• Jürgen Grafeneder, Andjela Baewert, Henri Katz, Anita Holzinger, Jan Niederdoeckl, and Dominik Roth.
• Department of Emergency Medicine, Medical University of Vienna.
• Eur J Emerg Med. 2023 Dec 1; 30 (6): 417423417-423.

Background And ImportanceRacial bias is found in both physicians and medical students. Immigrants in many parts of the world face challenges similar to racial minorities. Identification of immigrants might however be more subtle than identification by race, and currently, no data are available on a possible bias against the large minority group of migrants in Europe.DesignRandomized control trial.Settings And ParticipantsSecond-year medical students were randomized into four groups to watch a video of either a male or female patient with pain, with or without immigrant status.InterventionStudents were asked whether they would administer pain medication (primary outcome).Outcome Measures And AnalysisImmigrant status, patient's gender, student's gender, age, and language skills were covariates in a logistic regression model. Secondary outcomes included pain medication potency and the student's rating of the patient's pain intensity.Main ResultsWe recruited 607 students [337 females (56%), 387 (64%) between 18 and 22 years old]. Analgesia was administered in 95% (n = 576). Immigrant status was not associated with the probability of receiving pain medication [95 vs. 95%, odds ratio (OR) 0.81, 95% confidence interval (CI) 0.39-1.70, P  = 0.58]. Immigrants received high-potency analgesia less often (26 vs. 33%, OR 0.69, 95% CI 0.50-0.96, P  = 0.03). Female students administered pain medication more frequently (96 vs. 93%, OR 2.29, 95% CI 1.05-5.02, P  = 0.04), and rated the patients' pain higher (mean numeric rating scale 7.7, SD 0.9 vs. 7.4, SD 1.0, OR 1.36, 95% CI 1.16-1.60, P  < 0.001).ConclusionMedical students showed no immigration bias with regard to administering pain medication but were less likely to choose high-potency analgesia in immigrants. We also found a gender difference in pain management. These results demonstrate the importance of including knowledge about immigration bias in medical training.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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