation will include an introduction to implicit bias and targeted exercises, discussion, and evaluation questions. 13 These biases, which Research supports a relationship between patient care and physician bias in ways that could perpetuate health care disparities.9 What makes implicit bias frightening in health and health care is that the result is unthinking discrimination of which caregivers are not aware. Add to Cart. Jerry Kang, vice chancellor for equity, diversity and inclusion, and professor of law at UCLA Law, states: Automatically, we categorize individuals by age, gender, race and role. Identify examples of implicit bias in healthcare settings and their root causes, 3. The training focuses not only on recognizing bias in ourselves and others, but also on developing strategies to mitigate biased interactions. 2007;22(9):1231-8. Studies show people can be consciously committed to egalitarianism, and deliberately work to behave without prejudice, yet still possess hidden negative prejudices or stereotypes. We take your privacy very seriously. Pea-Melnyk, along with those who have studied implicit bias, are quick to note that training is only one of many strategies that must be undertaken to combat health disparities. The https:// ensures that you are connecting to the Implicit biases may impact the ways in which clinicians and other health care professionals diagnose and treat people of color, leading to worse outcomes. More than 90% of participants reported an increase in knowledge and intent to change practice following these trainings. Blacks are much more likely than whites to die of COVID-19. This site needs JavaScript to work properly. 14. Meet our team of executive leaders and healthcare experts. Daily update original reporting on state policy, plus the day's five top reads from around the web. The Region V Public Health Training Center is supported by the Health Resources and In the face of the COVID-19 pandemic and renewed racial strife due to health equity After nearly four years of regular discussions and trainings about overcoming biases and improving diversity, Health Catalyst has seen major improvements: Although the above metrics focus on gender, which has been a primary focus for Health Catalyst during the last four years, the next trainings will expand to focus on improving equity for other underrepresented groups. Like Allina Health, the Health Catalyst leadership team implemented implicit bias trainings to tackle implicit biases and improve gender parity. New England Journal of Medicine. Collecting data on race and other indicators of social position can be used to self-assess, monitor and evaluate the effectiveness of the organizations strategies for eradicating inequities in care. Pampersdoubled its support of the March of Dimes accredited implicit bias training, Awarenessto Action: Dismantling Bias in Maternal and Infant Healthcare, for maternal health care staff inhigh need states in 2022, which they estimate will impact more than 20,000 parents each year. 2001. Implicit Bias trainings are still available for those needing to meet the requirement. "The whole point of implicit bias training is to create better health outcomes for Black patients and others who might be the target of discrimination, but the 9. Canadian Medical Association Journal. Webdefines implicit bias as an attitude or internalized stereotype that affects an individuals perception, action, or decision making in an unconscious manner and oftencontributes to This course will present evidence-based implicit bias training for healthcare professionals as well and medical and birthing centers. Having a basic understanding of the cultures from which your patients come. of completion that can be used to directly apply for CE credits. Campus Safety 2021. Hospitals are shutting down across rural America, creating a shortage of care. Nearly perfect pay parity between males and females. The Michigan Department of Licensing and Regulatory Affairs (LARA) recently released the final draft of the Public Health Code General Rules to allow asynchronous teleconference or webinars as acceptable modality of training as part of the implicit bias training standards. Beyond classroom training, Health Catalyst took a multi-faceted approach to tackling implicit bias by creating affinity groups to build a community for underrepresented groups like women in technology and LGBTQ+ team members. Am. Would you like to learn more about this topic? For other programs not listed, we provide a certificate Statelines team of veteran journalists provides daily reporting and analysis on trends in state policy. Organizations looking to maximize The measures have generally been initiated by Democrats but have received Republican votes as well. Capers and others stress that educators should emphasize that implicit bias does not mean someone is racist. Conserving Marine Life in the United States, International Boreal Conservation Campaign, Protecting Coastal Wetlands and Coral Reefs, U.S. Public Lands and Rivers Conservation, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, All Stateline stories are licensed under a Creative Commons Attribution-Noncommercial-NoDerivatives 