New research has found evidence of ethnic bias among medical students in New Zealand.

The Bias and Decision-Making in Medicine (BDMM) study was conducted to assess ethnic bias towards Māori and New Zealand European patients among final year medical students.

The research was undertaken by Ricci Harris, Donna Cormack, Rhys Jones and Elana Curtis from the University of Auckland, and James Stanley and Cameron Lacey from the University of Otago.

Drawing from both University of Auckland and University of Otago, all 888 final year New Zealand medical students in 2014 and 2015 were invited to participate in an anonymous, cross-sectional online study.

The study included two chronic disease vignettes with randomly-assigned patient ethnicity, two measures of implicit bias, and measures of explicit bias, such as warmth towards ethnic groups and perceptions of the compliance and competence of patient groups.

From the 302 respondents (34% response rate), the study found evidence of both implicit and explicit racial/ethnic bias favouring New Zealand European relative to Māori patients.

Findings showed a ‘moderate’ implicit bias towards NZ European patients and a ‘slight’ implicit bias towards perceiving these patients as more compliant.

However no evidence of links to clinical decision-making were found.

Medical training can play an important role in improving the health of indigenous people and advancing an equitable health system in every country.

However despite widespread acknowledgement of ethnic biases among healthcare professionals, limited research has been done into the biases of medical students.

Researcher and senior lecturer at University of Auckland’s Te Kupenga Hauora Māori Dr Rhys Jones says there is scope to extend study in this emerging field, in particular to explore questions of how such bias might change over the course of a career and whether interventions in healthcare settings could reduce its impact.

“Our study raises a number of potential follow-up questions in the New Zealand context, such as, ‘do medical and other healthcare professionals have similar patterns of ethnic bias to the medical students in this study, and is this similar to patterns in the general population?,” he says.

“The patterns of ethnic bias identified amongst medical students in the study are what one would expect based on research in other populations. We live in a racialised society, in which we are all exposed to social narratives that draw on racist ideologies. Like everyone else, medical students are susceptible to ethnic bias based on these.”

It is also possible that medical education itself contributes to ethnic bias among students, he says.

“Our medical system is rooted in colonial values and ideologies that have been instrumental in marginalising and dehumanising indigenous peoples. We should not be surprised that these values and beliefs persist and are reinforced through medical education, and can act to augment the effect of wider social narratives on the development of ethnic bias among medical students and doctors.

“This is why it would be useful to have longitudinal information about the extent to which ethnic bias changes over the course of medical education, training and practice, and whether ethnic bias is reinforced or attenuated at different stages.”

It is unknown how much of this could be mitigated in medical education and training.

“There is evidence from other populations that individual levels of bias can be reduced using various interventions, and that the effects of bias on behaviour can be mitigated,” says Dr Jones.

“There is also some emerging research from the US that shows including teaching on racial/ethnic bias in medical education can be helpful. We can surmise that a curriculum based on reducing the impact of ethnic bias could help to address factors that contribute to inequitable health care and outcomes.”

The researchers state that to the best of their knowledge, this is the only study of its kind undertaken in New Zealand, and one of only two known international studies examining ethnic bias among medical students and its association to clinical decision-making.

As such, it forms an important addition to existing research in this field, and the authors highlight the need for the study to be considered in medical training.

“While more research would be extremely useful, there are important interventions that we could undertake in response to the findings of the study,” says Dr Jones.

“There is evidence of implicit and explicit ethnic bias among medical students, which could potentially lead to inequitable clinical practice. Research in this area highlights the need for medical education curricula to address ethnic bias through a dedicated, longitudinal curriculum.

“It is also important that health services address factors in clinical training and health care environments that can activate or exacerbate bias among health professionals.”

The Bias and Decision-Making in Medicine (BDMM) study was published on January 23, 2018.

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