1
|
Rompolski K, Pascoe MA. Does dissection influence weight bias among doctor of physical therapy students? ANATOMICAL SCIENCES EDUCATION 2024. [PMID: 39169821 DOI: 10.1002/ase.2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 08/23/2024]
Abstract
Anatomy with human dissection may help to develop respect for the human body and professionalism; however, dissection may worsen students' attitudes about body weight and adiposity. The purpose of this study was to measure weight bias among Doctor of Physical Therapy (DPT) students enrolled in gross anatomy and determine if, and how the experience of dissection impacts weight bias. Ninety-seven DPT students (70 University of Colorado [CU], 27 Moravian University [MU]) were invited to complete a survey during the first and final weeks of their anatomy course. The survey included demographic items, two measures of weight bias-the Modified Weight Bias Internalized Scale (M-WBIS) and the Attitudes Towards Obese Persons (ATOP) Scale-and open-ended questions for the students who participated in dissection (CU students) that explored attitudes about body weight and adiposity. At baseline, there were no significant differences (p > 0.202) in ATOP, M-WBIS, or BMI between the two universities. The mean scores on both the ATOP and M-WBIS indicated a moderate degree of both internalized and externalized weight bias. There were no significant changes in ATOP (p = 0.566) or M-WBIS scores (p = 0.428). BMI had a low correlation with initial M-WBIS scores (⍴ = 0.294, p = 0.038) and a high correlation with change scores in CU students (⍴ = 0.530, p = 0.011). Future studies should utilize the same measures of weight bias in other healthcare trainees to facilitate comparison and incorporate larger populations of DPT students.
Collapse
Affiliation(s)
| | - Michael A Pascoe
- Physical Therapy Program, School of Medicine, Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
2
|
Allnutt AE, Smith DJ, Torrence WA, Alexander DS. Examining weight bias attitudes and obesity beliefs among undergraduate students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1814-1819. [PMID: 35834745 DOI: 10.1080/07448481.2022.2093114] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 05/23/2022] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
Objective: This cross-sectional study examined the weight bias attitudes and obesity beliefs of health science (HS), nursing, and pre-medicine undergraduate students. Methods: Using snowballing and convenience sampling strategies, students (N = 139) completed an online survey, including a 24-item Antifat Attitudes Scale (AFAS) and eight-item Belief About Obese Persons (BAOP) scale. Results: HS students have higher weight bias than nursing and pre-medicine students combined (M = 43.45, SD = 10.75), t(137) = -2.45, p = .016). A negative correlation exists between AFAS and BAOP suggesting high weight bias influences a belief that obesity is controllable. Gender positively predicted weight bias attitudes (ß = -11.43, t = -4.33, p < .001) and obesity beliefs (ß = 3.75, t = 3.01, p = . 003). Conclusions: Findings confirm that HS students have weight bias attitudes. This supports undergraduate curricular changes on obesity etiology that may improve treatment plans of individuals who are obese.
Collapse
Affiliation(s)
| | - Daniel J Smith
- Concordia University Chicago, River Forest, Illinois, USA
| | | | | |
Collapse
|
3
|
Nagpal TS, Angrish K, Bonisteel E, Puhl RM, Ferraro ZM, Malkani NM, LeJour C, Adamo KB. 'It's not me, it's them' - a report describing the weight-related attitudes towards obesity in pregnancy among maternal healthcare providers. BMC Pregnancy Childbirth 2024; 24:404. [PMID: 38831416 PMCID: PMC11149224 DOI: 10.1186/s12884-024-06591-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/20/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Occurrences of weight stigma have been documented in prenatal clinical settings from the perspective of pregnant patients, however little is known from the viewpoint of healthcare providers themselves. Reported experiences of weight stigma caused by maternal healthcare providers may be due to negative attitudes towards obesity in pregnancy and a lack of obesity specific education. The objective of this study was to assess weight-related attitudes and assumptions towards obesity in pregnancy among maternal healthcare providers in order to inform future interventions to mitigate weight stigma in prenatal clinical settings. METHODS A cross-sectional survey was administered online for maternal healthcare providers in Canada that assessed weight-related attitudes and assumptions towards lifestyle behaviours in pregnancy for patients who have obesity. Participants indicated their level of agreement on a 5-point likert scale, and mean scores were calculated with higher scores indicating poorer attitudes. Participants reported whether they had observed weight stigma occur in clinical settings. Finally, participants were asked whether or not they had received obesity-specific training, and attitude scores were compared between the two groups. RESULTS Seventy-two maternal healthcare providers (midwives, OBGYNs, residents, perinatal nurses, and family physicians) completed the survey, and 79.2% indicated that they had observed pregnant patients with obesity experience weight stigma in a clinical setting. Those who had obesity training perceived that their peers had poorer attitudes (3.7 ± 0.9) than those without training (3.1 ± 0.7; t(70) = 2.23, p = 0.029, Cohen's d = 0.86). CONCLUSIONS Weight stigma occurs in prenatal clinical environments, and this was confirmed by maternal healthcare providers themselves. These findings support advocacy efforts to integrate weight stigma related content and mitigation strategies in medical education for health professionals, including maternal healthcare providers. Future work should include prospective examination of weight related attitudes among maternal healthcare providers and implications of obesity specific education, including strategies on mitigating weight stigma in the delivery of prenatal care.
