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

摘要 隐含的或无意识的偏见可能通过临床的两个方面导致健康差异 实践行为：沟通模式与医疗决策。有证据表明， 医生种族内隐偏见与沟通差异的相关性研究 有黑人和白人病人的医生是强大的。相比之下，研究人员调查了 医生种族内隐偏见与医疗决策的关系，导致了 相互矛盾的结果。此外，寻求设计基于技能的干预措施的调查人员 使医生认识到他们的偏见，并减轻他们对临床实践的影响 行为受到缺乏有效结果衡量标准的限制，如核对表和全球 评级等级。在这项建议中，克里斯蒂娜·冈萨雷斯博士试图利用她作为一名医生的专业知识 在标准化患者病例开发方面拥有新技能的教育工作者和定性研究人员， 心理测量，效度证据，统计分析，临床研究设计。这个 该提案的目标是开发新的结果指标来评估两位医生 沟通和医疗决策，并将它们与隐性偏见相关联。Dr。 冈萨雷斯将设计高保真的标准化患者病例。通过混合方法 她将以有效核对清单的形式制定新的成果衡量标准，并 评估特定临床实践行为的全球评级标准。这项提议的最终目的是 一项临床研究，旨在检验内隐偏见和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的一个重要缺口 未来的干预研究。冈萨雷斯博士将从这个K奖中脱颖而出 将医学教育者转变为能够进行多机构干预的临床医生研究员 关于医生种族隐含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.