Does Disability Bias Exist in Pediatric Orthopaedic Surgery?
Taylor M Adams1, Maria F Canizares1, Shanika D Silva1
1Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Background:
Implicit bias among health care providers can influence clinical decision-making and patient outcomes. These unconscious attitudes may be subtly shaping health care interactions and priorities in orthopaedics for complex care delivery in neuromuscular patients. This study assessed implicit disability bias among pediatric orthopaedic providers and examined whether factors such as race, gender, education level, medical specialty, and prior experience working with individuals with disabilities influenced bias levels.
Methods:
Members of a national pediatric orthopaedic organization were invited via email to complete a Qualtrics survey assessing implicit bias in orthopaedics. Implicit association test (IAT) scores (D-scores) were calculated based on respondent speed and accuracy. Statistical analyses included Fisher's exact tests for categorical data and Wilcoxon rank sum or Kruskal-Wallis rank sum tests for continuous data. The Benjamini-Hochberg procedure adjusted P values to control for false discovery rates.
Results:
Of the 183 providers surveyed, 86 (47%) fully completed the IAT, while 97 (53%) partially completed it. Among full respondents, 71% were male and 29% female, with a mean age range of 35-52 years. IAT scores showed that 73% of providers had a strong preference for abled patients. No significant differences in levels of bias were found across' demographic, educational, and occupational characteristics (P > .05). Providers working primarily with complex care patients also showed a strong preference for the physically abled (n = 80, 93%).
Conclusions:
Pediatric orthopaedic providers exhibited a moderate-to-strong implicit preference for abled patients, regardless of background or experience. These biases persisted even among those frequently treating complex care patients, suggesting that exposure alone may not mitigate bias. Increased education and awareness are needed to address implicit attitudes and their potential impact on patient care. Further research is needed to understand its impact on the care delivered to complex care patients.
Key Concepts:
(1)Disability bias refers to negative attitudes or beliefs about people with disabilities that operate either explicitly or implicitly.(2)Pediatric orthopaedic surgeons demonstrated a strong implicit preference for abled individuals, regardless of provider's background or experience.(3)Implicit bias can undermine communication, skew clinical judgment, and contribute to inequities in access and quality of care for patients with disabilities.(4)Mitigating disability bias requires coordinated strategies that combine individual awareness, disability-focused education, and system-level policies that prioritize accessibility and inclusion.
Level Of Evidence:
Level IV.
