Effects of Implicit Racial Bias and Standardized Patient Race on Genetic Counseling Students’ Patient-Centered Communication

ABSTRACT

Clinician racial bias has been associated with less patient-centered communication, but little is known about how it affects trainees’ communication. We investigated genetic counseling students’ communication during sessions with Black or White standardized patients (SPs) and the extent to which communication was associated with SP race or student scores on the Race Implicit Association Test (IAT). Sixty students conducted a baseline SP session and up to two follow-up sessions. Students were randomly assigned to a different White or Black SP and one of three clinical scenarios for each session. Fifty-six students completed the IAT. Session recordings were coded using the Roter Interaction Analysis System. Linear regression models assessed the effects of IAT score and SP race on a variety of patient-centered communication indicators. Random intercept models assessed the within-student effects of SP race on communication outcomes during the baseline session and in follow-up sessions (n = 138). Students were predominantly White (71%). Forty students (71%) had IAT scores indicating some degree of pro-White implicit preference. Baseline sessions with White relative to Black SPs had higher patient-centeredness scores. Within-participant analyses indicate that students used a higher proportion of back-channels (a facilitative behavior that cues interest and encouragement) and conducted longer sessions with White relative to Black SPs. Students’ stronger pro-White IAT scores were associated with using fewer other facilitative statements during sessions with White relative to Black SPs. Different patterns of communication associated with SP race and student IAT scores were found for students than those found in prior studies with experienced clinicians.

Acknowledgements

We thank Michele Massa for assistance with RIAS coding; Sara Benjamin-Neelon for input on an early draft of this manuscript; Rachel Hundert, Oluwademilade Dairo, Baridosia Kumbe, and Kinsey Cation for their roles as standardized patients; and Katherine Anderson, Leila Jamal, Jill Slamon, Cathy Lawson, JaLisa Decker, Diana Phan, Marina Dutra-Clarke, Franceska Hinkamp, and Ahna Rabani for their assistance with the standardized patient scenario scripts and training.

Disclosure statement

Debra Roter is the author of the Roter Interaction Analysis System (RIAS) and holds the copyright for the system. Johns Hopkins University also has rights to some enhancements of the system. Neither Debra Roter nor Johns Hopkins collects royalties for use of the system in research, as is the case for the current study. Debra Roter is also owner of RIAS Prime LLC, a company that provides consulting services related to doctor-patient communication and it is possible that the company may benefit indirectly from dissemination of the current research. The other authors declare no competing interests.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10410236.2024.2361583

Additional information

Funding

This work was supported by the Jane Engelberg Memorial Fellowship, an endowment from the Engelberg Foundation to the National Society of Genetic Counselors, Inc. Chenery Lowe is supported by an extramural grant from the National Human Genome Research Institute of the National Institutes of Health under award number T32HG008953.