Using Mask-Making to Foster Growth Mindset and Address Implicit Bias.

Introduction: Implicit biases, defined as unconscious attitudes influencing clinical decisions, can negatively affect patient care and contribute to health care disparities. Growth mindset-the belief that abilities can be developed through effort-encourages learners to view biases as modifiable rather than fixed. The mask expression project is an educational activity designed to foster growth mindset in first-year medical students and promote patient-centered care. Methods: Three hundred five (305) first-year medical students completed the project during a service-learning course. Students wrote or drew on a paper mask template divided into two halves: one side challenged identified implicit biases; the other depicted actions to reduce biases during patient encounters. Students worked in groups of five or six to write reflection paragraphs. Course faculty analyzed 51 group reflections using conventional content analysis to categorize primary implicit biases and assess for growth mindset language. Results: The most common patient characteristics toward which students identified implicit biases were health beliefs and choices (17.6%), homelessness (17.6%), obesity/overweight (15.7%), and socioeconomic status (15.7%). Strategies to minimize implicit biases included nonjudgmental listening, offering multiple treatment options, using translators, and connecting patients to community resources such as food banks. The majority of reflections included language consistent with growth mindset adoption. Conclusion: The mask expression project provided first-year medical students with a creative approach to identifying implicit biases and developing mitigation strategies, while also fostering a growth mindset. Arts-based interventions have significant value in medical education and can be used longitudinally to reinforce patient care concepts and skills.