Using the Implicit Association Test to Address Healthcare Disparities in Minority Patients: Initiating the Discussion in an Orthopedic Surgery Cohort

Healthcare disparities have become a notable topic of research in the last decade. Within orthopedics, minority patients experience these disparities via increased lengths of stay, higher 30-day hospital readmission rates, and poor patient reported outcomes. One possible cause for these disparities is implicit bias held by providers. The aims of this study were to assess the current state of implicit racial biases among orthopedic surgeons at various stages of training and to review the current literature involving effects of implicit bias on healthcare and patient outcomes. Orthopedic surgery medical student subinterns, residents, and attendings at an urban academic medical center were provided an anonymous, voluntary survey to document the results of an online Implicit Association Test (IAT) specifically focusing on race. These results were compared among the three groups and to that of the general population. Our results demonstrated that medical students and residents mirror the general population with an inherent preference for White over Black people. Attendings differed significantly from the general population with the most common result being little to no preference for either race. This small pilot study demonstrated varied IAT results, with both medical students and residents showing a preference for White over Black people, as compared to attendings who showed no preference for either race. Given the small cohort, it is difficult to generalize this data. Regardless, implicit racial biases are prevalent and can lead to poor patient interactions and worse clinical outcomes. The IAT provides a reliable assessment tool for implicit bias and can help guide interventions. Initiating this discussion is invaluable within orthopedics, but more research with larger cohorts is needed to evaluate feasibility of assessing bias and identify successful methods of reducing it.