A systematic review of the impact of physician implicit racial bias on clinical decision making
Open accessAbstract
OBJECTIVES: Disparities in diagnosis and treatment of racial minorities exist in the emergency department (ED). A better understanding of how physician implicit (unconscious) bias contributes to these disparities may help identify ways to eliminate such racial disparities. The objective of this systematic review was to examine and summarize the evidence on the association between physician implicit racial bias and clinical decision making. METHODS: Based on PRISMA guidelines, a structured electronic literature search of PubMed, CINAHL, Scopus, and PsycINFO databases was conducted. Eligible studies were those that: 1) included physicians, 2) included the Implicit Association Test as a measure of implicit bias, 3) included an assessment of physician clinical decision making, and 4) were published in peer-reviewed journals between 1998 and 2016. Articles were reviewed for inclusion by two independent investigators. Data extraction was performed by one investigator and checked for accuracy by a second investigator. Two investigators independently scored the quality of articles using a modified version of the Downs and Black checklist. RESULTS: Of the 1,154 unique articles identified in the initial search, nine studies (n = 1,910) met inclusion criteria. Three of the nine studies involved emergency providers including residents, attending physicians, and advanced practice providers. The majority of studies used clinical vignettes to examine clinical decision making. Studies that included emergency medicine (EM) providers had vignettes relating to treatment of acute myocardial infarction, pain, and pediatric asthma. An implicit preference favoring white people was common across providers, regardless of specialty. Two of the nine studies found evidence of a relationship between implicit bias and clinical decision making; one of these studies included EM providers. This one study found that EM and internal medicine residents who demonstrated an implicit preference for white individuals were more likely to treat white patients and not black patients with thrombolysis for myocardial infarction. Evidence from the two studies reporting a relationship between physician implicit racial bias and decision making was low in quality. CONCLUSIONS: The current literature indicates that although many physicians, regardless of specialty, demonstrate an implicit preference for white people, this bias does not appear to impact their clinical decision making. Further studies on the impact of implicit racial bias on racial disparities in ED treatment are needed.
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Multicollinearity was assessed using variance inflation factors; all VIF values were less than 5, and no covariates were eliminated or combined due to multicollinearity.
“Multicollinearity was assessed using variance inflation factors (VIF); all VIF values were less than 5, and no covariates were eliminated or combined due to multicollinearity.”
From Racial and ethnic disparities in interhospital transfer for complex emergency general surgical disease across the United States (2023) · cites this paper as [28]
The Results and Quality Assessment sections describe study selection and quality scoring, not a multicollinearity analysis. Searches for variance inflation factors, VIF values below 5, and covariates being eliminated or combined found no passage addressing the claim. Page numbers were not available in our copy. (LLM, conf=0.76)
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- Authors
- Dehon, E., Weiss, N., Jones, J., Faulconer, W., Hinton, E., & Sterling, S.
- Affiliations
- University of Mississippi Medical Center (US)
- Yale University (US)
- Corresponding author
- Dehon, Erin
- Venue
- Academic Emergency Medicine
- Publisher
- Wiley
- Published
- 2017-06-19
- Volume
- 24
- Issue
- 8
- Pages
- 895-904
- ISSN
- 1069-6563 (ISSN-L)
- 1553-2712
- OpenAlex
- W2611179471
- Cited by
- 404
- References
- 40
- Citations by year
- 2026: 25 · 2025: 37 · 2024: 51 · 2023: 64 · 2022: 74 · 2021: 71 · 2020: 45 · 2019: 26 · 2018: 8 · 2017: 2
- FWCI
- 6.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Academic Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Social Sciences › Gender Studies › Diversity and Career in Medicine
- Keywords
- implicit racial bias, physician bias, clinical decision-making, racial disparities, emergency department care, Implicit Association Test, acute myocardial infarction, thrombolysis, pain management, childhood asthma, racial minorities, medical residents
- MeSH terms
- Clinical Decision-Making, Attitude of Health Personnel, Black or African American, Decision Making, Emergency Service, Hospital, Humans, Internal Medicine, Internship and Residency, Physicians, White People, Healthcare Disparities, Racism
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