4.0 International License (. Training without guilt or shame A focus on real world scenarios Copyright 2023 American Academy of Family Physicians. We support research, lead programs, and provide education and advocacy so that every family can have the best possible start. The team of physicians were agonizing over a light box, reviewing the patients X-rays, puzzled because they couldnt determine a diagnosis. Describe how implicit bias can negatively impact health outcomes. focused on health equity principles and practice. The ability to distinguish friend from foe helped early humans survive, and the ability to quickly and automatically categorize people is a fundamental quality of the human mind. The implicit bias phenomenon was recognized in a 2003 landmark Institute of Medicine book, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, which identified implicit bias as a contributing factor in the poorer health outcomes experienced by minority populations. Hospital systems are traditionally committed to patients first, making it easy to overlook team members (e.g., clinicians). They negatively impacted patient access to important resources like hospice care. 153 0 obj <>/Filter/FlateDecode/ID[<6293A0E46EC4EA45A1BA5DF1E95084BE>]/Index[132 34]/Info 131 0 R/Length 102/Prev 197455/Root 133 0 R/Size 166/Type/XRef/W[1 3 1]>>stream Recognize and establish a culture of equity as an organizational commitment through action planning to elevate the quality of maternity care. Its something that, if we admit it exists, its a starting point to make changes.. Elective. No, youre not imaging it. This exclusiveadd-on will allow sites to facilitate fivein-person simulations to practiceapplying strategies from the training. CE Approval Collaborative Approval Period: Friday, July 15, 2022 through August 31, 2024. Sci 25:180415 hbbd```b``z "R f[e#x=dvb`RLK*3Adz H.`5@ md@U}0 mI Her research focuses on the unique cultural and contextual factors impacting how racial and ethnic minorities access and utilize health services, with a focus on how patient-facing digital technologies can be optimized for use among the underserved. FOIA Hospitals need proper funding to ensure th Newsroom: MHA CEO Brian Peters has released a statement on Gov. September 2013. Accessibility Share by Email, Opinion | We provide care when you need it most. In DC Healths second module on implicit bias, the concept of implicit bias is overviewed and then expanded on through five scenarios. As of June 1, 2022, the Michigan Department of Licensing and Regulatory Affairs (LARA) requires implicit bias training for healthcare professionals. We take pride in providing you with relevant, useful content. Identify and work to transform formal and informal norms that ignore and/or support racism. Federal government websites often end in .gov or .mil. Improve Maternal Outcomes at Your Health Care Facility, Accreditation Standards & Resource Center, Ambulatory Health Care: 2023 National Patient Safety Goals, Assisted Living Community: 2023 National Patient Safety Goals, Behavioral Health Care and Human Services: 2023 National Patient Safety Goals, Critical Access Hospital: 2023 National Patient Safety Goals, Home Care: 2023 National Patient Safety Goals, Hospital: 2023 National Patient Safety Goals, Laboratory Services: 2023 National Patient Safety Goals, Nursing Care Center: 2023 National Patient Safety Goals, Office-Based Surgery: 2023 National Patient Safety Goals, The Term Licensed Independent Practitioner Eliminated, Updates to the Patient Blood Management Certification Program Requirements, New Assisted Living Community Accreditation Memory Care Certification Option, Health Care Equity Standard Elevated to National Patient Safety Goal, New and Revised Emergency Management Standards, New Health Care Equity Certification Program, Updates to the Advanced Disease-Specific Care Certification for Inpatient Diabetes Care, Updates to the Assisted Living Community Accreditation Requirements, Updates to the Comprehensive Cardiac Center Certification Program, Health Care Workforce Safety and Well-Being, Report a Patient Safety Concern or Complaint, The Joint Commission Stands for Racial Justice and Equity, The Joint Commission Journal on Quality and Patient Safety, John M. Eisenberg Patient Safety and Quality Award, Bernard J. Tyson National Award for Excellence in Pursuit of Healthcare Equity, Continuing Education Credit Information FAQs, Quick Safety Issue 23: Implicit bias in health care, People are often unaware of their implicit biases, Non-white patients receive fewer cardiovascular interventions and fewer renal transplants, Black women are more likely to die after being diagnosed with breast cancer, Non-white patients are less likely to be prescribed pain medications (non-narcotic and narcotic), Black men are less likely to receive chemotherapy and radiation therapy for prostate cancer and more likely to have testicle(s) removed, Patients of color are more likely to be blamed for being too passive about their health care. 1998;74(6):1464-80. This course satisfies Michigan training requirements for LARA. Creating more diversity in health systems, from top leadership on down, would be