Department of Pediatrics Virginia Commonwealth University, Richmond, Virginia,
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
WMJ. 2022 Apr;121(1):18-25.
Both implicit bias-referred to as unconscious bias-and explicit bias affect how clinicians manage patients. The Implicit Association Test (IAT) has incremental predictive validity relative to self-reports of unconscious bias. Few studies have uniquely specified the impact of unconscious bias in pediatric practices.
We aimed to assess the influence of unconscious bias on decision-making in the faculty in a pediatric academic center using the IAT, in addition to and separately applying clinical vignettes with racial and socioeconomic class associations in both tools as it relates to clinicians' race, gender, years in practice, education achieved by the clinician's parents, and language spoken.
We conducted a prospective quality control evaluation of faculty in an academic center's pediatrics department. An anonymous online tool was used to gather IAT responses, clinical vignette responses, demographics, and explicit bias questions.
Of 295 faculty members (73% females), 230 completed the questionnaire, at least in part. Faculty reported on the explicit bias questions, neutral feelings when comparing the demands of educated vs noneducated patients, African American vs European American patients, and patients in the upper vs lower socioeconomic class. Of the approximately two-thirds who answered the IAT, faculty showed preference for European American and upper socioeconomic class. However, the clinical vignettes revealed no differences in how faculty responded to patients based on race or socioeconomic status when stratified by factors listed above, except physicians who favor upper socioeconomic class over lower socioeconomic class were more likely to give a detailed explanation of options if the patient's parent was upper socioeconomic class ( = 0.022).
Pediatricians exhibit racial and socioeconomic unconscious bias that minimally affects decision-making, at least based on vignette responses.
内隐偏见（又称无意识偏见）和外显偏见都会影响临床医生对患者的管理。与无意识偏见的自我报告相比，内隐联想测验（IAT）具有增量预测效度。很少有研究专门针对儿科实践中的无意识偏见的影响进行说明。
我们旨在使用 IAT 评估儿科学术中心教师的无意识偏见对决策的影响，此外，还分别在这两种工具中应用与临床医生的种族、性别、从业年限、父母所受教育程度以及所讲语言相关的种族和社会经济阶层关联的临床案例，以评估无意识偏见的影响。
我们对学术中心儿科学系的教师进行了前瞻性质量控制评估。使用匿名在线工具收集 IAT 反应、临床案例反应、人口统计学资料和外显偏见问题。
在 295 名教职员工中（73%为女性），有 230 名至少部分完成了问卷。教职员工报告了外显偏见问题、比较教育程度高的患者与教育程度低的患者、非裔美国患者与欧洲裔美国患者以及社会经济地位高的患者与社会经济地位低的患者时的中立感受。在大约三分之二回答 IAT 的教职员工中，他们对外裔美国人以及社会经济地位高的人表现出偏好。然而，在按上述因素分层后，根据种族或社会经济地位，临床案例并未显示出教师对患者的反应存在差异，除了那些偏好社会经济地位高的患者而非社会经济地位低的患者的医生，如果患者的父母属于社会经济地位高的阶层，他们更有可能详细解释治疗方案（ = 0.022）。
儿科医生表现出种族和社会经济无意识偏见，至少根据案例反应，这种偏见对决策的影响很小。
