Ethnic bias and clinical decision-making among New Zealand medical students: an observational study

Harris, Ricci; Cormack, Donna; Stanley, James; Curtis, Elana; Jones, Rhys; Lacey, Cameron

doi:10.1186/s12909-018-1120-7

BMC Medical Education

Table 4 Associations between ethnic bias measures (implicit and explicit) and student diagnosis and treatment in vignettes by patient ethnicity

From: Ethnic bias and clinical decision-making among New Zealand medical students: an observational study

Cardiovascular disease vignette	Patient Described as:				Difference in
Vignette question	NZ European		Māori		slope (NZE-Māori)	p-value
-bias measure	n	slope (95% CI)	n	slope (95% CI)	(95% CI)
Please assess the likelihood that Mr. [Wiremu’s/Williams’] pain is due to coronary artery disease^a
-IAT ethnicity preference	95	−0.11 (− 0.63, 0.41)	103	− 0.15 (− 0.63, 0.32)	0.04 (− 0.66, 0.75)	0.906
-IAT ethnicity and compliant patient	75	0.17 (− 0.57, 0.91)	69	0.02 (− 0.67, 0.72)	0.15 (− 0.87, 1.16)	0.777
-explicit ethnic preference	118	0.03 (−0.23, 0.30)	115	− 0.08 (− 0.34, 0.18)	0.12 (− 0.26, 0.49)	0.539
-explicit ethnic warmth difference	118	0.01 (− 0.18, 0.19)	115	0.11 (−0.08, 0.30)	− 0.10 (− 0.37, 0.17)	0.456
Using the information available, what would your recommendation be regarding thrombolysis for Mr. [Wiremu/Williams] when you discuss this case with your consultant?^b
-IAT ethnicity preference	95	0.56 (0.10, 1.03)	103	−0.23 (− 0.65, 0.19)	0.79 (0.17, 1.42)	0.013
-IAT ethnicity and compliant patient	75	0.68 (0.00, 1.35)	69	−0.09 (− 0.72, 0.54)	0.77 (− 0.16, 1.69)	0.104
-explicit ethnic preference	118	−0.03 (− 0.28, 0.21)	115	− 0.28 (− 0.52, − 0.03)	0.24 (− 0.11, 0.59)	0.173
-explicit ethnic warmth difference	118	0.08 (− 0.09, 0.26)	115	−0.12 (− 0.30, 0.06)	0.20 (− 0.05, 0.45)	0.120
If Mr. [Wiremu/Williams] refuses thrombolysis, how would you describe your subsequent management regarding thrombolysis?^c
-IAT ethnicity preference	95	0.39 (−0.06, 0.84)	103	0.41 (0.00, 0.82)	−0.02 (− 0.63, 0.59)	0.946
-IAT ethnicity and compliant patient	75	0.47 (−0.15, 1.08)	69	0.27 (−0.31, 0.84)	0.20 (−0.64, 1.05)	0.634
-explicit ethnic preference	118	0.09 (−0.15, 0.32)	115	−0.04 (− 0.28, 0.19)	0.13 (− 0.20, 0.46)	0.438
-explicit ethnic warmth difference	118	0.07 (−0.10, 0.23)	115	−0.07 (− 0.24, 0.10)	0.13 (− 0.11, 0.37)	0.277
Depression vignette	Patient described as:				Difference in
Vignette question	NZ European		Māori		slope (NZE-Māori)	p-value
-bias measure	n	slope (95% CI)	n	slope (95% CI)	(95% CI)
Please assess the likelihood that Mr. [Tipene/Stephens’s] symptoms are due to depression^a
-IAT ethnicity preference	105	0.00 (− 0.33, 0.33)	93	−0.25 (− 0.60, 0.10)	0.25 (− 0.24, 0.73)	0.316
-IAT ethnicity and compliant patient	71	−0.09 (− 0.60, 0.42)	73	0.00 (− 0.53, 0.53)	−0.09 (− 0.83, 0.64)	0.801
-explicit ethnic preference	122	−0.02 (− 0.21, 0.17)	111	0.02 (− 0.17, 0.20)	−0.04 (− 0.30, 0.22)	0.768
-explicit ethnic warmth difference	122	0.06 (−0.09, 0.21)	111	0.03 (−0.09, 0.15)	0.03 (−0.16, 0.22)	0.754
Based on the information you have, how would you rate the severity of Mr. [Tipene/Stephens’s] symptoms?^d
-IAT ethnicity preference	105	0.14 (−0.08, 0.35)	93	−0.05 (− 0.28, 0.18)	0.18 (− 0.13, 0.50)	0.257
-IAT ethnicity and compliant patient	71	0.07 (−0.24, 0.38)	73	−0.21 (− 0.53, 0.11)	0.28 (− 0.16, 0.72)	0.212
-explicit ethnic preference	122	−0.01 (− 0.13, 0.11)	111	− 0.07 (− 0.19, 0.04)	0.06 (− 0.10, 0.23)	0.466
-explicit ethnic warmth difference	122	− 0.03 (− 0.12, 0.07)	111	0.05 (− 0.03, 0.12)	−0.07 (− 0.20, 0.05)	0.236
Please rate the likelihood that Mr. [Tipene/Stephens] will benefit from your selected initial management approach^e
-IAT ethnicity preference	105	0.04 (−0.31, 0.40)	93	−0.02 (− 0.40, 0.36)	0.06 (− 0.46, 0.59)	0.811
-IAT ethnicity and compliant patient	71	−0.17 (− 0.69, 0.35)	73	0.20 (− 0.34, 0.73)	−0.37 (− 1.11, 0.38)	0.330
-explicit ethnic preference	122	0.36 (0.17, 0.54)	111	0.02 (−0.16, 0.20)	0.34 (0.08, 0.60)	0.011
-explicit ethnic warmth difference	122	−0.19 (− 0.34, − 0.04)	111	−0.08 (− 0.20, 0.04)	−0.11 (− 0.30, 0.09)	0.285

^aResponse options (1 = very unlikely (< 20%), 2 = somewhat unlikely (20–40%), 3 = as likely as not (41–59%), 4 = somewhat likely (60–80%), 5 = very likely (> 80%))
^bResponse options reverse scored so (1 = would definitely NOT recommend thrombolysis, 2 = would probably NOT recommend thrombolysis, 3 = not sure, 4 = would probably recommend thrombolysis, 5 = would definitely recommend thrombolysis)
^cResponse options (1 = I would not try to persuade him any further to 5 = I would try very hard to persuade him)
^dResponse options (1 = none-slight, 2 = mild, 3 = moderate, 4 = severe)
^eResponse options (1 = very unlikely, 2 = somewhat unlikely, 3 = as likely as not, 4 = somewhat likely, 5 = very likely)

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