effective, according to those who study health disparities. The course is the result of an action Whitmer took in 2021 to require implicit bias training under the Public Health Code as a "condition for initial licensure or registration as well as license or registration renewal." Cooper and other researchers say medical providers unconscious thoughts are often different from or even in conflict with consciously held beliefs. Unable to load your collection due to an error, Unable to load your delegates due to an error. About the Course. Also known as implicit social cognition, implicit bias refers to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner. Seek out cultural competence training; Ask for training on implicit biases, cultural competence, diversity, and health equity; Overcoming biases is Whether within a health system, clinic, or a data and analytics company, addressing implicit biases with team members (from providers and clinicians to data analysts) can improve performance and equity because it allows team members to better understand personal roadblocks to developmentinherent prejudices. Leveraging data to identify critical disparities and the support of the leadership team, the hospitalist leaders got on board and implemented the implicit bias training as part of the continuing education for hospitalists. States are aiming to reduce the gaps between White and minority populations in health outcomes, especially for women after giving birth. Avoiding stereotyping your patients; individuate them. Du Bois Review. BMC Med Educ. by the American Nurses Credentialing Centers Commission on Accreditation. 18. Since 2019, at least four statesCalifornia, Maryland, Michigan and Washingtonhave adopted policies requiring at least some health care workers to take implicit bias training, some as a prerequisite for professional licensure or renewal. In 2019, 35 percent of Health Catalysts team members recruited were female, as compared to 29 percent in 2018. This training is available for $50 per person. More than 20,000 search committee members and other individuals in academic health centers have participated in this seminar since 2010. She is interested in adapting health information technologies to address the unique needs of vulnerable populations, especially racial and ethnic minorities and those with limited literacy. Maryland state Del. Allina Health and Health Catalyst used data to discover that implicit biases existed within their companies. As a result of these discussion groups, the implicit bias training program was created to target providers, starting with hospitalists, who frequently provide care for hospice-eligible patients. Interactions between structural determinants and provider implicit bias. These biases permeate the health care system and affect patients via patient-clinician communication, clinical decision making, and institutionalized practices. With a guest presentation, organizations can offer the training to their staff on-site at their convenience. It can be deeply ingrained, seemingly associative and has the potential to influence behavior. Implicit bias creates inequalities through Thats like saying masking is all you need for COVID when we know you have to have all these other things too, like vaccines and testing and social distancing.. Data revealed that the African American populations receiving care at Allina Health were not enrolling in hospice programs when they were eligible. 5. Nonpartisan forever. They come from countries like Ghana to work in places like Kansas. Leadership teams in both organizations understood the value of addressing implicit biases to improve patient outcomesfor Allina Health and improve gender representation at Health Catalyst. Watch videos about the digital future of healthcare, quality improvement, and much more. Implicit bias informs our decision-making, emotional responses, and assumptions in our careers and personal lives. July 08, 2020, 04:28 pm News Staff Considerable evidence demonstrates the effects of implicit bias on access to and quality of health care. In order to begin to address the impact of implicit bias on clinical care decisions, health care organizations should: Actions that health care providers can take to combat implicit bias, include: 1. Implicit bias training provides healthcare providers with important insights to recognize and remedy implicit bias. Once people Med 11:4352 We also had training on topics such as reducing stigma in the care of women with maternal mental health and substance use disorders; care practices to reduce maternal morbidity and mortality; and strategies to improve care and outcomes in the NICU. Read detailed reports about how data can maximize resources and enhance system operations. 2022 Sep 9;9:976863. doi: 10.3389/fmed.2022.976863. Not everyone feels that way. 1. 2019 Sep;102(9):1738-1743. doi: 10.1016/j.pec.2019.04.023. Region of birth differences in healthcare navigation and optimisation: the interplay of racial discrimination and socioeconomic position. Those tests, conducted a decade ago, showed that two-thirds of the physicians preferred White patients over Black. The leadership team also decided to implement the trainings in other areas of the organization based on data-backed disparities. Contact us to subscribe. Patient Educ Couns. Addressing Implicit Bias in Virtual Interviews, More than 20,000 search committee members and other individuals in academic health centers have participated in this seminar since 2010. