The role of weight bias and role-modeling in medical students' patient-centered communication with higher weight standardized patients.

Phelan SM, Puhl RM, Burgess DJ, Natt N, Mundi M, Miller NE, Saha S, Fischer K, van Ryn M. The role of weight bias and role-modeling in medical students' patient-centered communication with higher weight standardized patients. Patient education and counseling. 2021 Aug 1; 104(8):1962-1969.

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Abstract:

OBJECTIVE: Patients with obesity may experience less patient-centered care. We assessed whether medical students'' implicit/explicit weight-related attitudes and perceptions of normative attitudes are associated with patient-centered care for patients with obesity. METHODS: Third and fourth year medical students (N = 111) at one medical school completed a survey and participated in a patient care scenario with a standardized patient with obesity. Encounters were coded for patient-centered behavior. Predictors of patient-centered behaviors were assessed. RESULTS: Student perceptions that negative attitudes about patients with obesity are normative in medical school were significantly associated with poorer patient-centered behaviors, including lower attentiveness (b = -0.19, p = 0.01), friendliness (b = -0.28, p < 0.001), responsiveness (b = -0.21, p = 0.002), respectfulness (b = -0.17, p = 0.003), interactivity (b = -0.22, p = 0.003), likelihood of being recommended by observers (b = -0.34, p < 0.001), and patient-centeredness index scores (b = -0.16, p = 0.002). Student reported faculty role-modeling of discrimination against patients with obesity predicted lower friendliness (b = -0.16, p = 0.03), recommendation likelihood (b = -0.22, p = 0.04), and patient-centeredness index score (b = -0.12, p = 0.03). CONCLUSIONS: Negative normative attitudes and behaviors regarding obesity in the medical school environment may adversely influence the quality of patient-centered behaviors provided to patients with obesity. PRACTICE IMPLICATIONS: Efforts to improve patient-centered communication quality among medical trainees may benefit from intervention to improve group normative attitudes about patients with obesity.