Hospital-Based Clinicians’ Knowledge and Practices Regarding Stigmatizing Language in Clinical Documentation: A Multicenter Survey

BACKGROUND: Stigmatizing language is common in the medical record and can perpetuate bias, which has downstream effects on clinical decision-making and patient care. Internal medicine faculty, residents, and advanced practice providers (APPs) are front-line clinicians for composing documentation, and faculty and APPs are also tasked with providing trainees with feedback and training on best documentation practices. However, resident, APP, and faculty preparedness to address stigmatizing language in documentation is unknown. Furthermore, little is known about clinicians' knowledge, attitudes, and behaviors regarding such language. OBJECTIVE: We sought to understand resident, APP, and faculty experiences, values, and beliefs around stigmatizing language in clinical documentation. DESIGN: We conducted a cross-sectional online survey and knowledge test. PARTICIPANTS: Internal medicine residents, faculty, and APPs within two large academic internal medicine departments. MAIN MEASURES: The knowledge test measured participants' ability to identify stigmatizing language in snippets of documentation and the survey measured attitudes and perceived skills via a series of Likert-style questions. KEY RESULTS: In total, 82 faculty/APPs (72 faculty and 10 APPs; 52% response rate) and 63 residents (21% response rate) responded. Nearly all respondents reported considering how their word choices impact patients (91% of faculty/APPs [n = 74] and 92% of residents [n = 58]) and other clinicians (90% of faculty/APPs [n = 73] and 84% of residents [n = 53]). However, only 10% (n = 8) of faculty/APPs and 24% (n = 15) of residents were confident that their clinical documentation avoided stigmatizing language. Only 4% (n = 3) of faculty/APPs and 3% (n = 2) of residents correctly identified all 11 stigmatizing terms assessed on the knowledge test. CONCLUSIONS: Faculty/APPs and residents at our institutions value the importance of patient-centered language, yet they lack knowledge and skills around this topic, highlighting key opportunities for future targeted educational and systems-level interventions.