Effect of Physician Race and Gender on Simulated Patients' Ratings

Yale University

Status: Completed

Conditions: Physician-Patient Relations; Patient Satisfaction; Bias, Sex; Bias, Racial

Treatments: Behavioral: Simulated White Male Physician; Behavioral: Simulated Black Female Physician; Behavioral: Simulated White Female Physician; Behavioral: Simulated Black Male Physician

Study type: Interventional

Funder types: Other

Identifiers

NCT04190901

2000022317

12916

9068 (Other Identifier)

Details and patient eligibility

About

The purpose of the study was to determine whether the race and gender of a simulated doctor affected analog patients' reported confidence and satisfaction in the simulated doctor's diagnosis and treatment plan. The study used two randomized patient analog experiments.

This study is complete and pre-analysis plans (PAPs) for each experiment were published prior to data collection. The PAPs are available at: http://aspredicted.org/blind.php?x=43xj25 (Study 1) and https://aspredicted.org/blind.php?x=369st7 (Study 2).

Full description

Prior literature is unclear on whether patients display bias in their evaluations of physicians based on their race or gender. The investigators estimated the effects of physician race and gender using an online clinical vignette. Participants played the role of analog patients reporting to the Emergency Department (ED) with symptoms consistent with gastroenteritis. Participants were provided with a diagnosis of gastroenteritis by a simulated ED physician. The race (black or white) and gender (male or female) of the simulated physician was randomly assigned in a 2x2 factorial experiment. Simulated physicians provided a diagnosis of gastroenteritis and contradicted by an Online Symptom Checker. Following the physician's diagnosis and contradiction by the Online Symptom Checker, participants rated the simulated physician on survey measures of satisfaction and confidence in both the treatment plan and diagnosis. The main (null) hypothesis tested was that there were no differences across the four treatment arms (Black Female, Black Male, White Female, White Male). Participants for the first experiment (Study 1) were recruited from Amazon Mechanical Turk (MTurk) and participants for the second experiment (Study 2) were recruited from Lucid.

Primary Aim: To determine whether the race and gender of a simulated physician had a causal effect on participants' confidence and satisfaction in the physician's diagnosis and treatment plan in an ED setting.

Exploratory Aims: To determine whether the race and gender of a simulated physician had a casual effect on participants' perceptions of the warmth and competence of the physician, their willingness to sue or complain about the physician for an incorrect diagnosis, and their perceived fairness of the charge for the visit.

Enrollment: 3,592 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Adults over 18 years old

Exclusion criteria

• Participants who reported current pregnancy
• Participants who reported a current or prior diagnosis of cancer
• Participants who reported a history of abdominal surgery

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: None (Open label)

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3,592 participants in 4 patient groups

Simulated Black Male Physician

Experimental group

Description:

Participants are randomized to view the clinical vignette with a simulated Black Male physician.

Treatment:

Behavioral: Simulated Black Male Physician

Simulated Black Female Physician

Experimental group

Description:

Participants are randomized to view the clinical vignette with a simulated Black Female physician.

Treatment:

Behavioral: Simulated Black Female Physician

Simulated White Male Physician

Experimental group

Description:

Participants are randomized to view the clinical vignette with a simulated White Male physician.

Treatment:

Behavioral: Simulated White Male Physician

Simulated White Female Physician

Experimental group

Description:

Participants are randomized to view the clinical vignette with a simulated White Female physician.

Treatment:

Behavioral: Simulated White Female Physician