Comparison of Physician Implicit Racial Bias Toward Adults Versus Children.
The general population and most physicians have implicit racial bias against black adults. Pediatricians also have implicit bias against black adults, albeit less than other specialties. There is no published research on the implicit racial attitudes of pediatricians or other physicians toward children. Our objectives were to compare implicit racial bias toward adults versus children among resident physicians working in a pediatric emergency department, and to assess whether bias varied by specialty (pediatrics, emergency medicine, or other), gender, race, age, and year of training.



We measured implicit racial bias of residents before a pediatric emergency department shift using the Adult and Child Race Implicit Association Tests (IATs). Generalized linear models compared Adult and Child IAT scores and determined the association of participant demographics with Adult and Child IAT scores.



Among 91 residents, we found moderate pro-white/anti-black bias on both the Adult (mean = 0.49, standard deviation = 0.34) and Child Race IAT (mean = 0.55, standard deviation = 0.37). There was no significant difference between Adult and Child Race IAT scores (difference = 0.06, P = .15). Implicit bias was not associated with resident demographic characteristics, including specialty.



This is the first study demonstrating that resident physicians have implicit racial bias against black children, similar to levels of bias against black adults. Bias in our study did not vary by resident demographic characteristics, including specialty, suggesting that pediatric residents are as susceptible as other physicians to implicit bias. Future studies are needed to explore how physicians' implicit attitudes toward parents and children may impact inequities in pediatric health care.
Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pa. Electronic address: johnsont6@email.chop.edu.
Tiffani J
TJ
Johnson
Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pa.
Daniel G
DG
Winger
Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pa.
Robert W
RW
Hickey
Division of General Internal Medicine, University of Pittsburgh, and Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, Pa.
Galen E
GE
Switzer
Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pa.
Elizabeth
E
Miller
Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pa.
Margaret B
MB
Nguyen
Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pa.
Richard A
RA
Saladino
Division of General Internal Medicine, University of Pittsburgh, and Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, Pa.
Leslie R M
LR
Hausmann
D000328:Adult; D001741:Black or African American; D001291:Attitude of Health Personnel; D002648:Child; D004635:Emergency Medicine; D004636:Emergency Service, Hospital; D006801:Humans; D016014:Linear Models; D000072143:Pediatricians; D010820:Physicians; D063505:Racism; D014481:United States; D044465:White People
implicit bias; pediatric health care disparities; physician implicit attitudes; racial bias; racial disparities