From the Center for Surgical Trials and Outcomes Research/Division of Acute Care Surgery (A.H.H., E.B.S., D.S.D., V.K.S., S.M.S., L.L., E.R.H., D.T.E., J.A.F., P.A.L.), Armstrong Institute of Patient Safety (P.J.P.), and Center for Elimination of Cardiovascular Disparities (L.A.C.), Johns Hopkins School of Medicine; and Department of Health Policy and Management (E.J.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Psychology (N.S.), University of Virginia, Charlottesville, Virginia; Department of Surgery (E.E.C.), Howard University College of Medicine, Washington, District of Columbia; and The Mayo Clinic, Arizona.
J Trauma Acute Care Surg. 2014 Sep;77(3):409-16. doi: 10.1097/TA.0000000000000392.
Recent studies have found that unconscious biases may influence physicians' clinical decision making. The objective of our study was to determine, using clinical vignettes, if unconscious race and class biases exist specifically among trauma/acute care surgeons and, if so, whether those biases impact surgeons' clinical decision making.
A prospective Web-based survey was administered to active members of the Eastern Association for the Surgery of Trauma. Participants completed nine clinical vignettes, each with three trauma/acute care surgery management questions. Race Implicit Association Test (IAT) and social class IAT assessments were completed by each participant. Multivariable, ordered logistic regression analysis was then used to determine whether implicit biases reflected on the IAT tests were associated with vignette responses.
In total, 248 members of the Eastern Association for the Surgery of Trauma participated. Of these, 79% explicitly stated that they had no race preferences and 55% stated they had no social class preferences. However, 73.5% of the participants had IAT scores demonstrating an unconscious preference toward white persons; 90.7% demonstrated an implicit preference toward upper social class persons. Only 2 of 27 vignette-based clinical decisions were associated with patient race or social class on univariate analyses. Multivariable analyses revealed no relationship between IAT scores and vignette-based clinical assessments.
Unconscious preferences for white and upper-class persons are prevalent among trauma and acute care surgeons. In this study, these biases were not statistically significantly associated with clinical decision making. Further study of the factors that may prevent implicit biases from influencing patient management is warranted.
Epidemiologic study, level II.
最近的研究发现，无意识偏见可能会影响医生的临床决策。我们的研究目的是通过临床案例来确定无意识的种族和阶级偏见是否确实存在于创伤/急症外科医生中，如果存在，这些偏见是否会影响外科医生的临床决策。
我们对东部创伤外科学会的活跃成员进行了一项前瞻性的网络调查。参与者完成了九个临床案例，每个案例都有三个创伤/急症外科管理问题。每位参与者都完成了种族内隐联想测验（IAT）和社会阶层 IAT 评估。然后，我们使用多变量有序逻辑回归分析来确定 IAT 测试中反映的无意识偏见是否与案例响应相关。
共有 248 名东部创伤外科学会成员参与了研究。其中，79%的人明确表示他们没有种族偏好，55%的人表示他们没有社会阶层偏好。然而，73.5%的参与者的 IAT 得分显示出对白人的无意识偏好；90.7%的参与者显示出对上层社会人士的隐性偏好。只有 2 个基于案例的临床决策在单变量分析中与患者的种族或社会阶层相关。多变量分析显示，IAT 分数与基于案例的临床评估之间没有关系。
无意识的对白人和上层阶级的偏好在创伤和急症外科医生中很普遍。在这项研究中，这些偏见与临床决策没有统计学上的显著关联。进一步研究可能预防无意识偏见影响患者管理的因素是必要的。
流行病学研究，二级。