Collapse
Affiliation(s)
- Taniya S Nagpal
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 116 St & 85 Ave, Edmonton, AB, T6G 2R3, Canada.
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Canada.
| | - Kirina Angrish
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Canada
| | - Emily Bonisteel
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Canada
| | - Rebecca M Puhl
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, CT, USA
| | | | - Niyati M Malkani
- Department of Obstetrics and Gynecology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | | | - Kristi B Adamo
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| |
Collapse
|
4
|
Ruprecht KA, Dunlop WA, Wah E, Phillips C, Martin SJ. Intergroup Contact Improves Medical Student Attitudes and Skill in Transgender Health Care. Transgend Health 2024; 9:162-173. [PMID: 38585241 PMCID: PMC10998020 DOI: 10.1089/trgh.2021.0203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Purpose Poorer health outcomes for transgender and gender diverse (TGD) individuals have been associated with lack of health care provider knowledge and personal bias. Training at all levels of medical education has been positioned as one strategy to combat these inequities. This study sought to characterize preclinical medical student attitude, skill, and knowledge pre- and post-teaching with TGD community volunteers. Methods This matched pre- and post-test study was conducted from July 2020 to August 2021 capturing two preclinical medical student cohorts exposed to the same teaching intervention. Students completed the Transgender Attitudes and Beliefs Scale (TABS) and the Transgender Development of Clinical Skills Scale (T-DOCSS) at baseline, 1 week, and 1 month after the clinical skills session. Tutors' attitudes to TGD health were measured before facilitating teaching, using the Attitudes Toward Transgender Patients and Beliefs and Knowledge about Treating Transgender Patients scales. Results Fifty-nine students completed questionnaires at three time points and were included in this study. Total TABS and T-DOCCS scores increased from preintervention to 1-week follow-up, maintained at 1 month, with significant changes in Interpersonal Comfort and Sex and Gender Beliefs subscales. Scores on the Human Value subscale did not change, remaining consistently high. Postintervention knowledge-question scores were high. Nine of 13 tutors completed surveys, demonstrating overall positive attitudes toward gender diversity and TGD health. Conclusion This study demonstrates improvement in preclinical medical student attitudes and self-reported skill toward gender health care sustained at 1 month after small-group teaching with TGD community volunteers.
