Ethnic bias and clinical decision-making among New Zealand medical students: an observational study

BMC Med Educ. 2018 Jan 23;18(1):18. doi: 10.1186/s12909-018-1120-7.


Background: Health professional racial/ethnic bias may impact on clinical decision-making and contribute to subsequent ethnic health inequities. However, limited research has been undertaken among medical students. This paper presents findings from the Bias and Decision-Making in Medicine (BDMM) study, which sought to examine ethnic bias (Māori (indigenous peoples) compared with New Zealand European) among medical students and associations with clinical decision-making.

Methods: All final year New Zealand (NZ) medical students in 2014 and 2015 (n = 888) were invited to participate in a cross-sectional online study. Key components included: two chronic disease vignettes (cardiovascular disease (CVD) and depression) with randomized patient ethnicity (Māori or NZ European) and questions on patient management; implicit bias measures (an ethnicity preference Implicit Association Test (IAT) and an ethnicity and compliant patient IAT); and, explicit ethnic bias questions. Associations between ethnic bias and clinical decision-making responses to vignettes were tested using linear regression.

Results: Three hundred and two students participated (34% response rate). Implicit and explicit ethnic bias favoring NZ Europeans was apparent among medical students. In the CVD vignette, no significant differences in clinical decision-making by patient ethnicity were observed. There were also no differential associations by patient ethnicity between any measures of ethnic bias (implicit or explicit) and patient management responses in the CVD vignette. In the depression vignette, some differences in the ranking of recommended treatment options were observed by patient ethnicity and explicit preference for NZ Europeans was associated with increased reporting that NZ European patients would benefit from treatment but not Māori (slope difference 0.34, 95% CI 0.08, 0.60; p = 0.011), although this was the only significant finding in these analyses.

Conclusions: NZ medical students demonstrated ethnic bias, although overall this was not associated with clinical decision-making. This study both adds to the small body of literature internationally on racial/ethnic bias among medical students and provides relevant and important information for medical education on indigenous health and ethnic health inequities in New Zealand.

Keywords: Bias and Decision-Making in Medicine (BDMM) study; Clinical decision-making; Implicit association test; Medical students; Māori; New Zealand; Racial/ethnic bias; Vignettes.

MeSH terms

  • Attitude of Health Personnel
  • Cardiovascular Diseases / ethnology*
  • Cardiovascular Diseases / therapy
  • Clinical Decision-Making*
  • Cross-Sectional Studies
  • Depression / ethnology*
  • Depression / therapy
  • Ethnicity*
  • Female
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Male
  • New Zealand
  • Physicians
  • Racism / psychology
  • Racism / statistics & numerical data*
  • Social Class
  • Social Desirability
  • Students, Medical / psychology*
  • Young Adult