Medical students’ intent to provide care unbiased

Results of a survey indicated that most first-year medical students at one institution were biased regarding race and social class. Yet, these unconscious preferences did not affect their clinical assessments or decision-making, according to findings published in the Journal of the American Medical Association.

“These findings among medical students are in contrast to emerging, but inconsistent evidence suggesting that implicit biases held by physicians may lead to differences in clinical treatment,” the researchers wrote in the study. “Our study raises the question of why the decision-making processes of first-year medical students do not correlate with their implicit biases in the same way that may occur among more experienced physicians.”

From 2009 to 2010, first-year medical students at Johns Hopkins School of Medicine were sent a secure Web-based survey that included eight clinical vignettes that assessed clinical decision-making and the race Implicit Association Test that assessed unconscious preference for whites vs. blacks.

Among 202 completed surveys, 69% of students (95% CI, 61-75) had test responses consistent with an inherent preference toward white people; 86% of students (95% CI, 80-90) had responses consistent with a preference toward those in the upper class. However, the researchers found that vignette assessments did not vary by patient race or occupation.

“Further studies are needed to have a better understanding of whether implicit preferences are associated with clinical assessments and whether experiences during medical training influence social or racial bias in decision-making,” the researchers wrote. “If this occurs, medical training could be an effective intervention point to decrease implicit biases and possibly mitigate physician-driven health care disparities.”

In an accompanying editorial, Michelle van Ryn, PhD, MPH, of the University of Minnesota Medical School, and Somnath Saha, MD, MPH, of the Oregon Health & Science University, wrote: “The students in the study were able to focus their attention fully on the vignettes and response options and were likely to be motivated to get the ‘right’ answer. The finding that neither the race nor the social class of the patient influenced students’ responses under these conditions provides important support for the hypothesis that when clinicians have sufficient cognitive resources, time, information and motivation to be unbiased, their intent to provide equitable care is not undermined by biased implicit attitudes.”

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Disclosure: This study was supported by grant K23GM093112-01 from the National Institute of General Medical Sciences, National Institutes of Health and by the American College of Surgeons C. James Carrico Fellowship for the study of Trauma and Critical Care, and grant K24HL083113 from the National Heart, Lung, and Blood Institute.

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