Collapse
Affiliation(s)
- Ky A. Ruprecht
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - William A. Dunlop
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Estee Wah
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Christine Phillips
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Sarah J. Martin
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
- Canberra Sexual Health Centre, Canberra Health Services, Garran, Australia
| |
Collapse
|
5
|
Saxena I, Swaroop R, Kumar A, Gupta AK, Kumari S, Kumar M. Sensitization Lectures for Reducing Weight Bias in Undergraduate Medical Students. Cureus 2024; 16:e56431. [PMID: 38505142 PMCID: PMC10949035 DOI: 10.7759/cureus.56431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Discrimination exists in one form or another in every society, usually against those who are weaker, in fewer numbers, or different from the rest. Most physicians are empathetic towards their patients but can either not keep an eye on their subordinates or lack the power to act against such employees. Persons experiencing discrimination in healthcare centers may try to avoid or postpone future visits, resulting in delayed diagnosis and treatment of ailments. Obesity bias present in society has crept into healthcare centers and intimidates persons with obesity who are seeking medical aid. Implicit and explicit obesity bias has been recorded in healthcare students. METHODS Data from 102 undergraduate medical students (23 female) who completed this study was analyzed. Implicit bias (tested online using the Implicit Association Test) and explicit bias (measured using four types of tool kits) were measured before and after conducting an obesity sensitization program (OSP) comprising four lectures on the causes and consequences of obesity and obesity discrimination and its consequences. RESULTS The change in implicit bias was not significant. However, a significant reduction was noted in the four different types of tools for explicit bias after conducting the OSP. CONCLUSION OSP helped medical students identify obesity bias and reduce explicit bias. Sensitization lectures conducted in medical colleges and schools can help reduce such discrimination in healthcare centers.
Collapse
Affiliation(s)
- Indu Saxena
- Biochemistry, All India Institute of Medical Sciences, Gorakhpur, IND
| | - Rohit Swaroop
- Medicine, All India Institute of Medical Sciences, Gorakhpur, IND
| | - Apurva Kumar
- Medicine, All India Institute of Medical Sciences, Gorakhpur, IND
| | - Arun K Gupta
- Medicine, All India Institute of Medical Sciences, Gorakhpur, IND
| | - Shweta Kumari
- Medicine, All India Institute of Medical Sciences, Gorakhpur, IND
| | - Manoj Kumar
- Physiology, Maharshi Vashishtha Autonomous State Medical College, Rampur, IND
| |
Collapse
|
6
|
Parvez M, Barnes L, Gonzalez R, Prestegaard K, Rick TJ. Health Care Students' Perceptions of Bias During Their Clinical Training and Insights on Mitigating It. J Physician Assist Educ 2024; 35:88-93. [PMID: 38377463 DOI: 10.1097/jpa.0000000000000550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
PURPOSE To understand health care students' perception of implicit bias and examine their insights to create a bias-free training environment. METHODS Clinical phase students from one university's 4 health care programs participated in this study. Students were surveyed regarding their knowledge of implicit bias and perception of their experiences in the clinical learning environment. RESULTS The response rate was 50.9%, N = 161. In total, 52.6% reported having prior training on implicit bias, and 55% self-reported that they had personally observed preceptors who exhibited an implicit bias toward patients based on race, ethnicity, or other qualities. There was no statistically significant relationship between those with prior training on implicit bias and being able to identify implicit bias exhibited by preceptors. Participants also expressed their unwillingness to report an incident unless it is confidential due to fear of retribution. CONCLUSION This study found that health care students from one university's 4 health care programs perceived implicit bias in their clinical learning environment, which they believe could be improved by taking intentional steps. Some suggestions provided were "Safe space to report and openly discuss bias," "Education/training on implicit bias," "Time for self-reflection," and "Hiring process that evaluates/trains against implicit bias." The implication of our study is to create a bias-free training environment that will help interrupt the propagation of biases contributing to health disparity. Further research should examine a national population and identify interventional methods and outcomes in multiple health care disciplines.
