WMJ Vol 121 Issue 1: Does Unconscious Bias Affect How Pediatricians Manage Their Patients?
Background: 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.
Objective: 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.
Methods: 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.
Results: 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 (P = 0.022).
Conclusions: Pediatricians exhibit racial and socioeconomic unconscious bias that minimally affects decision-making, at least based on vignette responses.
The target audience for this journal-based activity is healthcare providers caring for the people and communities of Wisconsin and beyond.
As a result of this journal-based activity, learners, as members of the healthcare team, will be able to:
- Discuss the published data about the impact of healthcare professionals’ unconscious biases on their practice of medicine.
- Summarize the results of a study that explored, using the Implicit Association Test and clinical vignette questions, unconscious bias and its influence on patient care decisions in an pediatric academic center.
- Reflect on unconscious bias in the learner’s clinical practice.
It is the policy of the University of Wisconsin–Madison Interprofessional Continuing Education Partnership (ICEP) to identify, mitigate and disclose all relevant financial relationships with ineligible companies* held by the speakers/presenters, authors, planners, and other persons who may influence content of this accredited continuing education (CE). In addition, speakers, presenters and authors must disclose any planned discussion of unlabeled/unapproved uses of drugs or devices during their presentation.
For this accredited continuing education activity all relevant financial relationships have been mitigated and detailed disclosures are listed below.
|Name of Individual||Individual's Role in Activity|
Financial Relationship Disclosure
|Marianna Shershneva, MD, PhD||Accreditation Specialist||No relevant relationships with ineligible companies to disclose||No|
|Gisela Chelimsky, MD||Author||No relevant relationships with ineligible companies to disclose||No|
|Pippa Simpson, PhD||Author||No relevant relationships with ineligible companies to disclose||No|
|Mingen Feng, PhD||Author||No relevant relationships with ineligible companies to disclose||No|
|Earnestine Willis, MD||Author||No relevant relationships with ineligible companies to disclose||No|
|Madhulika (Mala) Mathur, MD, MPH||Reviewer||No relevant relationships with ineligible companies to disclose||No|
|Greer Jordan, MBA, PhD, BSEE||Reviewer||No relevant relationships with ineligible companies to disclose||No|
|Paula Tran Inzeo, MPH||Reviewer||No relevant relationships with ineligible companies to disclose||No|
|Robert Treat, PhD||Editor||No relevant relationships with ineligible companies to disclose||No|
|David Dwyer, PhD, RN, NE-BC||Reviewer||No relevant relationships with ineligible companies to disclose||No|
|Laura Ozkan, PA||Reviewer||No relevant relationships with ineligible companies to disclose||No|
*Ineligible companies are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on, patients.
The ACCME does not consider providers of clinical services directly to patients to be ineligible companies.
The table below reflects unmitigated data. Please see the table above for final mitigated disclosure information.
|In support of improving patient care, this activity has been planned and implemented by the University of Wisconsin–Madison ICEP and the Wisconsin Medical Journal. The University of Wisconsin–Madison ICEP is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.|
Credit Designation Statements
American Medical Association (AMA)
The University of Wisconsin–Madison ICEP designates this journal-based CE activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
American Nurses Credentialing Center (ANCC)
The University of Wisconsin–Madison ICEP designates this journal-based CE activity for a maximum of 1.0 ANCC contact hour.
AMERICAN ACADEMY OF PHYSICIAN ASSISTANTS (AAPA)
|The University of Wisconsin–Madison ICEP has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credits. Approval is valid until 6/2/2023. PAs should only claim credit commensurate with the extent of their participation.|
Continuing Education Units
The University of Wisconsin–Madison ICEP, as a member of the University Professional & Continuing Education Association (UPCEA), authorizes this program for 0.1 continuing education units (CEUs) or 1 hour.
- 1.00 AAPA Category 1 CME
- 1.00 AMA PRA Category 1 Credit™
- 1.00 ANCC Contact Hours
- 1.00 University of Wisconsin–Madison Continuing Education Hours
- 1.00 Approved for AMA PRA Category 1 Credit™
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