Impact of Implicit Gender Bias on Perception of Leadership and Team Performance in Pediatric CPR

Introduction: Implicit gender bias (IGB) is present in healthcare professionals, impacting women leaders’ advancement in academic medicine. It is unknown whether IGB hinders leadership and team performance in the PICU. We hypothesize a clinician with stronger IGB will rate female’s leadership and team performance lower than male’s performance.


Methods: We designed a prospective study at a quaternary, US children’s hospital using a video-recorded, scripted pediatric CPR simulation. We recruited multidisciplinary participants who routinely have resuscitation roles. After receiving orientation to use Concise Assessment of Leadership Management Tool (CALM) for leadership and Team Emergency Assessment Measure (TEAM) for team performance, they rated leadership and team performance of two versions of identical resuscitation videos in a randomized order, where the only difference was the team leader gender. Leaders were unknown to the participants. After rating videos, participants completed Harvard Gender-Career Implicit Association Test (IAT) for IGB. We compared the score difference (female-male) between male-career-biased vs. non-biased participants using t-test and linear regression to account for confounders.


Results: 282 participants (63 physicians, 164 nurses, 29 respiratory therapists, 26 other) completed the study. Most were young (75% 18-34 yr), female (91%), and white (83%). 74% had male-career bias. The female leader and female-led team were rated higher for both CALM (difference: 3.7±8.7) and TEAM scores (difference: 1.8±6). Score difference (female-led minus male-led) was higher in both male-career biased and non-biased participants. However, the differences between biased vs. non-biased did not differ significantly: CALM 4.2 ± 8.4 vs.2.4±9.4, p=0.12; TEAM 1.9±5.8 vs.1.5±6.6, p=0.59. After adjusting for raters’ gender and video order, the insignificance of raters’ male-career bias remained (p=0.15 for CALM; p=0.58 for TEAM). Video order was not associated with score difference (p=0.65).


Conclusions: Contrary to our hypothesis, female leaders were rated higher regardless of participants’ IGB. It is unclear whether this finding is related to the study location with a large population of female clinicians. Future study is needed in different clinical settings.