A STUDY OF COVERT CULTURAL BIAS IN PHYSICAL THERAPY STUDENTS. Shannon J. Shillin*; Valerie J. Lee; Bini Litwin; Nicole A. Pierre-Louis; Raylene Z. Thomas Physical Therapy, Nova Southeastern University, Ft. Lauderdale, FL PURPOSE: The purpose of this study was (1) to determine if a physical therapy student's ethnicity affects how they are rated by their peers and (2) to determine if a physical therapist student's ethnicity affects how they rate their peers. BACKGROUNDS/SIGNIFICANCE: The United States is increasingly more diverse, requiring physical therapists to develop skills that demonstrate cultural competence. Current evidence demonstrates that cultural and ethnic bias exists in healthcare, which can impact patient satisfaction and outcomes. Haskins (1997) study of physical therapy clinicians found that covert bias exists in clinical evaluations of physical therapy students. This study builds on Haskins' work, looking at bias within the physical therapy student population. Gaining knowledge about bias among students can provide a framework to develop proactive strategies in academic and clinical settings that will encourage PT students to be culturally competent clinicians. The promotion of culturally competent PT students is in keeping with the physical therapy community's commitment to promoting culturally competent clinicians. SUBJECTS: 71 1st and 2nd year physical therapy Masters level students from 2 SE Florida Universities served as subjects for this study. Subjects consisted of 23 males and 52 females. The 71 subjects described their race/ethnicity as: 35 Caucasian, 19 Hispanic, 8 Black, 6 Asian, 3 Other, 0 Native American. Subject's ages ranged from 21 to 55. METHODS AND MATERIALS: A quasi-experimental approach was performed using a sample of convenience. Four actors (1 Hispanic, 1 Black, 1 Caucasian, 1 Asian) were videotaped posing as physical therapy students presenting a patient progress report. The videotapes used identical scripts to present patient information. Each subject was randomly assigned a color-coded survey and divided into 4 groups to view 1 of the 4 videotapes. Directions and a background case study were given to subjects prior to viewing the assigned tape. Subjects rated the student physical therapists performance on a questionnaire after viewing the video. The self-designed questionnaire included a demographic section, and a rating section that consisted of 8 closed-ended Likert-type questions on a 1-5 scale and four open-ended questions. The closed ended questions rated content, delivery and overall presentation. The open-ended questions provided an opportunity for comments on ratings assigned. Each group independently viewed and rated the assigned videotape, with no interaction permitted between groups. A pilot study was utilized to obtain feedback on the questionnaire and establish content validity of the questions. ANALYSES: The Kruskel-Wallis test was used to measure the difference between multiple independent variables. Statistical significance was not found in student ratings of their peers in 7 of 8 questions. The thoroughness of report category was found to be statistically significant (.017), with a p-value set at .05. RESULTS: Only 1 area (thoroughness of report) was found to be statistically sifnificant, however trends were noted in several areas: The Caucasian PT student was rated the highest in 7 of 8 categories, and the Asian was rated the highest in the overall presentation category. The Black PT student was rated lowest in the overall presentation and in presentation areas of confidence and interest. The Hispanic PT student was rated lowest in content areas, including communication, thoroughness, organization, clarity and competence. Responses to open-ended questions did not support numerical ratings, with negative comments noted in areas where ratings were neutral or positive. Neutral ratings were used most often in rating the Hispanic PT student (38%), although neutral ratings were evident in all ethnic categories e.g. Caucasian 26%, Black 29%, and Asian 30%. Ethnicity of raters may also influence peer ratings, with African American raters giving the lowest ratings overall and Hispanic raters giving the highest ratings overall, regardless of ethnicity of student evaluated. It is also interesting to note African Americans rated Asians and Caucasians lower than other raters and conversely, Caucasians and Asians rated African Americans and Hispanics lower than other groups. Although not statistically significant in 7 of 8 categories, these findings may indicate ethnic clustering of groups influence peer evaluation. CONCLUSIONS: Ethnicity was not shown to be a predictor of how physical therapy students rate their peers in areas other than thoroughness of report. However, these findings indicate that covert bias may influence physical therapy students' evaluative judgments of their peers since ratings varied in areas of both content and delivery although the same content was delivered by all students. Ratings may be influenced by both the ethnicity of the rater and the ethnicity of the student being rated. The number of neutral responses and incompatibility of ratings with open ended questions may also indicate that physical therapy students are reluctant to evaluate their peers. The use of a 5-point likert scale may also have limited the range of scores. These findings are compatible with Haskins (1997) study, which found Caucasians rated the highest and Blacks rated the lowest overall by physical therapists. The influence of ethnicity in providing evaluative judgments as well as a reluctance on the part of physical therapy students to provide evaluative judgments of their peers may negatively impact effective teamwork and patient outcomes in a clinical setting. Further research is indicated to determine the various factors e.g. prior experience, age, and gender that may influence peer evaluations conducted by physical therapy students. FUNDING SOURCE: No funding received or anticipated. KEYWORDS: students, cultural diversity, covert bias Copyright 2009 by the American Physical Therapy Association. Requests for reprints should be directed to the corresponding author of the article. Educators, students, and other academic customers may receive permission to reprint copyrighted material from Physical Therapy (ISSN 1538-6724) by contacting the Copyright Clearance Center Inc, 222 Rosewood Dr, Danvers, MA 01923. 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