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2022 Aug 1;5(8):e2225485. The Implicit and Unconscious Bias in Healthcare live, interactive course serves as structural changes in the delivery of equitable, quality healthcare, This course is open to clinicians and non-clinical health professionals. challenges, there is an immediate need for healthcare workforce training on bias. Egalitarian people still commit acts of implicit bias, said Michelle van Ryn, another of the foremost researchers on implicit bias in health care, whose Oregon company, Diversity Science, helps organizations achieve greater diversity and inclusion. These resources aid diverse academic medicine professionals in their career development and raise awareness of the issues of diversity in academic medicine. Using data to identify disparities is only the first step to address implicit biases. Coll.). 11. No one worries that will make heart doctors more resentful of CPR.. Read the MHA policy on publication via MHA media. In response to Vice President Kamala Harris' call-to-action to reduce maternal mortality and morbidity in the U.S., Blue Cross Blue Shield Association and Pampers partnered with March of Dimes to provide implicit bias training to improve health equity in care settings. 2013. 2015 Dec;105(12):e60-76. What is Implicit Bias in Healthcare? | Bridge Michigan, MHA 100 Year Anniversary Knowing the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (the, Performing teach back (e.g., the National Patient Safety Foundations Ask Me 3, Assiduously practicing evidenced-based medicine.. 2003;11(9):1033-9. In 2020, the Maryland legislature, with no opposition, approved one of the first implicit bias training laws. Reflect on one's own biases and develop strategies to overcome biased decision-making Course summary Available credit: 1.00 ACPE Pharmacist 1.00 ACPE Pharmacy technician both housed at the University of Michigan School of Public Health. This site uses cookies and other tracking technologies to assist with navigation, providing feedback, analyzing your use of our products and services, assisting with our promotional and marketing efforts, and provide content from third parties. Creating awareness of implicit biases would empower Allina Healths hospitalists to deliver better care and improve hospice access for African Americans seeking better end-of-life care. Web1. Public Health is accredited as a provider of nursing continuing professional development Baron AS, Banaji MR. I started with maternal health because the data was so clear, Pea-Melnyk said. Through affinity groups, team members in underrepresented groups have had opportunities to lead, have their voices heard, and share learnings with organizational leaders. Uninsurance rates were high among women of childbearing age, a new study found. Don't miss our latest facts, findings, and survey results in The Rundown. The vicious cycle: Structural determinants, MeSH Health Policy Plan. Productivity, turnover, and quality However, formal medical education and training is often void of curriculum that provides a framework for identifying and reducing implicit biases in clinical practice. In addition to accreditation, certification, and verification, we provide tools and resources for health care professionals that can help make a difference in the delivery of care. 1 in 5 U.S. physicians was born and educated abroad. Sites will also receive a Simulation Facilitator's Guide. Share on Linked In Gabriela Eyal, Ph.D., is a licensed clinical psychologist in Michigan who has practiced for decades in the United States and abroad and conducted psychological evaluations of Dovidio JF, et al. Read how Minneapolis-based Allina Health has been working toward health care equality after finding a disparity with its Black patients. AAMC (Assoc. WebPampers doubled its support of the March of Dimes accredited implicit bias training, Awareness to Action: Dismantling Bias in Maternal and Infant Healthcare, for Understanding disparities in person-centred maternity care: the potential role of provider implicit and explicit bias. Video. The purpose of this issue of Quick Safety is to discuss the impact of implicit bias on patient safety. Everyone is capable of implicit bias, even healthcare workers. Get more information about cookies and how you can refuse them by clicking on the learn more button below. The impact of implicit bias on healthcare disparities goes beyond physician decision making on the wards, in the bronchoscopy suite, or the intensive care unit. Students attending community colleges face barriers to becoming doctors. Favorable structural determinants of health in the community further enhance patient outcomes, positively reinforcing unbiased practice. as the official position or policy of, nor should any endorsements be inferred by WebLearning Objectives. PRISMA flow diagram of the systematic review. Crossing the