Collapse
Affiliation(s)
- Mehnaz Parvez
- Mehnaz Parvez, MBBS, MS, is an associate professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
- Lisa Barnes, MPAS-PAC, is a physician assistant, Colon & Rectal Surgery Associates, Minneapolis, Minnesota
- Rebecca Gonzalez, MPAS-PAC, is a physician assistant, Spine and Orthopedic Center, Santa Barbara, California
- Keanna Prestegaard, MPAS-PAC, is a physician assistant, Summit Orthopedics, Woodbury, Minnesota
- Tara J. Rick, PhD, MPAS-PAC, is a physician assistant, University of Minnesota Physicians, Greater Minneapolis - St. Paul Area Research Associate in Cancer Survivorship, University of Minnesota, Minneapolis, Minnesota. She is also an adjunct professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
| | - Lisa Barnes
- Mehnaz Parvez, MBBS, MS, is an associate professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
- Lisa Barnes, MPAS-PAC, is a physician assistant, Colon & Rectal Surgery Associates, Minneapolis, Minnesota
- Rebecca Gonzalez, MPAS-PAC, is a physician assistant, Spine and Orthopedic Center, Santa Barbara, California
- Keanna Prestegaard, MPAS-PAC, is a physician assistant, Summit Orthopedics, Woodbury, Minnesota
- Tara J. Rick, PhD, MPAS-PAC, is a physician assistant, University of Minnesota Physicians, Greater Minneapolis - St. Paul Area Research Associate in Cancer Survivorship, University of Minnesota, Minneapolis, Minnesota. She is also an adjunct professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
| | - Rebecca Gonzalez
- Mehnaz Parvez, MBBS, MS, is an associate professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
- Lisa Barnes, MPAS-PAC, is a physician assistant, Colon & Rectal Surgery Associates, Minneapolis, Minnesota
- Rebecca Gonzalez, MPAS-PAC, is a physician assistant, Spine and Orthopedic Center, Santa Barbara, California
- Keanna Prestegaard, MPAS-PAC, is a physician assistant, Summit Orthopedics, Woodbury, Minnesota
- Tara J. Rick, PhD, MPAS-PAC, is a physician assistant, University of Minnesota Physicians, Greater Minneapolis - St. Paul Area Research Associate in Cancer Survivorship, University of Minnesota, Minneapolis, Minnesota. She is also an adjunct professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
| | - Keanna Prestegaard
- Mehnaz Parvez, MBBS, MS, is an associate professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
- Lisa Barnes, MPAS-PAC, is a physician assistant, Colon & Rectal Surgery Associates, Minneapolis, Minnesota
- Rebecca Gonzalez, MPAS-PAC, is a physician assistant, Spine and Orthopedic Center, Santa Barbara, California
- Keanna Prestegaard, MPAS-PAC, is a physician assistant, Summit Orthopedics, Woodbury, Minnesota
- Tara J. Rick, PhD, MPAS-PAC, is a physician assistant, University of Minnesota Physicians, Greater Minneapolis - St. Paul Area Research Associate in Cancer Survivorship, University of Minnesota, Minneapolis, Minnesota. She is also an adjunct professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
| | - Tara J Rick
- Mehnaz Parvez, MBBS, MS, is an associate professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
- Lisa Barnes, MPAS-PAC, is a physician assistant, Colon & Rectal Surgery Associates, Minneapolis, Minnesota
- Rebecca Gonzalez, MPAS-PAC, is a physician assistant, Spine and Orthopedic Center, Santa Barbara, California
- Keanna Prestegaard, MPAS-PAC, is a physician assistant, Summit Orthopedics, Woodbury, Minnesota
- Tara J. Rick, PhD, MPAS-PAC, is a physician assistant, University of Minnesota Physicians, Greater Minneapolis - St. Paul Area Research Associate in Cancer Survivorship, University of Minnesota, Minneapolis, Minnesota. She is also an adjunct professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
| |
Collapse
|
7
|
Dunham M. Obesity bias awareness decreases nursing students' bias toward patients with obesity. Nursing 2024; 54:56-60. [PMID: 38271133 DOI: 10.1097/01.nurse.0000998024.65699.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
PURPOSE To determine if obesity bias scores among nursing students changed after education was delivered and to what degree body mass index (BMI) was associated with a personal experience of bias during a student's healthcare history. METHODS A quantitative, quasi-experimental design was used to analyze sociodemographic information and Implicit Association Test scores of junior, senior, and full-time accelerated coursework track nursing students. RESULTS Generally, obesity bias declined among the group. However, bias increased regarding increasing BMI. CONCLUSION Obesity bias awareness and obesity education can decrease obesity bias among nursing students.
