Racial Implicit Bias and Communication Among Physicians in a Simulated Environment Article Swipe
Cristina M. González
,
Tavinder K. Ark
,
M. Fisher
,
Paul R. Marantz
,
Diana J. Burgess
,
Felise B. Milan
,
Malika T. Samuel
,
Monica L. Lypson
,
Carlos J. Rodríguez
,
Adina Kalet
·
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1001/jamanetworkopen.2024.2181
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1001/jamanetworkopen.2024.2181
Importance Racial implicit bias can contribute to health disparities through its negative influence on physician communication with Black patients. Interventions for physicians to address racial implicit bias in their clinical encounters are limited by a lack of high-fidelity (realistic) simulations to provide opportunities for skill development and practice. Objective To describe the development and initial evaluation of a high-fidelity simulation of conditions under which physicians might be influenced by implicit racial bias. Design, Setting, and Participants This cross-sectional study, performed on an online platform from March 1 to September 30, 2022, recruited a convenience sample of physician volunteers to pilot an educational simulation. Exposures In the simulation exercise, physicians saw a 52-year-old male standardized patient (SP) (presenting as Black or White) seeking urgent care for epigastric pain, nausea, and vomiting. The case included cognitive stressors common to clinical environments, including clinical ambiguity, stress, time constraints, and interruptions. Physicians explained their diagnosis and treatment plan to the SP, wrote an assessment and management plan, completed surveys, and took the Race Implicit Association Test (IAT) and Race Medical Cooperativeness IAT. The SPs, blinded to the purpose of the study, assessed each physician’s communication using skills checklists and global rating scales. Main Outcomes and Measures Association between physicians’ IAT scores and SP race with SP ratings of communication skills. Results In 60 physicians (23 [38.3%] Asian, 4 [6.7%] Black, 23 [38.3%] White, and 10 [16.7%] other, including Latina/o/x, Middle Eastern, and multiracial; 31 [51.7%] female, 27 [45.0%] male, and 2 [3.3%] other), the interaction of physicians’ Race IAT score and SP race was significant for overall communication (mean [SD] β = −1.29 [0.41]), all subdomains of communication (mean [SD] β = −1.17 [0.52] to −1.43 [0.59]), and overall global ratings (mean [SD] β = −1.09 [0.39]). Black SPs rated physicians lower on communication skills for a given pro-White Race IAT score than White SPs; White SP ratings increased as physicians’ pro-White bias increased. Conclusions and Relevance In this cross-sectional study, a high-fidelity simulation calibrated with cognitive stressors common to clinical environments elicited the expected influence of racial implicit bias on physicians’ communication skills. The outlined process and preliminary results can inform the development and evaluation of interventions that seek to address racial implicit bias in clinical encounters and improve physician communication with Black patients.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1001/jamanetworkopen.2024.2181
- https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2816500/gonzalez_2024_oi_240104_1710263194.48321.pdf
- OA Status
- gold
- Cited By
- 19
- References
- 68
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4392986117
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4392986117Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1001/jamanetworkopen.2024.2181Digital Object Identifier
- Title
-
Racial Implicit Bias and Communication Among Physicians in a Simulated EnvironmentWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2024Year of publication
- Publication date
-
2024-03-20Full publication date if available
- Authors
-
Cristina M. González, Tavinder K. Ark, M. Fisher, Paul R. Marantz, Diana J. Burgess, Felise B. Milan, Malika T. Samuel, Monica L. Lypson, Carlos J. Rodríguez, Adina KaletList of authors in order
- Landing page
-
https://doi.org/10.1001/jamanetworkopen.2024.2181Publisher landing page
- PDF URL
-
https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2816500/gonzalez_2024_oi_240104_1710263194.48321.pdfDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
goldOpen access status per OpenAlex
- OA URL
-
https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2816500/gonzalez_2024_oi_240104_1710263194.48321.pdfDirect OA link when available
- Concepts
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Implicit-association test, Psychological intervention, Medicine, Psychology, Stressor, Clinical psychology, Test (biology), Family medicine, Psychiatry, Social psychology, Paleontology, BiologyTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
19Total citation count in OpenAlex
- Citations by year (recent)
-
