Using the Implicit Association Test to address Healthcare Disparities in Minority Patients: Initiating the Discussion in Orthopedic Surgery

Abstract

Healthcare disparities have become a notable topic of research in the last decade. Within Orthopedic Surgery, and more specifically, spine surgery, minority patients experience these disparities via increased lengths of stay, higher 30-day hospital readmission rates, and poor patient reported outcomes. One possible cause for these disparities is the implicit biases held by these patients’ physicians. The aim of this study is to assess the current state of implicit racial biases amongst orthopedic surgeons at various stages of training. To do this, 4th year medical students, majority applying into orthopedic surgery, as well as Orthopedic Surgery residents and attendings at an urban academic medical center were provided an anonymous, voluntary survey to document the results of an online Implicit Association Test specifically focusing on race. Our results demonstrated that medical students and residents mirror the general population with an inherent preference for white over black people. Attendings differed significantly from the general population with little to no preference for either race. While there are various hypotheses for these findings, the results suggest that there is a strong need for further research surrounding implicit bias and healthcare disparities in orthopedic surgery among both future and current physicians. With a better understanding of how to shift these biases, achieving equity in patient care can become a more attainable goal.