Background: General Practitioners (GPs) are the first point of contact for people from ethnic and migrant groups
who have health problems. Discrimination can occur in this health care sector. Few studies, however, have investigated
implicit and explicit biases in general practice against ethnic and migrant groups. This study, therefore, investigated
the extent of implicit ethnic biases and willingness to adapt care to migrant patients among trainee GPs, and
the factors involved therein, in order to measure explicit bias and explore a dimension of cultural competence.
Methods: In 2021, data were collected from 207 trainee GPs in the French-speaking part of Belgium. The respondents
passed an Implicit Association Test (IAT), a validated tool used to measure implicit biases against ethnic groups.
An explicit attitude of willingness to adapt care to diversity, one of the dimensions of cultural competence, was measured
using the Hudelson scale.
Results: The overwhelming majority of trainee GPs (82.6%, 95% CI: 0.77 – 0.88) had implicit preferences for their
ingroup to the detriment of ethnic and migrant groups. Overall, the majority of respondents considered it the
responsibility of GPs to adapt their attitudes and practices to migrants’ needs. More than 50% of trainee GPs, however,
considered it the responsibility of migrant patients to adapt to the values and habits of the host country.
Conclusions: This study found that the trainee GPs had high to very high levels of implicit ethnic bias and that they
were not always willing to adapt care to the values of migrants. We therefore recommend that they are made aware
of this bias and we recommend using the IAT and Hudelson scales as educational tools to address ethnic biases in
primary care.