Abstract 9313: Clinician Training, Implicit Bias, and Self-Efficacy in Treating African American Patients: A Substudy of the HYpertension and VALUEs Trial

Abstract

Background: Implicit bias among clinicians is believed to contribute to health disparities. Clinicians have racial biases comparable to others in society, leading to calls for trainings in cultural awareness. However, whether such trainings improve clinician self-efficacy or reduce bias is not well known. We assessed the relationships between prior cultural awareness training, perceived efficacy in caring for African American patients, and implicit race bias. Methods: As part of a larger trial, a sample of primary care clinicians (PCPs) completed a race implicit association test (IAT) and survey regarding prior training in cultural awareness, and perceived efficacy in caring for African American patients (i.e., preparation to care for, and skill in developing positive relationships and overcoming bias). IAT d-scores measure racial implicit bias with scores >+0.15 indicating “pro-White” race bias, scores <-0.15 indicating “pro-Black”race bias and scores between -0.15 to +0.15 indicating “no bias”. Groups were compared using chi-squared tests for categorical variables and t-tests for continuous variables Results: Among 137 PCPs (63% female, 61% White, 51% ≤10 years in practice), 65% showed implicit pro-White race bias (mean IAT d-score = 0.34 (SD 0.44)) and 79% reported prior training in cultural awareness. Though 67% of participants felt “very prepared” to care for and 59% felt “very skilled” in developing a positive relationship with African American patients, only 26% felt “very skilled” in overcoming implicit racial bias. Prior training in cultural awareness was not associated with perceived efficacy in caring for African American patients (all p >0.05). IAT scores were similar between clinicians who had training in cultural awareness and those without prior training (Mean(SD)=0.32(0.47) vs. 0.42(0.35), p=0.32). Conclusions: In this sample of PCPs, prior cultural awareness training was not associated with either implicit bias or preceived efficacy in caring for African American patients. This study suggests that cultural awareness trainings may need to be further developed and expanded to target implicit bias and improve clinician self-efficacy.