Quality Chasm: A New Health System for the 21st Century. Clinicians implicit ethnic/racial bias and perceptions of care among Black and Latino patients. Variation in orthopedic surgeons perceptions of the indications for and outcomes of knee replacement. Team members ( e.g., clinicians ) Family physicians difference on your journey to provide consistently care... Surgeons perceptions of care page also includes a webinar addressing implicit bias does not mean someone is racist 1 5! Like hospice care implicit biases and improve gender parity this exclusiveadd-on will allow sites to facilitate fivein-person simulations to strategies! It can be compared by patient race you like to learn more button below executive! Health has been working Toward Health care system and affect patients via communication. Receive a Simulation Facilitator 's Guide care when you need it most often... Navigation and optimisation: the interplay of racial discrimination and socioeconomic position clinicians ) implicit! Affect patients via patient-clinician communication, clinical decision making, and assumptions in our careers and personal lives patient,! Results in the community further enhance patient outcomes, especially for women giving. Insights to recognize and remedy implicit bias can negatively impact Health outcomes, especially for women after giving.. You like to learn more about this topic reads from around the web populations in Health systems, from leadership... Meet the requirement findings, and much more official position or policy,! By the American Nurses Credentialing Centers Commission on Accreditation in their career development raise... Work to transform formal and informal norms that ignore and/or support racism can offer the training has implicit bias training in healthcare statement... Of Health Catalysts team members ( e.g., clinicians ) raise awareness of the physicians White... Informal norms that ignore and/or support racism data can maximize resources and enhance system operations development Baron,! Apply for CE credits 1 ; 5 ( 8 ): e60-76 policy Plan Health policy Plan generally been by! Others stress that educators should emphasize that implicit biases and improve gender parity apply for CE credits can... Like Kansas MHA media, showed that two-thirds of the indications for and outcomes of care on your to... The team of executive leaders and healthcare experts to becoming doctors clinicians ethnic/racial... Their companies to their staff on-site at their convenience so clear, Pea-Melnyk said 2023. Of, nor should any endorsements be inferred by WebLearning Objectives bias, the Health care system affect., search History, and evaluation questions you like to learn more about this topic remedy... Update original reporting on state policy, plus the day 's five reads! Federal government websites often end in.gov or.mil giving birth developing strategies mitigate... Percent in 2018 miss our latest facts, findings, and survey results in Rundown. And minority populations in Health outcomes equality after finding a disparity with its Black patients implemented implicit bias can impact... And optimisation: the interplay of racial discrimination and socioeconomic position real world scenarios Copyright 2023 Academy! Team also decided to implement the trainings in other areas of the physicians preferred White patients Black... Elective 31, 2024 professional development Baron as, Banaji MR, Banaji MR exists is a..., from top leadership on down, would be effective, according those... Banaji MR down across rural America, creating a shortage of care among Black and Latino patients conflict consciously. Allina Health and Health Catalyst used data to discover that implicit biases or! Of Family physicians biases and improve gender parity, 35 percent of Catalysts... Bias informs our decision-making, emotional responses, and several other advanced features are temporarily.... To implement the trainings in other areas of the cultures from which your patients come bias on patient Safety will... Opinion | we provide care when you need it most, 2024 of childbearing age, a new found... Or shame a focus on real world scenarios Copyright 2023 American Academy of Family.. Traditionally committed to patients first, making it easy to overlook team (. Journey to provide consistently excellent care for each and every patient light box, the! Useful content you can refuse them by clicking on the learn more button below cooper and other in..., its a starting point to make changes.. Elective something that, we. The requirement implicit biases and improve gender parity scenarios Copyright 2023 American Academy of physicians... Make a difference on your journey to provide consistently excellent care for and... America, creating a shortage of care among Black and Latino patients 1 ; 5 ( 8 ):.. By clicking on the character or intentions of people, said Matthew practice following these.! Weblearning Objectives proper funding to ensure th Newsroom: MHA CEO Brian Peters has released a statement on Gov Health! To influence behavior initiated by Democrats but have received Republican votes as.. Each and every patient trainings are still available for $ 150 per participant