Collapse
Affiliation(s)
- Marguerite Dunham
- Marguerite Dunham is an NP and the program coordinator in Bariatric Surgery for Comprehensive Weight Management at Jefferson Health-Abington
| |
Collapse
|
8
|
Trofymenko S, Kutob R, Algotar A. A Multi-Modality Intervention Improves Obesity Bias among Medical Students. MEDICINES (BASEL, SWITZERLAND) 2024; 11:4. [PMID: 38392692 PMCID: PMC10890647 DOI: 10.3390/medicines11020004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/09/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024]
Abstract
Background: Obesity is linked to chronic diseases in adults and children. Its prevalence continues to grow in the United States, necessitating the need for healthcare provider training and presenting an opportunity for the education of future medical providers. Despite this need, effectively implementing obesity education into medical school curricula has been challenging. Anti-obesity bias amongst healthcare providers and trainees represents a significant obstacle to the care of patients with obesity. Obesity bias may affect up to 1/3 of medical students. Methods: This study describes the development and preliminary testing of a brief, 2.5 h multi-modality teaching intervention consisting of online, interactive, and independent learning modules for first-year medical students and a patient panel focused on obesity, obesity bias, and motivational interviewing. The participants took Crandall's anti-fat attitude (AFA) questionnaire before and after an online independent learning module on motivational interviewing and obesity bias. The AFA consists of three subscales ("dislike", "fear of fat", and "willpower"). Individual responses were measured using a nine-point Likert-type response format (0 = very strongly disagree; 9 = very strongly agree). An average composite score was calculated for each subscale. Results: Data were analyzed from 103 first-year medical students enrolled at a college of medicine in the southwestern United States in 2022. The AFA mean composite scores decreased significantly, indicating a decrease in explicit anti-obesity attitude bias after completing the online module. This decrease was present in all three domains of fear (4.63 vs. 3.72, p < 0.001), dislike (1.25 vs. 0.88, p < 0.001) and willpower (3.23 vs. 2.31, p < 0.001). Conclusions: Relatively brief educational interventions can positively impact students' anti-obesity attitudes.
Collapse
Affiliation(s)
- Stephanie Trofymenko
- Department of Biomedical Sciences, Noorda College of Osteopathic Medicine, 2162 S 180 East, Provo, UT 84606, USA
| | - Randa Kutob
- Department of Family & Community Medicine, College of Medicine, University of Arizona, 655N Alvernon Way, Suite 228, Tucson, AZ 85711, USA
| | - Amit Algotar
- Department of Family & Community Medicine, College of Medicine, University of Arizona, 655N Alvernon Way, Suite 228, Tucson, AZ 85711, USA
| |
Collapse
|
9
|
Kurtek P. Explicit and implicit attitudes of occupational therapy workshops' staff towards people with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13171. [PMID: 37941324 DOI: 10.1111/jar.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 07/31/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
The aim of this article is to present explicit and implicit attitudes of occupational therapy (OT) staff towards people with intellectual disabilities. The study was conducted on a group of 77 OT employees. To explore the explicit attitude, the Conditional Respect for Persons with Disabilities Questionnaire (Kurtek, Roczniki Psychologiczne, 2018, 4, 327-344) was used, while to estimate the implicit attitude, the Intellectual Disability Attitudes Implicit Association Test was applied (Kurtek, Roczniki Psychologiczne, 2021, 1, 43-64). At the explicit level, OT staff tended to tolerate negative and overrate positive behaviours of people with intellectual disabilities, which indicates a tendency to favour the individuals. However, the opposite devalorizing tendency was observed at the implicit dimension, which indicates aversive ableism. Although the study confirmed the independence of the two dimensions of the personnel's attitude, relationships were observed between the disclosure of negativity towards antagonistic behaviours of the people with intellectual disabilities and a decrease in the level of their implicit devaluation.
Collapse
Affiliation(s)
- Paweł Kurtek
- Faculty of Education and Psychology, Jan Kochanowski University, Kielce, Poland
| |
Collapse
|
10
|
Lewis BE, Naik AR. A scoping review to identify and organize literature trends of bias research within medical student and resident education. BMC MEDICAL EDUCATION 2023; 23:919. [PMID: 38053172 DOI: 10.1186/s12909-023-04829-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/01/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Physician bias refers to the unconscious negative perceptions that physicians have of patients or their conditions. Medical schools and residency programs often incorporate training to reduce biases among their trainees. In order to assess trends and organize available literature, we conducted a scoping review with a goal to categorize different biases that are studied within medical student (MS), resident (Res) and mixed populations (MS and Res). We also characterized these studies based on their research goal as either documenting evidence of bias (EOB), bias intervention (BI) or both. These findings will provide data which can be used to identify gaps and inform future work across these criteria. METHODS Online databases (PubMed, PsycINFO, WebofScience) were searched for articles published between 1980 and 2021. All references were imported into Covidence for independent screening against inclusion criteria. Conflicts were resolved by deliberation. Studies were sorted by goal: 'evidence of bias' and/or 'bias intervention', and by population (MS or Res or mixed) andinto descriptive categories of bias. RESULTS Of the initial 806 unique papers identified, a total of 139 articles fit the inclusion criteria for data extraction. The included studies were sorted into 11 categories of bias and showed that bias against race/ethnicity, specific diseases/conditions, and weight were the most researched topics. Of the studies included, there was a higher ratio of EOB:BI studies at the MS level. While at the Res level, a lower ratio of EOB:BI was found. CONCLUSIONS This study will be of interest to institutions, program directors and medical educators who wish to specifically address a category of bias and identify where there is a dearth of research. This study also underscores the need to introduce bias interventions at the MS level.
