Does Implicit Bias Influence Medical Decision-Making? Developing and Validating Novel Models and Outcome Metrics

摘要 内隐或无意识的偏见可能通过临床症状的两个方面导致健康差异。 实践行为：沟通模式和医疗决策。A的证据 医生种族内隐偏见与沟通差异的相关性 黑人和白色病人的医生是强大的。相比之下，研究 医生种族内隐偏见和医疗决策之间的关系，导致 矛盾的结果。此外，寻求设计基于技能的干预措施的研究人员， 使医生能够认识到他们的偏见，并减轻他们对临床实践的影响 由于缺乏经过验证的结果指标，如检查表和全球 评分量表在这项提案中，克里斯蒂娜·冈萨雷斯博士试图建立在她的专业知识作为一个医疗 教育工作者和定性研究人员，具有标准化患者病例开发方面的新技能， 心理测量、效度证据、统计分析和临床研究设计。的 该提案的目的是开发新的结果指标，以评估医生和 沟通和医疗决策，并将其与内隐偏见相关联。博士 冈萨雷斯将设计高保真标准化的病人病例。通过混合方法 方法，她将开发新的成果措施的形式验证清单， 全球评级量表，以评估具体的临床实践行为。本提案的最终目的是 一项临床研究，旨在检查内隐偏见与医疗决策之间的任何相关性。 这一最终目标的结果将解决与设计相关的知识方面的一个重要空白 未来的干预研究。冈萨雷斯博士将从这个K奖中脱颖而出， 医学教育者转变为能够进行多机构干预的临床研究者 针对医生种族内隐偏见和患者结局的研究。

Abstract Implicit, or unconscious, bias may contribute to health disparities via two facets of clinical practice behaviors: communication patterns and medical decision-making. The evidence for a correlation between physician racial implicit bias and disparities in communication by physicians with Black and White patients is strong. In contrast, research investigating the relationship between physician racial implicit bias and medical decision-making, has led to conflicting results. Moreover, investigators seeking to design skills-based interventions to enable physicians to recognize their biases and mitigate their influence on their clinical practice behaviors are limited by the lack of validated outcome metrics, such as checklists and global rating scales. In this proposal Dr. Cristina Gonzalez seeks to build on her expertise as a medical educator and qualitative researcher with new skills in standardized patient case development, psychometric measurement, validity evidence, statistical analysis, and clinical study design. The objectives of the proposal are to develop novel outcome metrics to assess both physician communication and medical decision-making and correlate them with implicit bias. Dr. Gonzalez will design high-fidelity standardized patient cases. Through a mixed-method approach, she will develop novel outcome measures in the form of validated checklists and global rating scales to assess specific clinical practice behaviors. The final aim of this proposal is a clinical study to examine any correlation between implicit bias and medical decision-making. The outcome of this final aim will address an important gap in knowledge relevant to the design future intervention studies. Dr. Gonzalez will emerge from this K award transformed from a medical educator into a clinician investigator able to conduct multi-institution intervention studies addressing physician racial implicit bias and patient outcomes.