Abstract
PurposeThere is robust research examining the negative impact of racial and socioeconomic implicit bias on healthcare provider clinical decision-making. However, other under-studied important biases are likely to impact clinical care as well. The goal of this study was to explore the presence of bias against people with physical disability among a heterogeneous group of healthcare workers and trainees and to evaluate the effect of implicit association testing and an educational module on this bias.MethodThe study was composed of a one-hour web-based survey and educational module. The survey included an explicit disability bias assessment, disability Implicit Association Tests (IATs), demographic collection, and pre- and post- module clinical vignettes of prenatal patient scenarios. In addition to providing counseling to hypothetical patients, participants also indicated their personal preferences on genetic testing and termination. The educational module focused on the principles of patient-centered counseling.ResultsThe collected data reflects responses from 335 participants. Within this sample, there were both explicit and implicit biases towards individuals with physical disabilities. Prior to the IAT and educational module, when respondents were tasked with providing genetic testing recommendations, implicit biases and personal preferences for genetic testing and termination influenced respondents’ clinical recommendations. Importantly, having previous professional experience with individuals with disabilities diminished biased clinical recommendations prior to the intervention. In response to the IAT and educational intervention, the effect of implicit bias and personal preferences on clinical recommendations decreased.ConclusionsThis study demonstrates how bias against a marginalized group exists within the medical community and that personal opinions can impact clinical counseling. Importantly, our findings suggest that there are strategies that can be easily implemented into curricula to address disability bias, including formal educational interventions and the addition of professional experiences into healthcare professional training programs.
Highlights
Numerous studies have demonstrated that unconscious, or implicit, bias held by healthcare providers can strongly and negatively impact patient encounters
Prior to the Implicit Association Test (IAT) and educational module, when respondents were tasked with providing genetic testing recommendations, implicit biases and personal preferences for genetic testing and termination influenced respondents’ clinical recommendations
Our findings suggest that there are strategies that can be implemented into curricula to address disability bias, including formal educational interventions and the addition of professional experiences into healthcare professional training programs
Summary
Numerous studies have demonstrated that unconscious, or implicit, bias held by healthcare providers can strongly and negatively impact patient encounters. Previous studies examining racial and socioeconomic biases among students have shown effective educational interventions that decrease implicit association test scores, indicating a decrease in implicit bias [5, 6]. Given these findings, it is possible that biases generally have the potential to contribute to healthcare disparities and may be amenable to educational intervention. Implicit Association Tests (IATs) have become the tool-of-choice for measuring bias because they can identify unreported, unconscious bias [11]
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