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CONTEXT: Studies documenting racial/ethnic disparities in health care frequently implicate physicians' unconscious biases. No study to date has measured physicians' unconscious racial bias to test whether this predicts physicians' clinical decisions. OBJECTIVE:To test whether physicians show implicit race bias and whether the magnitude of such bias predicts thrombolysis recommendations for black and white patients with acute coronary syndromes. DESIGN, SETTING, AND PARTICIPANTS:An internetbased tool comprising a clinical vignette of a patient presenting to the emergency department with an acute coronary syndrome, followed by a questionnaire and three Implicit Association Tests (IATs). Study invitations were e-mailed to all internal medicine and emergency medicine residents at four academic medical centers in Atlanta and Boston; 287 completed the study, met inclusion criteria, and were randomized to either a black or white vignette patient.MAIN OUTCOME MEASURES: IAT scores (normal continuous variable) measuring physicians' implicit race preference and perceptions of cooperativeness. Physicians' attribution of symptoms to coronary artery disease for vignette patients with randomly assigned race, and their decisions about thrombolysis. Assessment of physicians' explicit racial biases by questionnaire. RESULTS:Physicians reported no explicit preference for white versus black patients or differences in perceived cooperativeness. In contrast, IATs revealed implicit preference favoring white Americans (mean IAT score=0.36, P<.001, one-sample t test) and implicit stereotypes of black Americans as less cooperative with medical procedures (mean IAT score 0.22, P<.001), and less cooperative generally (mean IAT score 0.30, P<.001). As physicians' prowhite implicit bias increased, so did their likelihood of treating white patients and not treating black patients with thrombolysis (P=.009).CONCLUSIONS: This study represents the first evidence of unconscious (implicit) race bias among physicians, its dissociation from conscious (explicit) bias, and its predictive validity. Results suggest that physicians' unconscious biases may contribute to racial/ ethnic disparities in use of medical procedures such as thrombolysis for myocardial infarction.

Humans and other animals express power through open, expansive postures, and they express powerlessness through closed, contractive postures. But can these postures actually cause power? The results of this study confirmed our prediction that posing in high-power nonverbal displays (as opposed to low-power nonverbal displays) would cause neuroendocrine and behavioral changes for both male and female participants: High-power posers experienced elevations in testosterone, decreases in cortisol, and increased feelings of power and tolerance for risk; low-power posers exhibited the opposite pattern. In short, posing in displays of power caused advantaged and adaptive psychological, physiological, and behavioral changes, and these findings suggest that embodiment extends beyond mere thinking and feeling, to physiology and subsequent behavioral choices. That a person can, by assuming two simple 1-min poses, embody power and instantly become more powerful has real-world, actionable implications.

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The authors tested whether engaging in expansive (vs. contractive) "power poses" before a stressful job interview--preparatory power posing--would enhance performance during the interview. Participants adopted high-power (i.e., expansive, open) poses or low-power (i.e., contractive, closed) poses, and then prepared and delivered a speech to 2 evaluators as part of a mock job interview. All interview speeches were videotaped and coded for overall performance and hireability and for 2 potential mediators: verbal content (e.g., structure, content) and nonverbal presence (e.g., captivating, enthusiastic). As predicted, those who prepared for the job interview with high- (vs. low-) power poses performed better and were more likely to be chosen for hire; this relation was mediated by nonverbal presence, but not by verbal content. Although previous research has focused on how a nonverbal behavior that is enacted during interactions and observed by perceivers affects how those perceivers evaluate and respond to the actor, this experiment focused on how a nonverbal behavior that is enacted before the interaction and unobserved by perceivers affects the actor's performance, which, in turn, affects how perceivers evaluate and respond to the actor. This experiment reveals a theoretically novel and practically informative result that demonstrates the causal relation between preparatory nonverbal behavior and subsequent performance and outcomes.