Collapse
Affiliation(s)
- Brianne E Lewis
- Department of Foundational Sciences, Central Michigan University College of Medicine, Mt. Pleasant, MI, 48859, USA
| | - Akshata R Naik
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI, 48309, USA.
| |
Collapse
|
11
|
Grafeneder J, Baewert A, Katz H, Holzinger A, Niederdoeckl J, Roth D. Immigration bias among medical students: a randomized controlled trial. Eur J Emerg Med 2023; 30:417-423. [PMID: 37650729 DOI: 10.1097/mej.0000000000001057] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND AND IMPORTANCE Racial bias is found in both physicians and medical students. Immigrants in many parts of the world face challenges similar to racial minorities. Identification of immigrants might however be more subtle than identification by race, and currently, no data are available on a possible bias against the large minority group of migrants in Europe. DESIGN Randomized control trial. SETTINGS AND PARTICIPANTS Second-year medical students were randomized into four groups to watch a video of either a male or female patient with pain, with or without immigrant status. INTERVENTION Students were asked whether they would administer pain medication (primary outcome). OUTCOME MEASURES AND ANALYSIS Immigrant status, patient's gender, student's gender, age, and language skills were covariates in a logistic regression model. Secondary outcomes included pain medication potency and the student's rating of the patient's pain intensity. MAIN RESULTS We recruited 607 students [337 females (56%), 387 (64%) between 18 and 22 years old]. Analgesia was administered in 95% (n = 576). Immigrant status was not associated with the probability of receiving pain medication [95 vs. 95%, odds ratio (OR) 0.81, 95% confidence interval (CI) 0.39-1.70, P = 0.58]. Immigrants received high-potency analgesia less often (26 vs. 33%, OR 0.69, 95% CI 0.50-0.96, P = 0.03). Female students administered pain medication more frequently (96 vs. 93%, OR 2.29, 95% CI 1.05-5.02, P = 0.04), and rated the patients' pain higher (mean numeric rating scale 7.7, SD 0.9 vs. 7.4, SD 1.0, OR 1.36, 95% CI 1.16-1.60, P < 0.001). CONCLUSION Medical students showed no immigration bias with regard to administering pain medication but were less likely to choose high-potency analgesia in immigrants. We also found a gender difference in pain management. These results demonstrate the importance of including knowledge about immigration bias in medical training.
Collapse
Affiliation(s)
| | - Andjela Baewert
- Teaching Center, Medical University of Vienna, Wien, Austria
| | - Henri Katz
- Teaching Center, Medical University of Vienna, Wien, Austria
| | - Anita Holzinger
- Teaching Center, Medical University of Vienna, Wien, Austria
| | | | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna
| |
Collapse
|
12
|
Gu J, Ross J, Leitch S. Patient representation in New Zealand general practice and rural health case-based teaching: a quality improvement exercise. J Prim Health Care 2023; 15:281-287. [PMID: 37756233 DOI: 10.1071/hc23070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/23/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Healthcare inequity disproportionately affects minority populations in Aotearoa New Zealand. Healthcare providers may contribute to inequity due to their biases. Medical education can unintentionally promote biases by reinforcing stereotypes or limiting exposure to diversity. Teaching staff from the Department of General Practice and Rural Health suggested a need to review current teaching materials to ascertain if they have the potential to contribute to this bias. Aim The aim of this study was to review case-based teaching material to determine its representation of the New Zealand population, and whether there is potential to contribute to implicit bias. Methods Document analysis of 135 cases used to teach fourth- and fifth-year medical students in the Department of General Practice and Rural Health, Otago Medical School was performed. Demographic, clinical and social features of each case were recorded and analysed. Results Cases typically included patient age (129/135, 95.6%), sex (127/135, 94.1%) and occupation status (91/136, 66.9%). Ethnicity (31/135, 23.0%), living situation (55/135, 40.7%), relationship status (57/135, 42.2%) and sexual orientation (52/135, 40.0%) were less frequently defined. Cases typically represented the population majority norms. Discussion Case-based teaching materials require regular review and updating to match population demographics. There is potential to improve representation of diversity, and hence cultural safety, though review and revision of written teaching cases.
