Comparison of Physician Implicit Racial Bias Toward Adults Versus Children

Abstract

Background and Objectives The general population and most physicians have implicit racial bias against black adults. Pediatricians also have implicit bias against black adults, albeit less than other specialties. There is no published research on the implicit racial attitudes of pediatricians or other physicians towards children. Our objectives were to compare implicit racial bias towards adults versus children among resident physicians working in a pediatric emergency department (ED), and to assess whether bias varied by specialty (pediatrics, emergency medicine, or other), gender, race, age, and year of training. Methods We measured implicit racial bias of residents before a pediatric ED shift using the Adult and Child Race Implicit Association Tests (IATs). Generalized linear models compared Adult and Child IAT scores and determined the association of participant demographics with Adult and Child IAT scores. Results Among 91 residents, we found moderate pro-white/anti-black bias on both the Adult (M=0.49, SD=0.34) and Child Race IAT (M=0.55, SD=0.37). There was no significant difference between Adult and Child Race IAT scores (difference=0.06, p=0.15). Implicit bias was not associated with resident demographic characteristics, including specialty. Conclusions This is the first study demonstrating that resident physicians have implicit racial bias against black children, similar to levels of bias against black adults. Bias in our study did not vary by resident demographic characteristics, including specialty, suggesting that pediatric residents are as susceptible as other physicians to implicit bias. Future studies are needed to explore how physicians’ implicit attitudes towards parents and children may impact inequities in pediatric healthcare.

Implicit Bias in Pediatrics: An Emerging Focus in Health Equity Research

“…18 Another recent study found that resident physicians had implicit racial bias against African American children that was similar to levels of bias against African American adults. 19 This emerging body of work indicates that being a child does not protect against the experience of implicit bias.…”

Obesity bias among preclinical and clinical chiropractic students and faculty at an integrative health care institution: A cross-sectional study

“…2,3 Yet, despite the recognition that harboring bias, stereotypes, and negative attitudes (prejudice) can be a significant barrier to effective patientcentered care, many studies have reported on the pervasiveness of these affects among health care practitioners. [4][5][6][7][8][9][10][11] One significant area of concern is the startling prevalence of obesity bias within the allopathic medicine health care community. [12][13][14][15][16][17][18][19][20][21][22] The present study investigated whether this same bias was also commonplace among members of the complementary and integrative medicine (CIM) community.…”

What Do Clinicians Caring for Children Need to Know about Pediatric Medical Traumatic Stress and the Ethics of Trauma-Informed Approaches?

“…In another study, children whose parents had limited English language proficiency had their pain assessed less frequently during postsurgery care and experienced greater pain levels before receiving analgesic medication [32]. And a growing body of research demonstrates that physicians and other health care professionals exhibit implicit (i.e., unconscious) biases based on race [33,34]. To actively combat unconscious bias in pain management and other aspects of trauma-informed pediatric care, professionals can take concrete steps such as acknowledging their own susceptibility to implicit bias and practicing taking the perspective of stigmatized groups; there is empirical support for at least short-term reductions in implicit bias based on these steps [35].…”