A Systematic Review of the Impact of Physician Implicit Racial Bias on Clinical Decision Making

Dehon, Erin; Weiss, Nicole H.; Jones, Jonathan Spencer; Faulconer, Whitney; Hinton, Elizabeth; Sterling, Sarah A.

doi:10.1111/acem.13214

Cited by 325 publications

(278 citation statements)

References 36 publications

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“…The issue of race in general medical decision-making remains contentious, but has not been explored in ICU admission decisions. [10] Race is not recorded on our referral forms. We nevertheless attempted to evaluate race as a factor in this study by ascribing race status according to patient names.…”

Section: Researchmentioning

confidence: 99%

Factors influencing decisions to admit or refuse patients entry to a South African tertiary intensive care unit

Gopalan

Vasconcellos

2019

S Afr Med J

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Section: Researchmentioning

confidence: 99%

Factors influencing decisions to admit or refuse patients entry to a South African tertiary intensive care unit

Gopalan

Vasconcellos

2019

S Afr Med J

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“…Early identification and timely treatment of critical cases of SARS-CoV-2 is vital for reducing disease severity and preventing spread 21 , so biases in care could have significant consequences. It is important to note that the literature is divided upon whether or not implicit biases of clinicians translate to different treatment recommendations or care 124,125,126 , though existing studies generally confirm an implicit preference for NHWs over Blacks 127,128,129 . Efforts to treat without acknowledging race or ethnicity (i.e.…”

Section: Racism and Discrimination In Medical Carementioning

confidence: 99%

Compounding Health Risks and Increased Vulnerability to SARS-CoV-2 for Racial and Ethnic Minorities and Low Socioeconomic Status Individuals in the United States

Em¹

2020

Preprint

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Recent clinical SARS-CoV-2 studies link diabetes, cardiovascular disease, and hypertension to increased disease severity. In the US, racial and ethnic minorities and low socioeconomic status (SES) individuals are more likely to have increased rates of these comorbidities, lower baseline health, limited access to care, increased perceived discrimination, and limited resources, all of which increase their vulnerability to severe disease and poor health outcomes from SARS-CoV-2. Previous studies demonstrated the disproportionate impact of pandemic and seasonal influenza on these populations, due to these risk factors. This paper reviews increased health risks and documented health disparities of racial and ethnic minorities and low SES individuals in the US. Pandemic response must prioritize these marginalized communities to minimize the negative, disproportionate impacts of SARS-CoV-2 on them and manage spread throughout the entire population. This paper concludes with recommendations applicable to healthcare facilities and public officials at various government levels.

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“…Although a prowhite bias has been demonstrated as the norm in numerous studies, the effects of this bias on outcomes and clinical decision making are unclear. A recent systematic review by Dehon and colleagues included studies that evaluated implicit bias and clinical decision making. The results indicate that although there is a prowhite bias among physicians, none of the nine studies reviewed found bias to have an impact on clinical decision making …”

Section: Introductionmentioning

confidence: 99%

Implicit Bias Education and Emergency Medicine Training: Step One? Awareness

Zeidan

Khatri

Aysola

et al. 2018

AEM Education and Training

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Objective: Prior research suggests that health care providers are susceptible to implicit biases, specifically prowhite biases, and that these may contribute to health care disparities by influencing physician behavior. Despite these findings, implicit bias training is not currently embedded into emergency medicine (EM) residency training and few studies exist that evaluate the effectiveness of implicit bias training on awareness during residency conference. We sought to conduct a mixed-methods program evaluation of a formalized educational intervention targeted on the topic of implicit bias. Methods:We used a design thinking framework to develop a curricular intervention. The intervention consisted of taking the Harvard Implicit Association Test (IAT) on race to introduce the concept of implicit bias, followed by a facilitated discussion to explore participant's perceptions on whether implicit bias may lead to variations in care. The facilitated discussion was audio recorded, transcribed, and coded for emerging themes. An online survey assessed participant awareness of these topics before and after the intervention and was analyzed using paired t-tests. Results: After the intervention, participant's awareness of their individual implicit biases increased by 33.3%(p = 0.003) and their awareness of how their IAT results influences how they deliver care to patients increased by 9.1% (p = 0.03). Emerging themes included skepticism of the implicit bias test results with the desire to have "neutral" results, acknowledgment that pattern recognition may lead to "blind spots" in care, recognition that bias exists on a personal and systemic level, and interest in regular educational interventions to address implicit bias.Conclusions: This novel educational intervention on implicit bias resulted in improvement in participants' awareness of their implicit biases and how it may affect their patient care. Our intervention can serve as a model for other residency programs to develop and implement an intervention to create awareness of implicit bias and its potential impact on patient care.

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A Systematic Review of the Impact of Physician Implicit Racial Bias on Clinical Decision Making

Cited by 325 publications

References 36 publications

Factors influencing decisions to admit or refuse patients entry to a South African tertiary intensive care unit

Factors influencing decisions to admit or refuse patients entry to a South African tertiary intensive care unit

Compounding Health Risks and Increased Vulnerability to SARS-CoV-2 for Racial and Ethnic Minorities and Low Socioeconomic Status Individuals in the United States

Implicit Bias Education and Emergency Medicine Training: Step One? Awareness

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