Racial Implicit Bias and Communication Among Physicians in a Simulated Environment.

Autor:	Gonzalez CM; Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York.; Department of Medicine, New York University Grossman School of Medicine, New York.; Department of Population Health, New York University Grossman School of Medicine, New York., Ark TK; Medical College of Wisconsin, Milwaukee., Fisher MR; Department of Psychiatry, Mount Sinai Morningside-West, New York, New York., Marantz PR; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.; Department of Medicine, Albert Einstein College of Medicine, Bronx, New York., Burgess DJ; Department of Medicine, University of Minnesota, Minneapolis.; Center for Care Delivery and Outcomes Research in the Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota., Milan F; Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York., Samuel MT; New York University Tisch School of the Arts, New York., Lypson ML; Columbia University Vagelos College of Physicians and Surgeons, New York, New York.; Department of Medicine, Columbia University Irving Medical Center, New York, New York., Rodriguez CJ; Department of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York., Kalet AL; Medical College of Wisconsin, Milwaukee.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2024 Mar 04; Vol. 7 (3), pp. e242181. Date of Electronic Publication: 2024 Mar 04.
DOI:	10.1001/jamanetworkopen.2024.2181
Abstrakt:	Importance: Racial implicit bias can contribute to health disparities through its negative influence on physician communication with Black patients. Interventions for physicians to address racial implicit bias in their clinical encounters are limited by a lack of high-fidelity (realistic) simulations to provide opportunities for skill development and practice. Objective: To describe the development and initial evaluation of a high-fidelity simulation of conditions under which physicians might be influenced by implicit racial bias. Design, Setting, and Participants: This cross-sectional study, performed on an online platform from March 1 to September 30, 2022, recruited a convenience sample of physician volunteers to pilot an educational simulation. Exposures: In the simulation exercise, physicians saw a 52-year-old male standardized patient (SP) (presenting as Black or White) seeking urgent care for epigastric pain, nausea, and vomiting. The case included cognitive stressors common to clinical environments, including clinical ambiguity, stress, time constraints, and interruptions. Physicians explained their diagnosis and treatment plan to the SP, wrote an assessment and management plan, completed surveys, and took the Race Implicit Association Test (IAT) and Race Medical Cooperativeness IAT. The SPs, blinded to the purpose of the study, assessed each physician's communication using skills checklists and global rating scales. Main Outcomes and Measures: Association between physicians' IAT scores and SP race with SP ratings of communication skills. Results: In 60 physicians (23 [38.3%] Asian, 4 [6.7%] Black, 23 [38.3%] White, and 10 [16.7%] other, including Latina/o/x, Middle Eastern, and multiracial; 31 [51.7%] female, 27 [45.0%] male, and 2 [3.3%] other), the interaction of physicians' Race IAT score and SP race was significant for overall communication (mean [SD] β = -1.29 [0.41]), all subdomains of communication (mean [SD] β = -1.17 [0.52] to -1.43 [0.59]), and overall global ratings (mean [SD] β = -1.09 [0.39]). Black SPs rated physicians lower on communication skills for a given pro-White Race IAT score than White SPs; White SP ratings increased as physicians' pro-White bias increased. Conclusions and Relevance: In this cross-sectional study, a high-fidelity simulation calibrated with cognitive stressors common to clinical environments elicited the expected influence of racial implicit bias on physicians' communication skills. The outlined process and preliminary results can inform the development and evaluation of interventions that seek to address racial implicit bias in clinical encounters and improve physician communication with Black patients.
Databáze:	MEDLINE
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