The Impact of Cognitive Stressors in the Emergency Department on Physician Implicit Racial Bias
The Impact of Cognitive Stressors in the Emergency Department on Physician Implicit Racial Bias
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DOI：
10.1111/acem.12901
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发表时间：
2016-03-01
影响因子：
4.4
通讯作者：
Hausmann, Leslie R. M.
中科院分区：
文献类型：
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作者：
Johnson, Tiffani J.;Hickey, Robert W.;Hausmann, Leslie R. M.
目的急诊科（艾德）的特点是压力源（例如，疲劳、压力、时间压力和复杂的决策），这可能对提供高质量、公平的护理构成挑战。虽然有人认为，艾德的特点可能会加剧对认知推理的依赖，但没有研究直接调查艾德的压力源是否会影响医生的种族偏见，这是一种常见的启发。我们试图确定，如果医生有不同程度的隐式种族偏见后，艾德转移与转移前，并检查人口统计学和认知压力与bias.MethodsThis重复测量研究的住院医师在儿科艾德使用电子转移前和转移后评估隐式种族偏见，人口统计学和认知压力之间的关联。使用种族内隐联想测验（IAT）测量内隐偏见。线性回归模型比较了IAT得分的差异前，以postshift和参与者的人口统计学和认知压力与postshift IAT和pre-to-postshift difference scores.ResultsParticipants（n = 91）之间的关联显示中度prowhite/antiblack偏见对preshift（平均SD = 0.50 +/- 0.34，d = 1.48）和转移后（平均+/- SD = 0.55 +/- 0.39，d = 1.40）IAT评分。总体而言，转移前与转移后的IAT评分无差异（平均增加= 0.05，95% CI = -0.02至0.14，d = 0.13）。亚组分析显示，当艾德更加拥挤时工作的参与者（平均增加= 0.09，95% CI = 0.01至0.17，d = 0.24）和照顾>10名患者的参与者（平均增加= 0.17，95% CI = 0.05至0.27，d = 0.47）的前后偏移增加。居民的人口统计学（包括专业），疲劳，忙碌，紧张，和班次的数量与班后IAT或差异分数无关。在多变量模型中，艾德过度拥挤与更大的postshift偏差（系数= 0.11每1个单位的NEDOCS评分，SE = 0.05，95%CI = 0.00至0.21）。艾德的医生应该意识到认知压力如何加剧内隐种族偏见。
ObjectivesThe emergency department (ED) is characterized by stressors (e.g., fatigue, stress, time pressure, and complex decision-making) that can pose challenges to delivering high-quality, equitable care. Although it has been suggested that characteristics of the ED may exacerbate reliance on cognitive heuristics, no research has directly investigated whether stressors in the ED impact physician racial bias, a common heuristic. We seek to determine if physicians have different levels of implicit racial bias post-ED shift versus preshift and to examine associations between demographics and cognitive stressors with bias.MethodsThis repeated-measures study of resident physicians in a pediatric ED used electronic pre- and postshift assessments of implicit racial bias, demographics, and cognitive stressors. Implicit bias was measured using the Race Implicit Association Test (IAT). Linear regression models compared differences in IAT scores pre- to postshift and determined associations between participant demographics and cognitive stressors with postshift IAT and pre- to postshift difference scores.ResultsParticipants (n = 91) displayed moderate prowhite/antiblack bias on preshift (mean SD = 0.50 +/- 0.34, d = 1.48) and postshift (mean +/- SD = 0.55 +/- 0.39, d = 1.40) IAT scores. Overall, IAT scores did not differ preshift to postshift (mean increase = 0.05, 95% CI = -0.02 to 0.14, d = 0.13). Subanalyses revealed increased pre- to postshift bias among participants working when the ED was more overcrowded (mean increase = 0.09, 95% CI = 0.01 to 0.17, d = 0.24) and among those caring for >10 patients (mean increase = 0.17, 95% CI = 0.05 to 0.27, d = 0.47). Residents' demographics (including specialty), fatigue, busyness, stressfulness, and number of shifts were not associated with postshift IAT or difference scores. In multivariable models, ED overcrowding was associated with greater postshift bias (coefficient = 0.11 per 1 unit of NEDOCS score, SE = 0.05, 95% CI = 0.00 to 0.21).ConclusionsWhile resident implicit bias remained stable overall preshift to postshift, cognitive stressors (overcrowding and patient load) were associated with increased implicit bias. Physicians in the ED should be aware of how cognitive stressors may exacerbate implicit racial bias.