2025: 12, 2024: 7Per-year citation counts (last 5 years)
- References (count)
-
68Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.as | 117, 315 |
| abstract_inverted_index.be | 66 |
| abstract_inverted_index.by | 33, 68 |
| abstract_inverted_index.in | 27, 371 |
| abstract_inverted_index.of | 36, 56, 60, 95, 184, 213, 251, 272, 342, 362 |
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| abstract_inverted_index.or | 119 |
| abstract_inverted_index.to | 6, 22, 40, 87, 98, 136, 154, 181, 280, 335, 366 |
| abstract_inverted_index.β | 266, 276, 289 |
| abstract_inverted_index.(23 | 220 |
| abstract_inverted_index.30, | 89 |
| abstract_inverted_index.IAT | 205, 254, 306 |
| abstract_inverted_index.SP, | 156 |
| abstract_inverted_index.SPs | 294 |
| abstract_inverted_index.The | 130, 178, 350 |
| abstract_inverted_index.all | 270 |
| abstract_inverted_index.and | 46, 53, 74, 128, 145, 151, 160, 165, 173, 194, 200, 207, 229, 237, 245, 256, 283, 321, 353, 360, 374 |
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| abstract_inverted_index.can | 4, 356 |
| abstract_inverted_index.for | 20, 43, 124, 261, 301 |
| abstract_inverted_index.its | 10 |
| abstract_inverted_index.saw | 109 |
| abstract_inverted_index.the | 51, 105, 155, 167, 182, 185, 249, 339, 358 |
| abstract_inverted_index.was | 259 |
| abstract_inverted_index.(SP) | 115 |
| abstract_inverted_index.IAT. | 177 |
| abstract_inverted_index.Main | 198 |
| abstract_inverted_index.Race | 168, 174, 253, 305 |
| abstract_inverted_index.SPs, | 179 |
| abstract_inverted_index.SPs; | 310 |
| abstract_inverted_index.Test | 171 |
| abstract_inverted_index.This | 76 |
| abstract_inverted_index.[SD] | 265, 275, 288 |
| abstract_inverted_index.bias | 3, 26, 318, 345, 370 |
| abstract_inverted_index.care | 123 |
| abstract_inverted_index.case | 131 |
| abstract_inverted_index.each | 188 |
| abstract_inverted_index.from | 84 |
| abstract_inverted_index.lack | 35 |
| abstract_inverted_index.male | 112 |
| abstract_inverted_index.plan | 153 |
| abstract_inverted_index.race | 209, 258 |
| abstract_inverted_index.seek | 365 |
| abstract_inverted_index.than | 308 |
| abstract_inverted_index.that | 364 |
| abstract_inverted_index.this | 324 |
| abstract_inverted_index.time | 143 |
| abstract_inverted_index.took | 166 |
| abstract_inverted_index.with | 16, 210, 331, 378 |
| abstract_inverted_index.(IAT) | 172 |
| abstract_inverted_index.(mean | 264, 274, 287 |
| abstract_inverted_index.2022, | 90 |
| abstract_inverted_index.Black | 17, 118, 293, 379 |
| abstract_inverted_index.March | 85 |
| abstract_inverted_index.White | 309, 311 |
| abstract_inverted_index.bias. | 71 |
| abstract_inverted_index.given | 303 |
| abstract_inverted_index.lower | 297 |
| abstract_inverted_index.male, | 244 |
| abstract_inverted_index.might | 65 |
| abstract_inverted_index.pain, | 126 |
| abstract_inverted_index.pilot | 99 |
| abstract_inverted_index.plan, | 162 |
| abstract_inverted_index.rated | 295 |
| abstract_inverted_index.score | 255, 307 |
| abstract_inverted_index.skill | 44 |
| abstract_inverted_index.their | 28, 149 |
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| abstract_inverted_index.using | 191 |
| abstract_inverted_index.which | 63 |
| abstract_inverted_index.wrote | 157 |
| abstract_inverted_index.Asian, | 222 |
| abstract_inverted_index.Black, | 225 |
| abstract_inverted_index.Middle | 235 |
| abstract_inverted_index.Racial | 1 |
| abstract_inverted_index.White) | 120 |
| abstract_inverted_index.White, | 228 |
| abstract_inverted_index.[0.52] | 279 |
| abstract_inverted_index.[3.3%] | 247 |
| abstract_inverted_index.[6.7%] | 224 |
| abstract_inverted_index.common | 135, 334 |
| abstract_inverted_index.global | 195, 285 |
| abstract_inverted_index.health | 7 |
| abstract_inverted_index.inform | 357 |
| abstract_inverted_index.online | 82 |
| abstract_inverted_index.other, | 232 |
| abstract_inverted_index.racial | 24, 70, 343, 368 |
| abstract_inverted_index.rating | 196 |
| abstract_inverted_index.sample | 94 |
| abstract_inverted_index.scores | 206 |
| abstract_inverted_index.skills | 192, 300 |
| abstract_inverted_index.study, | 78, 186, 326 |
| abstract_inverted_index.urgent | 122 |
| abstract_inverted_index.Design, | 72 |
| abstract_inverted_index.Medical | 175 |
| abstract_inverted_index.Results | 216 |
| abstract_inverted_index.[16.7%] | 231 |
| abstract_inverted_index.[38.3%] | 221, 227 |
| abstract_inverted_index.[45.0%] | 243 |
| abstract_inverted_index.[51.7%] | 240 |
| abstract_inverted_index.address | 23, 367 |
| abstract_inverted_index.between | 203 |
| abstract_inverted_index.blinded | 180 |
| abstract_inverted_index.female, | 241 |
| abstract_inverted_index.improve | 375 |
| abstract_inverted_index.initial | 54 |
| abstract_inverted_index.limited | 32 |
| abstract_inverted_index.nausea, | 127 |
| abstract_inverted_index.other), | 248 |
