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Implicit Racial Bias in Pediatric Orthopaedic Surgery.

Ryan Guzek1, Christine M Goodbody1, Lori Jia2

  • 1Division of Orthopaedic Surgery, Children's Hospital of Philadelphia.

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Summary

Most pediatric orthopaedic surgeons exhibit implicit racial bias, with a significant portion showing a strong pro-White bias. However, this bias did not appear to influence clinical decisions regarding pediatric fracture management in this study.

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Area of Science:

  • Medical research
  • Health equity
  • Socio-medical sciences

Background:

  • Healthcare disparities persist for racial and ethnic minority patients.
  • Provider-level factors, including implicit bias, may contribute to health inequities.
  • Understanding implicit racial bias in pediatric orthopaedics is crucial for addressing disparities.

Purpose of the Study:

  • To assess implicit racial bias in pediatric orthopaedic surgeons.
  • To investigate the correlation between implicit bias and clinical decision-making.
  • To compare surgeons' bias levels with national physician and general population data.

Main Methods:

  • A web-based survey including a child-race implicit association test (IAT) was administered to 415 pediatric orthopaedic surgeons.
  • Surgeons' IAT scores were compared to US physician and general population data.
  • Clinical vignettes were used to assess decision-making, with surgeons randomly assigned race-specific versions (White or Black).

Main Results:

  • A 29% response rate yielded data from 119 surgeons.
  • 87% of surgeons displayed some level of implicit racial bias, with 29% showing strong pro-White bias.
  • Surgeons with strong pro-White bias exceeded rates in US physicians and the general population, but no significant differences were found in clinical decisions based on bias concordance.

Conclusions:

  • The majority of surveyed pediatric orthopaedic surgeons demonstrated implicit racial bias, a notable percentage exhibiting strong pro-White bias.
  • No evidence was found linking implicit racial bias to the management decisions for pediatric fractures in this study.
  • Further research is needed to explore the complex relationship between implicit bias and clinical practice in orthopaedics.