Sean M Phelan1, Rebecca M Puhl2, Sara E Burke3, Rachel Hardeman4, John F Dovidio3, David B Nelson4,5, Julia Przedworski6, Diana J Burgess4,5, Sylvia Perry7, Mark W Yeazel8, Michelle van Ryn1. 1. Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA. 2. Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA. 3. Department of Psychology, Yale University, New Haven, Connecticut, USA. 4. Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA. 5. Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA. 6. Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota, USA. 7. Department of Psychological Science, University of Vermont, Burlington, Vermont, USA. 8. Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA.
Abstract
CONTEXT: Health care trainees demonstrate implicit (automatic, unconscious) and explicit (conscious) bias against people from stigmatised and marginalised social groups, which can negatively influence communication and decision making. Medical schools are well positioned to intervene and reduce bias in new physicians. OBJECTIVES: This study was designed to assess medical school factors that influence change in implicit and explicit bias against individuals from one stigmatised group: people with obesity. METHODS: This was a prospective cohort study of medical students enrolled at 49 US medical schools randomly selected from all US medical schools within the strata of public and private schools and region. Participants were 1795 medical students surveyed at the beginning of their first year and end of their fourth year. Web-based surveys included measures of weight bias, and medical school experiences and climate. Bias change was compared with changes in bias in the general public over the same period. Linear mixed models were used to assess the impact of curriculum, contact with people with obesity, and faculty role modelling on weight bias change. RESULTS: Increased implicit and explicit biases were associated with less positive contact with patients with obesity and more exposure to faculty role modelling of discriminatory behaviour or negative comments about patients with obesity. Increased implicit bias was associated with training in how to deal with difficult patients. On average, implicit weight bias decreased and explicit bias increased during medical school, over a period of time in which implicit weight bias in the general public increased and explicit bias remained stable. CONCLUSIONS: Medical schools may reduce students' weight biases by increasing positive contact between students and patients with obesity, eliminating unprofessional role modelling by faculty members and residents, and altering curricula focused on treating difficult patients.
CONTEXT: Health care trainees demonstrate implicit (automatic, unconscious) and explicit (conscious) bias against people from stigmatised and marginalised social groups, which can negatively influence communication and decision making. Medical schools are well positioned to intervene and reduce bias in new physicians. OBJECTIVES: This study was designed to assess medical school factors that influence change in implicit and explicit bias against individuals from one stigmatised group: people with obesity. METHODS: This was a prospective cohort study of medical students enrolled at 49 US medical schools randomly selected from all US medical schools within the strata of public and private schools and region. Participants were 1795 medical students surveyed at the beginning of their first year and end of their fourth year. Web-based surveys included measures of weight bias, and medical school experiences and climate. Bias change was compared with changes in bias in the general public over the same period. Linear mixed models were used to assess the impact of curriculum, contact with people with obesity, and faculty role modelling on weight bias change. RESULTS: Increased implicit and explicit biases were associated with less positive contact with patients with obesity and more exposure to faculty role modelling of discriminatory behaviour or negative comments about patients with obesity. Increased implicit bias was associated with training in how to deal with difficult patients. On average, implicit weight bias decreased and explicit bias increased during medical school, over a period of time in which implicit weight bias in the general public increased and explicit bias remained stable. CONCLUSIONS: Medical schools may reduce students' weight biases by increasing positive contact between students and patients with obesity, eliminating unprofessional role modelling by faculty members and residents, and altering curricula focused on treating difficult patients.
Authors: Louis A Penner; John F Dovidio; Tessa V West; Samuel L Gaertner; Terrance L Albrecht; Rhonda K Dailey; Tsveti Markova Journal: J Exp Soc Psychol Date: 2010-03-01
Authors: Jennifer L Kraschnewski; Christopher N Sciamanna; Heather L Stuckey; Cynthia H Chuang; Erik B Lehman; Kevin O Hwang; Lisa L Sherwood; Harriet B Nembhard Journal: Med Care Date: 2013-02 Impact factor: 2.983
Authors: Sean M Phelan; John F Dovidio; Rebecca M Puhl; Diana J Burgess; David B Nelson; Mark W Yeazel; Rachel Hardeman; Sylvia Perry; Michelle van Ryn Journal: Obesity (Silver Spring) Date: 2014-01-09 Impact factor: 5.002
Authors: Marissa R Mastrocola; Sebastian S Roque; Lauren V Benning; Fatima Cody Stanford Journal: Int J Obes (Lond) Date: 2019-09-24 Impact factor: 5.095
Authors: Erica L Kenney; Morgan T Redman; Shaniece Criss; Kendrin R Sonneville; S Bryn Austin Journal: Eat Weight Disord Date: 2016-03-15 Impact factor: 4.652
Authors: Natalie M Wittlin; John F Dovidio; Sara E Burke; Julia M Przedworski; Jeph Herrin; Liselotte Dyrbye; Ivuoma N Onyeador; Sean M Phelan; Michelle van Ryn Journal: Soc Sci Med Date: 2019-08-04 Impact factor: 4.634
Authors: Janey S A Pratt; Allen Browne; Nancy T Browne; Matias Bruzoni; Megan Cohen; Ashish Desai; Thomas Inge; Bradley C Linden; Samer G Mattar; Marc Michalsky; David Podkameni; Kirk W Reichard; Fatima Cody Stanford; Meg H Zeller; Jeffrey Zitsman Journal: Surg Obes Relat Dis Date: 2018-03-23 Impact factor: 4.734
Authors: R S Doshi; K A Gudzune; L N Dyrbye; J F Dovidio; S E Burke; R O White; S Perry; M Yeazel; M van Ryn; S M Phelan Journal: Clin Obes Date: 2018-10-24
Authors: Sara E Burke; John F Dovidio; Marianne LaFrance; Julia M Przedworski; Sylvia P Perry; Sean M Phelan; Diana J Burgess; Rachel R Hardeman; Mark W Yeazel; Michelle van Ryn Journal: J Exp Soc Psychol Date: 2017-02-24