Abstract
BackgroundHealth professional racial/ethnic bias may impact on clinical decision-making and contribute to subsequent ethnic health inequities. However, limited research has been undertaken among medical students. This paper presents findings from the Bias and Decision-Making in Medicine (BDMM) study, which sought to examine ethnic bias (Māori (indigenous peoples) compared with New Zealand European) among medical students and associations with clinical decision-making.MethodsAll final year New Zealand (NZ) medical students in 2014 and 2015 (n = 888) were invited to participate in a cross-sectional online study. Key components included: two chronic disease vignettes (cardiovascular disease (CVD) and depression) with randomized patient ethnicity (Māori or NZ European) and questions on patient management; implicit bias measures (an ethnicity preference Implicit Association Test (IAT) and an ethnicity and compliant patient IAT); and, explicit ethnic bias questions. Associations between ethnic bias and clinical decision-making responses to vignettes were tested using linear regression.ResultsThree hundred and two students participated (34% response rate). Implicit and explicit ethnic bias favoring NZ Europeans was apparent among medical students. In the CVD vignette, no significant differences in clinical decision-making by patient ethnicity were observed. There were also no differential associations by patient ethnicity between any measures of ethnic bias (implicit or explicit) and patient management responses in the CVD vignette. In the depression vignette, some differences in the ranking of recommended treatment options were observed by patient ethnicity and explicit preference for NZ Europeans was associated with increased reporting that NZ European patients would benefit from treatment but not Māori (slope difference 0.34, 95% CI 0.08, 0.60; p = 0.011), although this was the only significant finding in these analyses.ConclusionsNZ medical students demonstrated ethnic bias, although overall this was not associated with clinical decision-making. This study both adds to the small body of literature internationally on racial/ethnic bias among medical students and provides relevant and important information for medical education on indigenous health and ethnic health inequities in New Zealand.
Highlights
Health professional racial/ethnic bias may impact on clinical decision-making and contribute to subsequent ethnic health inequities
Participants showed a ‘slight’ implicit association between the concept of a ‘compliant patient’ and New Zealand (NZ) European patients compared with Māori patients
On explicit measures we observed higher warmth toward NZ European compared to Māori and a mean ethnic preference for NZ Europeans compared to Māori
Summary
Health professional racial/ethnic bias may impact on clinical decision-making and contribute to subsequent ethnic health inequities. Implicit racial bias has been shown to impact on the quality of healthcare encounters [8], and on clinical decision-making [9, 10], not consistently [11,12,13,14,15] Within this field, most studies have been undertaken among physicians, with very few among medical students [12, 16, 17]. No consistent differences were found in vignette assessment by patient race or in the relationship between racial/ethnic bias and clinical assessment in this study [12] In another US study of students entering medicine, nursing and pharmacy, medical students (along with nursing and pharmacy students) demonstrated an implicit preference for ‘Whites’ (compared to ‘Blacks’) and a preference for lighter (compared to darker) skin tone [16]. In a study of third year medical students, Gonzales et al [17] demonstrated that medical students were more likely to have an implicit “preference for people like themselves” (p66) in a sample where the majority of students were ‘White’
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