Association of Unconscious Race and Social Class Bias With Vignette-Based Clinical Assessments by Medical Students
Association of Unconscious Race and Social Class Bias With Vignette-Based Clinical Assessments by Medical Students
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DOI：
10.1001/jama.2011.1248
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发表时间：
2011-09-07
影响因子：
120.7
通讯作者：
Cornwell, Edward E., III
中科院分区：
文献类型：
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作者：
Haider, Adil H.;Sexton, Janel;Cornwell, Edward E., III
涉及医生的研究表明，无意识的偏见可能与临床决策有关，并可能预测不良的医患互动。医学生无意识种族和社会阶层偏见的存在及其与临床评估或决策的关系尚不清楚。目的评估医学一年级学生无意识种族和社会阶层偏见，并探讨其与临床评估的关系。和参与者2009年8月和2010年8月，在马里兰州的巴尔的摩的约翰霍普金斯医学院，对211名入学的医学生进行了一项安全的基于网络的调查。该调查包括内隐联想测试（IAT），以评估无意识的偏好，关于学生的明确的种族和社会阶层偏好的直接问题，和8个临床评估小插曲集中在疼痛评估，知情同意，病人的可靠性，和病人的信任。调整学生的人口统计学，多元逻辑回归被用来确定是否反应的小插曲与无意识的种族或社会阶层preferences.Main结果测量关联的分数上建立的IAT的种族和一个新的IAT的社会阶层与小插曲responses. ResultsAmong 202名学生谁完成了调查，在140名学生中，IAT反应与对白色人的内隐偏好一致（69%，95%CI，61%-75%）。174名学生的反应与对上层阶级的偏好一致（86%，95% CI，80%-90%）。评估一般不因患者种族或职业而异，对所有小插曲的多变量分析发现，隐式偏倚和临床评估之间没有显著关系。疼痛评估与种族IAT评分之间相关性的回归系数为-0.49（95%CI，-1.00至0.03），社会阶层相关性的回归系数为-0.04（95%CI，-0.50至0.41）。其他小插曲的调整后比值比范围为0.69至3.03每单位IAT评分的变化，但没有统计学意义。按患者种族或类别分层的分析得出了类似的阴性结果。测试患者的种族或阶级地位和学生IAT D分数之间的相互作用，在预测临床assessment.Conclusions大多数一年级的医学生在一所学校的IAT分数一致的内隐偏好白色的人，并可能为那些在上层阶级。然而，整体基于晕轮的临床评估与患者的种族或职业无关，并且内隐偏好与评估之间不存在关联。JAMA. 2011;306（9）：942-951
Context Studies involving physicians suggest that unconscious bias may be related to clinical decision making and may predict poor patient-physician interaction. The presence of unconscious race and social class bias and its association with clinical assessments or decision making among medical students is unknown.Objective To estimate unconscious race and social class bias among first-year medical students and investigate its relationship with assessments made during clinical vignettes.Design, Setting, and Participants A secure Web-based survey was administered to 211 medical students entering classes at Johns Hopkins School of Medicine, Baltimore, Maryland, in August 2009 and August 2010. The survey included the Implicit Association Test (IAT) to assess unconscious preferences, direct questions regarding students' explicit race and social class preferences, and 8 clinical assessment vignettes focused on pain assessment, informed consent, patient reliability, and patient trust. Adjusting for student demographics, multiple logistic regression was used to determine whether responses to the vignettes were associated with unconscious race or social class preferences.Main Outcome Measures Association of scores on an established IAT for race and a novel IAT for social class with vignette responses.Results Among the 202 students who completed the survey, IAT responses were consistent with an implicit preference toward white persons among 140 students (69%, 95% CI, 61%-75%). Responses were consistent with a preference toward those in the upper class among 174 students (86%, 95% CI, 80%-90%). Assessments generally did not vary by patient race or occupation, and multivariable analyses for all vignettes found no significant relationship between implicit biases and clinical assessments. Regression coefficient for the association between pain assessment and race IAT scores was -0.49 (95% CI, -1.00 to 0.03) and for social class, the coefficient was -0.04 (95% CI, -0.50 to 0.41). Adjusted odds ratios for other vignettes ranged from 0.69 to 3.03 per unit change in IAT score, but none were statistically significant. Analysis stratified by vignette patient race or class status yielded similarly negative results. Tests for interactions between patient race or class status and student IAT D scores in predicting clinical assessments were not statistically significant.Conclusions The majority of first-year medical students at a single school had IAT scores consistent with implicit preference for white persons and possibly for those in the upper class. However, overall vignette-based clinical assessments were not associated with patient race or occupation, and no association existed between implicit preferences and the assessments. JAMA. 2011;306(9):942-951