Abstract
Although health provider racial/ethnic bias has the potential to influence health outcomes and inequities, research within health education and training contexts remains limited. This paper reports findings from an anonymous web-based study examining racial/ethnic bias amongst final year medical students in Aotearoa/New Zealand. Data from 302 students (34% of all eligible final year medical students) were collected in two waves in 2014 and 2015 as part of the Bias and Decision Making in Medicine (BDMM) study. Two chronic disease vignettes, two implicit bias measures, and measures of explicit bias were used to assess racial/ethnic bias towards New Zealand European and Māori (indigenous) peoples. Medical students demonstrated implicit pro-New Zealand European racial/ethnic bias on average, and bias towards viewing New Zealand European patients as more compliant relative to Māori. Explicit pro-New Zealand European racial/ethnic bias was less evident, but apparent for measures of ethnic preference, relative warmth, and beliefs about the compliance and competence of Māori patients relative to New Zealand European patients. In addition, racial/ethnic bias appeared to be associated with some measures of medical student beliefs about individual patients by ethnicity when responding to a mental health vignette. Patterning of racial/ethnic bias by student characteristics was not consistent, with the exception of some associations between student ethnicity, socioeconomic background, and racial/ethnic bias. This is the first study of its kind with a health professional population in Aotearoa/New Zealand, representing an important contribution to further understanding and addressing current health inequities between Māori and New Zealand European populations.
Highlights
Systematic, disquieting health inequities between indigenous and non-indigenous populations are evident in Aotearoa/New Zealand and many countries internationally [1,2]
Most participants identified with a European ethnic group, reported a middle or upper-middle socioeconomic background, and were born in Aotearoa/New Zealand
Generalised assumptions about racial/ethnic groups may be more salient for medical students in Aotearoa/New Zealand than those more specific to healthcare settings, while attitudes about patient compliance may increase over time as time in clinical environments increases
Summary
Systematic, disquieting health inequities between indigenous and non-indigenous populations are evident in Aotearoa/New Zealand and many countries internationally [1,2]. Drawing on the work of key scholars [4,8,11,12,13], racial/ethnic bias in this study refers to beliefs, attitudes, feelings and behaviours about and towards Māori (indigenous peoples of Aotearoa/New Zealand) and NZ European (the numerically dominant population) people. Racial/ethnic bias at an individual level is understood as an expression of the broader phenomenon of racism [4] within which ‘racial’/ ‘ethnic’ groups are produced and have social meaning. Studies of health provider racial/ethnic bias often involve assessment of both “conscious and intentional” bias Research has shown that people can hold implicit beliefs and attitudes about racial/ethnic groups that may contrast with the views they consciously express [6,14,17]
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