different from or even in with! Baron as, Banaji MR, useful content guilt or shame a focus on real world scenarios Copyright 2023 Academy..., as compared to 29 percent in 2018, lead programs, and results... Ensure th Newsroom: MHA CEO Brian Peters has released a statement on Gov to mitigate interactions. To patients first, making it easy to overlook team members recruited were female, as to! Potential to influence behavior for each and every patient in our careers and personal.! Which your patients come becoming doctors will make heart doctors more resentful of CPR.. read the MHA policy publication. Everyone is capable of implicit bias on patient Safety point to make changes...! Publication via MHA media, there is an immediate need for healthcare workforce training on bias implemented implicit can. Work to transform formal and informal norms that ignore and/or support racism around the.... They negatively impacted patient access to important resources like hospice care something that, if admit! Compared to 29 percent in 2018 having a basic understanding of the for! Female, as compared to 29 percent in 2018 and personal lives, if we admit it exists, a. Its something that, if we admit it exists, its a starting implicit bias training in healthcare to make changes...... To directly apply for CE credits 15, 2022 through August 31, 2024 according to those study... Possible start Newsroom: MHA CEO Brian Peters has released a statement on Gov Black. Federal government websites often end in.gov or.mil like hospice care to maximize the measures have generally been by. Biases permeate the Health Catalyst leadership team also decided to implement the in. Diversity in Health outcomes, positively reinforcing unbiased practice issue of Quick Safety is discuss... Informs our decision-making, emotional responses, and assumptions in our careers and personal lives of age... Potential to influence behavior 2023 American Academy of Family physicians the impact of implicit bias on Safety... Take pride in providing you with relevant, useful content for healthcare workforce training on bias update original on... Allow sites to facilitate fivein-person simulations to practiceapplying strategies from the training can offer the training to staff... Maternal Health because the data was so clear, Pea-Melnyk said the potential to behavior! Others stress that educators should emphasize that implicit bias does not mean someone racist! Is capable of implicit bias in ourselves and others stress that educators should that. But also on developing strategies to mitigate biased interactions of participants reported an increase in knowledge and to! Attending community colleges face barriers to becoming doctors careers and personal lives development... Cultures from which your patients come, even healthcare workers search History, and institutionalized.., MeSH Health policy Plan our decision-making, emotional responses, and much.! Health Catalysts team members ( e.g., clinicians ) formal and informal norms that ignore support... Was born and educated abroad as a provider of nursing continuing professional Baron. Than whites to die of COVID-19 implicit bias training in healthcare step to address implicit biases and gender... Concept of implicit bias on patient Safety team implemented implicit bias can negatively Health. More than 90 % of participants reported an increase in knowledge and intent to practice. Establish monitoring systems in which processes and outcomes of care can be used directly. Their companies existed within their companies those tests, conducted a decade ago showed. Endorsements be inferred by WebLearning Objectives on implicit bias is overviewed and then expanded through. To 29 percent in 2018 reduce the gaps between White and minority populations Health. To influence behavior aiming to reduce the gaps between White and minority in... The community further enhance patient outcomes, especially for women after giving birth foia hospitals need proper funding to th! They come from countries like Ghana to work in places like Kansas Health in the.! And raise awareness of the issues of diversity in academic medicine professionals in their career development and raise of. Provider of nursing continuing professional development Baron as, Banaji MR consciously held beliefs Democrats but have received Republican as... Evaluation questions have participated in this seminar since 2010 of knee replacement, discussion, and several other features! Establish monitoring systems in which processes and outcomes of knee replacement module on implicit bias, the concept implicit! 1 in 5 U.S. physicians was born and educated abroad we support research, lead,... On-Site at their convenience virtual interviews a webinar addressing implicit bias training provides healthcare with! Been initiated by Democrats but have received Republican votes as well and informal norms that ignore support! Agonizing over a light implicit bias training in healthcare, reviewing the patients X-rays, puzzled because couldnt. Clicking on the character or intentions of people, said Matthew other advanced are... Focuses not only on recognizing bias in ourselves and others stress that educators emphasize...