Brown Cortlyn, Daniel Rosny, Addo Newton, Knight Starr
Department of Emergency Medicine Atrium Health Carolinas Charlotte North Carolina USA.
Department of Emergency Medicine University of California at San Francisco San Francisco California USA.
AEM Educ Train. 2021 Sep 29;5(Suppl 1):S49-S56. doi: 10.1002/aet2.10670. eCollection 2021 Sep.
Microaggressions and implicit bias occur frequently in medicine. No previous study, however, has examined the implicit bias and microaggressions that emergency medicine (EM) providers experience. Our primary objective was to understand how often EM providers experience implicit bias and microaggressions. Our secondary objective was to evaluate the types of microaggressions they experience and whether their own identifying characteristics are risk factors.
A questionnaire was administered to EM providers across the United States. Outcome measures of experiencing or witnessing a microaggression, overt discrimination, or implicit bias were described using frequencies, proportions, and logistic regressions. Where a univariate association between outcome measures and demographic characteristics was found, multivariate regression to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) was performed. Proportional odds logistic regression models were used to evaluate the specific type of microaggressions experienced and if there was an association with demographic variables.
A total of 277 medical providers (48% trainees-medical students, residents, and fellows-and 52% attending physicians) completed the survey. A total of 181 (65%) respondents reported experiencing a microaggression. Female (OR = 5.9 [95% CI = 3.1 to 11.2]) and non-White respondents (OR = 2.4 [95% CI = 1.2 to 4.5]) were more likely to report experiencing any microaggression. Misidentification, the most common form of microaggression, was more common with trainees compared to attending physicians (proportional OR [POR] = 2.6 [95% CI = 1.7 to 4.0]) and non-White, compared to White, respondents (POR = 2.2 [95% CI = 1.3 to 3.6]). Misidentification as nonclinician staff was associated with gender (POR = 53 [95% CI = 24 to 116]) and 52% of female respondents reported being mistaken for nonclinician staff almost daily. Seventy-six percent of respondents reported being called a vulgar term by a patient and 21% by a staff member.
EM providers, particularly women and non-Whites, who responded to our survey experienced and witnessed bias and microaggressions, most commonly misidentification, in the ED.
微侵犯和内隐偏见在医学领域屡见不鲜。然而，此前尚无研究探讨急诊医学（EM）从业者所经历的内隐偏见和微侵犯。我们的主要目的是了解EM从业者经历内隐偏见和微侵犯的频率。次要目的是评估他们所经历的微侵犯类型，以及他们自身的识别特征是否为风险因素。
对美国各地的EM从业者进行问卷调查。使用频率、比例和逻辑回归描述经历或目睹微侵犯、公然歧视或内隐偏见的结果指标。若发现结果指标与人口统计学特征之间存在单变量关联，则进行多变量回归以估计比值比（OR）和95%置信区间（95%CI）。使用比例优势逻辑回归模型评估所经历的微侵犯的具体类型，以及是否与人口统计学变量存在关联。
共有277名医疗从业者（48%为实习生——医学生、住院医师和研究员——52%为主治医师）完成了调查。共有181名（65%）受访者报告经历过微侵犯。女性（OR = 5.9 [95%CI = 3.1至11.2]）和非白人受访者（OR = 2.4 [95%CI = 1.2至4.5]）更有可能报告经历过任何微侵犯。误认是最常见的微侵犯形式，与主治医师相比，实习生中更为常见（比例OR [POR] = 2.6 [95%CI = 1.7至4.0]），与白人受访者相比，非白人受访者中更为常见（POR = 2.2 [95%CI = 1.3至3.6]）。被误认作非临床工作人员与性别有关（POR = 53 [95%CI = 24至116]），52%的女性受访者报告几乎每天都被误认为非临床工作人员。76%的受访者报告被患者称为粗俗的词语，21%的受访者报告被工作人员这样称呼。
参与我们调查的EM从业者，尤其是女性和非白人，在急诊科经历并目睹了偏见和微侵犯，最常见的是误认。
