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

• Published in: Patient education and counseling Vol. 104; no. 8; pp. 1962 - 1969
• Main Authors: Phelan, Sean M., Puhl, Rebecca M., Burgess, Diana J., Natt, Neena, Mundi, Manpreet, Miller, Nathaniel E., Saha, Somnath, Fischer, Kristin, van Ryn, Michelle
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.08.2021
• Subjects: Bias; Communication; Medical students; Nursing; Obesity; Stigma; Medical students; Obesity; Stigma; Bias; Communication
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2021.01.003

•Perceiving weight bias as normative for physicians was associated with less friendliness, attentiveness, respectfulness and interactivity.•Self-reported frequency of faculty role-modeling of discrimination against patients with obesity was also associated with less patient-centered behavior.•Implicit weight bias was not associated with any measure of patient-centered communication. 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. 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. 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). 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. Efforts to improve patient-centered communication quality among medical trainees may benefit from intervention to improve group normative attitudes about patients with obesity.