Publication Date



residency, bias, inpatient, training


Background: The utilization of patient characteristics can allow health care providers to arrive at diagnosis or decide on treatment options; however, the subjective nature of patient characterization can negatively affect patient care. A 2003 Institute of Medicine report, called Unequal Treatment, recognized that bias or stereotyping may affect provider-patient communication or the care offered.

Purpose: To investigate residents’ recognition of bias in an inpatient care setting.

Methods: In order to explore the topic of bias among providers, we elected to indirectly assess its recognition among providers by asking their opinion in an anonymous manner about their fellow residents. This, we thought, would remove the issue of self-judgment and make it easier for responders to reflect on their observations. We asked residents the following two-step question: “Have you observed a colleague of yours SAY, PORTRAY, or ACT in a biased manner toward a patient while providing inpatient service?” If the answer was yes, we subsequently asked them to elaborate on the bias.

Results: The survey was sent to 39 postgraduate internal medicine residents in their first to third year of training. Half of the responders (20/39) were female. The response rate was 100%, and 46% (18/39) reported observing their colleague(s) being biased toward patients. Of those who reported bias, 77.8% (14/18) reported one or more examples about the content of the perceived bias. The largest category of these, at 42.8% (9/21), regarded bias toward patients with past or current “drug/substance abuse” or “narcotic seeking” behavior; 14.3% (3/21) involved patients with repeated admissions or so-called “frequent fliers”; 9.5% (2/21) related to race/ethnicity; 14.3% (3/21) indicated providers not wanting to care for patients who were perceived to be “difficult.” Interestingly, another 9.5% (2/21) reported witnessing preferential service for “affluent/VIP” patients. Other examples included bias against obese patients, female patients and general stereotyping with no specifics given.

Conclusion: The majority of resident physicians did recognize bias in their colleagues’ approach to patient care. Given the evidence that implicit bias can be recognized and improved upon, this study reinforces the need for implicit bias training/ discussion to be included in residency programs.