| abstract_inverted_index.overall | 262, 284 |
| abstract_inverted_index.patient | 114 |
| abstract_inverted_index.process | 352 |
| abstract_inverted_index.provide | 41 |
| abstract_inverted_index.purpose | 183 |
| abstract_inverted_index.ratings | 212, 286, 313 |
| abstract_inverted_index.results | 355 |
| abstract_inverted_index.scales. | 197 |
| abstract_inverted_index.seeking | 121 |
| abstract_inverted_index.skills. | 215, 349 |
| abstract_inverted_index.stress, | 142 |
| abstract_inverted_index.through | 9 |
| abstract_inverted_index.−1.09 | 291 |
| abstract_inverted_index.−1.17 | 278 |
| abstract_inverted_index.−1.29 | 268 |
| abstract_inverted_index.−1.43 | 281 |
| abstract_inverted_index.Eastern, | 236 |
| abstract_inverted_index.Implicit | 169 |
| abstract_inverted_index.Measures | 201 |
| abstract_inverted_index.Outcomes | 199 |
| abstract_inverted_index.Setting, | 73 |
| abstract_inverted_index.[0.39]). | 292 |
| abstract_inverted_index.[0.41]), | 269 |
| abstract_inverted_index.[0.59]), | 282 |
| abstract_inverted_index.assessed | 187 |
| abstract_inverted_index.clinical | 29, 137, 140, 336, 372 |
| abstract_inverted_index.describe | 50 |
| abstract_inverted_index.elicited | 338 |
| abstract_inverted_index.expected | 340 |
| abstract_inverted_index.implicit | 2, 25, 69, 344, 369 |
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| abstract_inverted_index.negative | 11 |
| abstract_inverted_index.outlined | 351 |
| abstract_inverted_index.platform | 83 |
| abstract_inverted_index.surveys, | 164 |
| abstract_inverted_index.Exposures | 103 |
| abstract_inverted_index.Objective | 48 |
| abstract_inverted_index.Relevance | 322 |
| abstract_inverted_index.September | 88 |
| abstract_inverted_index.cognitive | 133, 332 |
| abstract_inverted_index.completed | 163 |
| abstract_inverted_index.diagnosis | 150 |
| abstract_inverted_index.exercise, | 107 |
| abstract_inverted_index.explained | 148 |
| abstract_inverted_index.including | 139, 233 |
| abstract_inverted_index.increased | 314 |
| abstract_inverted_index.influence | 12, 341 |
| abstract_inverted_index.patients. | 18, 380 |
| abstract_inverted_index.performed | 79 |
| abstract_inverted_index.physician | 14, 96, 376 |
| abstract_inverted_index.practice. | 47 |
| abstract_inverted_index.pro-White | 304, 317 |
| abstract_inverted_index.recruited | 91 |
| abstract_inverted_index.stressors | 134, 333 |
| abstract_inverted_index.treatment | 152 |
| abstract_inverted_index.vomiting. | 129 |
| abstract_inverted_index.Importance | 0 |
| abstract_inverted_index.Physicians | 147 |
| abstract_inverted_index.ambiguity, | 141 |
| abstract_inverted_index.assessment | 159 |
| abstract_inverted_index.calibrated | 330 |
| abstract_inverted_index.checklists | 193 |
| abstract_inverted_index.conditions | 61 |
| abstract_inverted_index.contribute | 5 |
| abstract_inverted_index.encounters | 30, 373 |
| abstract_inverted_index.epigastric | 125 |
| abstract_inverted_index.evaluation | 55, 361 |
| abstract_inverted_index.increased. | 319 |
| abstract_inverted_index.influenced | 67 |
| abstract_inverted_index.management | 161 |
| abstract_inverted_index.physicians | 21, 64, 108, 219, 296 |
| abstract_inverted_index.simulation | 59, 106, 329 |
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| abstract_inverted_index.volunteers | 97 |
| abstract_inverted_index.(presenting | 116 |
| abstract_inverted_index.(realistic) | 38 |
| abstract_inverted_index.52-year-old | 111 |
| abstract_inverted_index.Association | 170, 202 |
| abstract_inverted_index.Conclusions | 320 |
| abstract_inverted_index.Latina/o/x, | 234 |
| abstract_inverted_index.convenience | 93 |
| abstract_inverted_index.development | 45, 52, 359 |
| abstract_inverted_index.disparities | 8 |
| abstract_inverted_index.educational | 101 |
| abstract_inverted_index.interaction | 250 |
| abstract_inverted_index.preliminary | 354 |
| abstract_inverted_index.significant | 260 |
| abstract_inverted_index.simulation. | 102 |
| abstract_inverted_index.simulations | 39 |
| abstract_inverted_index.Participants | 75 |
| abstract_inverted_index.constraints, | 144 |
| abstract_inverted_index.environments | 337 |
| abstract_inverted_index.multiracial; | 238 |
| abstract_inverted_index.standardized | 113 |
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| abstract_inverted_index.environments, | 138 |
| abstract_inverted_index.high-fidelity | 37, 58, 328 |
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| abstract_inverted_index.opportunities | 42 |
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| abstract_inverted_index.physician’s | 189 |
| abstract_inverted_index.interruptions. | 146 |
| abstract_inverted_index.Cooperativeness | 176 |
| abstract_inverted_index.cross-sectional | 77, 325 |
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| institutions_distinct_count | 10 |
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