Does Implicit Bias Influence Medical Decision-Making? Developing and Validating Novel Models and Outcome Metrics

Abstract Implicit, or unconscious, bias may contribute to health disparities via two facets of clinical practice behaviors: communication patterns and medical decision-making. The evidence for a correlation between physician racial implicit bias and disparities in communication by physicians with Black and White patients is strong. In contrast, research investigating the relationship between physician racial implicit bias and medical decision-making, has led to conflicting results. Moreover, investigators seeking to design skills-based interventions to enable physicians to recognize their biases and mitigate their influence on their clinical practice behaviors are limited by the lack of validated outcome metrics, such as checklists and global rating scales. In this proposal Dr. Cristina Gonzalez seeks to build on her expertise as a medical educator and qualitative researcher with new skills in standardized patient case development, psychometric measurement, validity evidence, statistical analysis, and clinical study design. The objectives of the proposal are to develop novel outcome metrics to assess both physician communication and medical decision-making and correlate them with implicit bias. Dr. Gonzalez will design high-fidelity standardized patient cases. Through a mixed-method approach, she will develop novel outcome measures in the form of validated checklists and global rating scales to assess specific clinical practice behaviors. The final aim of this proposal is a clinical study to examine any correlation between implicit bias and medical decision-making. The outcome of this final aim will address an important gap in knowledge relevant to the design future intervention studies. Dr. Gonzalez will emerge from this K award transformed from a medical educator into a clinician investigator able to conduct multi-institution intervention studies addressing physician racial implicit bias and patient outcomes.