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      Racial/Ethnic Disparities in Clinical Grading in Medical School

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          Implicit Bias among Physicians and its Prediction of Thrombolysis Decisions for Black and White Patients

          Context Studies documenting racial/ethnic disparities in health care frequently implicate physicians’ unconscious biases. No study to date has measured physicians’ unconscious racial bias to test whether this predicts physicians’ clinical decisions. Objective To test whether physicians show implicit race bias and whether the magnitude of such bias predicts thrombolysis recommendations for black and white patients with acute coronary syndromes. Design, Setting, and Participants An internet-based tool comprising a clinical vignette of a patient presenting to the emergency department with an acute coronary syndrome, followed by a questionnaire and three Implicit Association Tests (IATs). Study invitations were e-mailed to all internal medicine and emergency medicine residents at four academic medical centers in Atlanta and Boston; 287 completed the study, met inclusion criteria, and were randomized to either a black or white vignette patient. Main Outcome Measures IAT scores (normal continuous variable) measuring physicians’ implicit race preference and perceptions of cooperativeness. Physicians’ attribution of symptoms to coronary artery disease for vignette patients with randomly assigned race, and their decisions about thrombolysis. Assessment of physicians’ explicit racial biases by questionnaire. Results Physicians reported no explicit preference for white versus black patients or differences in perceived cooperativeness. In contrast, IATs revealed implicit preference favoring white Americans (mean IAT score = 0.36, P < .001, one-sample t test) and implicit stereotypes of black Americans as less cooperative with medical procedures (mean IAT score 0.22, P < .001), and less cooperative generally (mean IAT score 0.30, P < .001). As physicians’ prowhite implicit bias increased, so did their likelihood of treating white patients and not treating black patients with thrombolysis (P = .009). Conclusions This study represents the first evidence of unconscious (implicit) race bias among physicians, its dissociation from conscious (explicit) bias, and its predictive validity. Results suggest that physicians’ unconscious biases may contribute to racial/ethnic disparities in use of medical procedures such as thrombolysis for myocardial infarction.
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            Empathy in medical students as related to academic performance, clinical competence and gender.

            Empathy is a major component of a satisfactory doctor-patient relationship and the cultivation of empathy is a learning objective proposed by the Association of American Medical Colleges (AAMC) for all American medical schools. Therefore, it is important to address the measurement of empathy, its development and its correlates in medical schools. We designed this study to test two hypotheses: firstly, that medical students with higher empathy scores would obtain higher ratings of clinical competence in core clinical clerkships; and secondly, that women would obtain higher empathy scores than men. A 20-item empathy scale developed by the authors (Jefferson Scale of Physician Empathy) was completed by 371 third-year medical students (198 men, 173 women). Associations between empathy scores and ratings of clinical competence in six core clerkships, gender, and performance on objective examinations were studied by using t-test, analysis of variance, chi-square and correlation coefficients. Both research hypotheses were confirmed. Empathy scores were associated with ratings of clinical competence and gender, but not with performance in objective examinations such as the Medical College Admission Test (MCAT), and Steps 1 and 2 of the US Medical Licensing Examinations (USMLE). Empathy scores are associated with ratings of clinical competence and gender. The operational measure of empathy used in this study provides opportunities to further examine educational and clinical correlates of empathy, as well as stability and changes in empathy at different stages of undergraduate and graduate medical education.
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              Physicians' implicit and explicit attitudes about race by MD race, ethnicity, and gender.

              Recent reports suggest that providers' implicit attitudes about race contribute to racial and ethnic health care disparities. However, little is known about physicians' implicit racial attitudes. This study measured implicit and explicit attitudes about race using the Race Attitude Implicit Association Test (IAT) for a large sample of test takers (N=404,277), including a sub-sample of medical doctors (MDs) (n=2,535). Medical doctors, like the entire sample, showed an implicit preference for White Americans relative to Black Americans. We examined these effects among White, African American, Hispanic, and Asian MDs and by physician gender. Strength of implicit bias exceeded self-report among all test takers except African American MDs. African American MDs, on average, did not show an implicit preference for either Blacks or Whites, and women showed less implicit bias than men. Future research should explore whether, and under what conditions, MDs' implicit attitudes about race affect the quality of medical care.
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                Author and article information

                Journal
                Teaching and Learning in Medicine
                Teaching and Learning in Medicine
                Informa UK Limited
                1040-1334
                1532-8015
                October 20 2019
                April 29 2019
                October 20 2019
                : 31
                : 5
                : 487-496
                Affiliations
                [1 ] Swedish Cherry Hill Family Medicine Residency, University of Washington School of Medicine, Seattle, Washington, WA, USA;
                [2 ] Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA;
                [3 ] Jackson Memorial Hospital, Internal Medicine Residency, University of Miami, Miami, FL, USA;
                [4 ] Student Affairs, University of Washington School of Medicine, Seattle, Washington, USA;
                [5 ] Wyoming WWAMI Program, University of Washington School of Medicine, Seattle, Washington, USA;
                [6 ] Kaiser Permanente School of Medicine, Pasadena, California, USA;
                [7 ] Center for Health Equity, Diversity, and Inclusion, University of Washington School of Medicine, Seattle, Washington, USA
                Article
                10.1080/10401334.2019.1597724
                31032666
                27a4d8ca-10da-482a-a766-7fe8bdae88ba
                © 2019
                History

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