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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.

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|April 20, 2026
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Summary

Pediatric orthopaedic providers show implicit bias favoring abled patients, even those with complex care needs. This unconscious bias persists regardless of provider background, highlighting the need for targeted education and awareness to improve care for patients with disabilities.

Keywords:
DisabilityImplicit association test (IAT)Implicit biasNeuromuscularOrthopaedic surgery

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Area of Science:

  • Orthopaedic Surgery
  • Healthcare Disparities
  • Implicit Bias Research

Background:

  • Implicit bias among healthcare providers can impact clinical decisions and patient outcomes.
  • Unconscious attitudes in pediatric orthopaedics may affect care delivery for patients with complex needs, particularly those with neuromuscular conditions.
  • This study investigated implicit disability bias in pediatric orthopaedic providers and its potential influencing factors.

Purpose of the Study:

  • To assess implicit disability bias among pediatric orthopaedic providers.
  • To examine if demographic, educational, or experiential factors influence these bias levels.
  • To understand the prevalence of implicit bias in the context of complex care delivery.

Main Methods:

  • A national survey of pediatric orthopaedic providers using the Implicit Association Test (IAT) to measure bias.
  • IAT scores (D-scores) were calculated based on response speed and accuracy.
  • Statistical analyses included Fisher's exact tests and Wilcoxon/Kruskal-Wallis rank sum tests, with adjustments for false discovery rates.

Main Results:

  • Out of 183 providers, 86 fully completed the IAT; 73% demonstrated a strong implicit preference for abled patients.
  • No significant differences in bias levels were found across demographic, educational, or occupational characteristics (P > .05).
  • Providers working with complex care patients also showed a strong preference for the physically abled (93%).

Conclusions:

  • Pediatric orthopaedic providers exhibit significant implicit bias favoring abled patients, irrespective of their background or experience.
  • Exposure to complex care patients did not mitigate this bias, indicating a need for targeted interventions.
  • Addressing implicit bias through education and awareness is crucial to reduce potential inequities in patient care.