Implicit Bias and Caring for Diverse Populations: Pediatric Trainee Attitudes and Gaps in Training

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

The objective of this study was to determine the attitudes, skill level, and preferred educational interventions of pediatric residents related to implicit bias and caring for diverse patient populations. A cross-sectional survey of pediatric residents at a single, large urban residency program was utilized. Surveys were completed by 88 (55%) residents who were 69% female and 35% non-White or mixed race. Almost all residents felt that it was very or extremely important to receive training on health disparities, diverse patient populations, and implicit bias. Self-assessment of skill level revealed that residents felt confident in areas often covered by cultural competency curricula, such as interpreter use, but were less confident in other areas. The top 3 areas identified for further training included implicit bias, working with transgender and gender nonconforming patients, and weight bias. For the majority of diversity and bias-related skills, prior training was significantly correlated with higher skill level ( P < .05).

Related collections

Most cited references 47

Record: found
Abstract: found
Article: found

Is Open Access

Implicit bias in healthcare professionals: a systematic review

Chloë FitzGerald, Samia Hurst (2017)

Background Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This review examines the evidence that healthcare professionals display implicit biases towards patients. Methods PubMed, PsychINFO, PsychARTICLE and CINAHL were searched for peer-reviewed articles published between 1st March 2003 and 31st March 2013. Two reviewers assessed the eligibility of the identified papers based on precise content and quality criteria. The references of eligible papers were examined to identify further eligible studies. Results Forty two articles were identified as eligible. Seventeen used an implicit measure (Implicit Association Test in fifteen and subliminal priming in two), to test the biases of healthcare professionals. Twenty five articles employed a between-subjects design, using vignettes to examine the influence of patient characteristics on healthcare professionals’ attitudes, diagnoses, and treatment decisions. The second method was included although it does not isolate implicit attitudes because it is recognised by psychologists who specialise in implicit cognition as a way of detecting the possible presence of implicit bias. Twenty seven studies examined racial/ethnic biases; ten other biases were investigated, including gender, age and weight. Thirty five articles found evidence of implicit bias in healthcare professionals; all the studies that investigated correlations found a significant positive relationship between level of implicit bias and lower quality of care. Discussion The evidence indicates that healthcare professionals exhibit the same levels of implicit bias as the wider population. The interactions between multiple patient characteristics and between healthcare professional and patient characteristics reveal the complexity of the phenomenon of implicit bias and its influence on clinician-patient interaction. The most convincing studies from our review are those that combine the IAT and a method measuring the quality of treatment in the actual world. Correlational evidence indicates that biases are likely to influence diagnosis and treatment decisions and levels of care in some circumstances and need to be further investigated. Our review also indicates that there may sometimes be a gap between the norm of impartiality and the extent to which it is embraced by healthcare professionals for some of the tested characteristics. Conclusions Our findings highlight the need for the healthcare profession to address the role of implicit biases in disparities in healthcare. More research in actual care settings and a greater homogeneity in methods employed to test implicit biases in healthcare is needed.

0 comments Cited 501 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

The associations of clinicians' implicit attitudes about race with medical visit communication and patient ratings of interpersonal care.

K Carson, Caroline Sabin, Mary Beach … (2012)

We examined the associations of clinicians' implicit attitudes about race with visit communication and patient ratings of care. In a cross-sectional study of 40 primary care clinicians and 269 patients in urban community-based practices, we measured clinicians' implicit general race bias and race and compliance stereotyping with 2 implicit association tests and related them to audiotape measures of visit communication and patient ratings. Among Black patients, general race bias was associated with more clinician verbal dominance, lower patient positive affect, and poorer ratings of interpersonal care; race and compliance stereotyping was associated with longer visits, slower speech, less patient centeredness, and poorer ratings of interpersonal care. Among White patients, bias was associated with more verbal dominance and better ratings of interpersonal care; race and compliance stereotyping was associated with less verbal dominance, shorter visits, faster speech, more patient centeredness, higher clinician positive affect, and lower ratings of some aspects of interpersonal care. Clinician implicit race bias and race and compliance stereotyping are associated with markers of poor visit communication and poor ratings of care, particularly among Black patients.

0 comments Cited 206 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test.

Ivy W. Maina, Tanisha D. Belton, Sara Ginzberg … (2018)

Disparities in the care and outcomes of US racial/ethnic minorities are well documented. Research suggests that provider bias plays a role in these disparities. The implicit association test enables measurement of implicit bias via tests of automatic associations between concepts. Hundreds of studies have examined implicit bias in various settings, but relatively few have been conducted in healthcare. The aim of this systematic review is to synthesize the current knowledge on the role of implicit bias in healthcare disparities. A comprehensive literature search of several databases between May 2015 and September 2016 identified 37 qualifying studies. Of these, 31 found evidence of pro-White or light-skin/anti-Black, Hispanic, American Indian or dark-skin bias among a variety of HCPs across multiple levels of training and disciplines. Fourteen studies examined the association between implicit bias and healthcare outcomes using clinical vignettes or simulated patients. Eight found no statistically significant association between implicit bias and patient care while six studies found that higher implicit bias was associated with disparities in treatment recommendations, expectations of therapeutic bonds, pain management, and empathy. All seven studies that examined the impact of implicit provider bias on real-world patient-provider interaction found that providers with stronger implicit bias demonstrated poorer patient-provider communication. Two studies examined the effect of implicit bias on real-world clinical outcomes. One found an association and the other did not. Two studies tested interventions aimed at reducing bias, but only one found a post-intervention reduction in implicit bias. This review reveals a need for more research exploring implicit bias in real-world patient care, potential modifiers and confounders of the effect of implicit bias on care, and strategies aimed at reducing implicit bias and improving patient-provider communication. Future studies have the opportunity to build on this current body of research, and in doing so will enable us to achieve equity in healthcare and outcomes.

0 comments Cited 192 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Hannah Barber Doucet: (View ORCID Profile)

Journal

Title: Clinical Pediatrics

Abbreviated Title: Clin Pediatr (Phila)

Publisher: SAGE Publications

ISSN (Print): 0009-9228

ISSN (Electronic): 1938-2707

Publication date Created: September 2021

Publication date (Electronic): July 26 2021

Publication date (Print): September 2021

Volume: 60

Issue: 9-10

Pages: 408-417

Affiliations

[1 ]Hasbro Children’s Hospital, Providence, RI, USA

[2 ]Boston Children’s Hospital, Boston, MA, USA

[3 ]University of California Davis, Sacramento, CA, USA

Article

DOI: 10.1177/00099228211035225

PubMed ID: 34308661

SO-VID: f75347eb-9740-4696-9407-015712d2d377

License:

http://journals.sagepub.com/page/policies/text-and-data-mining-license

History

Data availability:

Comments

Comment on this article

scite_

Cited by 5

See all cited by

Most referenced authors 586

See all reference authors

Implicit Bias and Caring for Diverse Populations: Pediatric Trainee Attitudes and Gaps in Training

Read this article at

Abstract

Related collections

Pediatric Pulse: Advancing Neonatal and Child Health

Most cited references 47

Implicit bias in healthcare professionals: a systematic review

The associations of clinicians' implicit attitudes about race with medical visit communication and patient ratings of interpersonal care.

A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test.

Author and article information

Contributors

Journal

Affiliations

Article

History

Comments

Comment on this article

Similar content 83

Cited by 5

Most referenced authors 586