215 - Increasing Awareness of Physician Implicit Bias in Youth with Adverse Childhood Experiences

Publication Number: 215.5170

Alexandria Laws, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Andrea Pinto, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Kevin C. Rix, University of Texas Health Science Center at Houston, Dallas, TX, United States; Sandra McKay, McGovern Medical School at the University of Texas Health Science Center at Houston, Missouri City, TX, United States; Chinyere O’Connor, UTHealth Houston, Houston, TX, United States; Terri L. Major-Kincade, UT Health Houston MCGovern Medical School, Richardson, TX, United States

Background: In resident physician education, there remains limited training on the role of implicit bias and social determinants of health (SDOH). This may result in poorer health outcomes for vulnerable populations. There is limited knowledge regarding resident physicians’ awareness of their personal implicit biases. This project introduces a curriculum focused on improving physician practices.

Objective: To (a) examine UTHealth pediatric residents’ recognition of health equity, SDOH, and implicit bias’ impact on children’s health, (b) enhance understanding and introduce better practice principles, and (c) assess knowledge gained on topics affecting system-impacted youth.

Design/Methods: A seven-part, weekly lecture series was developed and integrated into our program's Academic Half Day. Each 1-hr session was conducted by expert faculty, community and national leaders. Participants included pediatric residents across all training years. Lectures covered implicit bias, adverse childhood experiences, toxic stress, trauma-informed care and their impact on youth in the carceral system. Residents completed a 16-question pre-intervention survey (PreA), and a 17-question post-intervention survey (PostA) to evaluate knowledge and perceptions of these topics affecting health equity within practice. Survey score differences were examined using a two-tailed t-test.

Results: 61 residents participated in the PreA and 49 participated in the PostA. In the PreA, residents reported they believed the top three SDOH impacting youth care were financial status (31.7%), religion (15%), and zip code (14.8%). In the PostA, the top three shifted to zip code (31.3%), financial status (15%), and race (15%) (Fig. 1). On average, zip code shifted up in ranking by 1.1 points, and zip code rankings were significantly higher after the intervention (p-value = 0.02) (Fig. 2). Additionally, residents perceived lesser impact of their own implicit bias on patient care in the PostA compared to PreA (p-value < 0.01, Fig. 2). All participating residents (100%) reported the curriculum to be beneficial.

Conclusion(s): This study identifies gaps in resident understanding of SDOH and the impact of implicit bias on health disparities. Residents increasingly recognized zip code as a key factor while reporting that they believed they would be more aware of their own biases when providing patient care. These shifts suggest that enhanced training can change physician perspectives on critical health indicators. Overall, feedback was positive, emphasizing the need for ongoing interventions to address deficits impacting health outcomes in broader audiences.

Difference of Means t-Test of Pre and Post-Intervention Groups on SDOH Ranking
Figure 1. Difference of means paired t-test analysis of the unexposed (pre) and exposed (post) groups of resident physicians’ rankings of SDOH impacting health disparities. Zip code had a significant difference in the pre and post assessment rankings - moving from a mean of 4.6 to 3.5 with a p-value <0.05 (0.017).


Difference of Means t-Test of Pre and Post-Intervention: Improved Recognition of Implicit Bias Influence on Care Provided to Patients
Figure 2. Difference of means paired t-test analysis of the unexposed (pre) and exposed (post) groups of resident physicians’ assessment using Likert scale Never (1), Rarely (2), Sometimes (3), Often (4), Always (5). A lower score suggest that residents perceive that their implicit biases will have less of an impact on their patient care, as they are now more aware own implicit biases. P-value <0.01.


Pre and Post-Intervention Survey Raw Data of No. 1 Ranked SDOH Impacting Health
Figure 3. This image displays the rankings of the social determinants of health that were selected as the top choice by a group of unexposed (preA, left) and exposed (postA, right) resident pediatricians. Among the respondents in the preA, 32% identified financial status as the number one factor impacting health disparities, while 31% in the post-assessment group ranked zip code as their top choice.


Difference of Means t-Test of Pre and Post-Intervention Groups on SDOH Ranking
Figure 1. Difference of means paired t-test analysis of the unexposed (pre) and exposed (post) groups of resident physicians’ rankings of SDOH impacting health disparities. Zip code had a significant difference in the pre and post assessment rankings - moving from a mean of 4.6 to 3.5 with a p-value <0.05 (0.017).


Difference of Means t-Test of Pre and Post-Intervention: Improved Recognition of Implicit Bias Influence on Care Provided to Patients
Figure 2. Difference of means paired t-test analysis of the unexposed (pre) and exposed (post) groups of resident physicians’ assessment using Likert scale Never (1), Rarely (2), Sometimes (3), Often (4), Always (5). A lower score suggest that residents perceive that their implicit biases will have less of an impact on their patient care, as they are now more aware own implicit biases. P-value <0.01.


Pre and Post-Intervention Survey Raw Data of No. 1 Ranked SDOH Impacting Health
Figure 3. This image displays the rankings of the social determinants of health that were selected as the top choice by a group of unexposed (preA, left) and exposed (postA, right) resident pediatricians. Among the respondents in the preA, 32% identified financial status as the number one factor impacting health disparities, while 31% in the post-assessment group ranked zip code as their top choice.