Provider Implicit Racial Bias &Medical Decision-Making

Sabin, Janice

Abstract

Empirical evidence suggests that racial and ethnic minority groups receive and experience poorer quality health care than whites but little is known about the mechanisms that lead to these experiences. Recent evidence, most notably coming from the National Academy of Sciences, Institute of Medicine, indicates that provider/physician behavior, attitudes and beliefs play a role in unequal treatment of racial and ethnic groups in the health care system (Smedley, Stith, & Nelson, 2003). There has been speculation that unconscious provider racial bias contributes to unequal treatment in health care. However, this is an empirical question that has not been explored. The research question this proposal seeks to answer is: does implicit racial bias affect medical decision-making and medical care? The findings of the proposed research will be used to develop and evaluate an intervention aimed at purposefully incorporating anti-stereotypical information into medical education curricula with the goal of changing implicit negative associations. The proposed study will consist of a single-session, on-line survey of University of Washington, Department of Pediatrics, pediatric residents, fellows, and physicians using the Implicit Association Test (IAT), to measure unconscious (implicit) racial bias, medical decision-making and medical care.
The specific aims of this three-part experiment are: (1) to indirectly measure the association strengths between attitudes toward ordinary medical care versus extraordinary medical care and race (African American and European American) among a sample of pediatricians using the Implicit Association Test; (2) to measure physician explicit racial bias by self-report; and (3) to use a medical pediatric case vignette, in which two variables, patient race and pressure of time, are manipulated to measure bias in medical decision-making. The experiment will examine the correlation between physician implicit racial bias, physician explicit racial bias, and medical decision bias. The overarching goal of this research is to improve the quality of clinical care for minority populations.