Collapse
Affiliation(s)
- Jessica Gu
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Jim Ross
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sharon Leitch
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| |
Collapse
|
13
|
Nadolsky K, Addison B, Agarwal M, Almandoz JP, Bird MD, DeGeeter Chaplin M, Garvey WT, Kyle TK. American Association of Clinical Endocrinology Consensus Statement: Addressing Stigma and Bias in the Diagnosis and Management of Patients with Obesity/Adiposity-Based Chronic Disease and Assessing Bias and Stigmatization as Determinants of Disease Severity. Endocr Pract 2023; 29:417-427. [PMID: 37140524 DOI: 10.1016/j.eprac.2023.03.272] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To focus on the intersection of perception, diagnosis, stigma, and weight bias in the management of obesity and obtain consensus on actionable steps to improve care provided for persons with obesity. METHODS The American Association of Clinical Endocrinology (AACE) convened a consensus conference of interdisciplinary health care professionals to discuss the interplay between the diagnosis of obesity using adiposity-based chronic disease (ABCD) nomenclature and staging, weight stigma, and internalized weight bias (IWB) with development of actionable guidance to aid clinicians in mitigating IWB and stigma in that context. RESULTS The following affirmed and emergent concepts were proposed: (1) obesity is ABCD, and these terms can be used in differing ways to communicate; (2) classification categories of obesity should have improved nomenclature across the spectrum of body mass index (BMI) using ethnic-specific BMI ranges and waist circumference (WC); (3) staging the clinical severity of obesity based on the presence and severity of ABCD complications may reduce weight-centric contribution to weight stigma and IWB; (4) weight stigma and internalized bias are both drivers and complications of ABCD and can impair quality of life, predispose to psychological disorders, and compromise the effectiveness of therapeutic interventions; (5) the presence and of stigmatization and IWB should be assessed in all patients and be incorporated into the staging of ABCD severity; and (6) optimal care will necessitate increased awareness and the development of educational and interventional tools for health care professionals that address IWB and stigma. CONCLUSIONS The consensus panel has proposed an approach for integrating bias and stigmatization, psychological health, and social determinants of health in a staging system for ABCD severity as an aid to patient management. To effectively address stigma and IWB within a chronic care model for patients with obesity, there is a need for health care systems that are prepared to provide evidence-based, person-centered treatments; patients who understand that obesity is a chronic disease and are empowered to seek care and participate in behavioral therapy; and societies that promote policies and infrastructure for bias-free compassionate care, access to evidence-based interventions, and disease prevention.
Collapse
Affiliation(s)
- Karl Nadolsky
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Brandi Addison
- South Texas Endocrinology and Metabolism Center, Corpus Christi, Texas
| | - Monica Agarwal
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Melanie D Bird
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | | | | |
Collapse
|
14
|
Koran-Scholl J, Geske J, Khandalavala KR, Khandalavala B. Teaching module for obesity bias education: incorporating comprehensive competencies and innovative techniques. BMC MEDICAL EDUCATION 2023; 23:340. [PMID: 37193997 DOI: 10.1186/s12909-023-04310-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 04/30/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND The majority of the United States population is overweight or obese, and obesity bias is frequently reported by patients. Obesity bias is associated with adverse health outcomes, even independent of body weight. Primary care residents are often sources of obesity bias towards patients with weight, yet education regarding obesity bias is significantly lacking in most family medicine residency teaching curricula. The aim of this study is to describe an innovative web-based module on obesity bias and discuss its impact in family medicine residents. METHODS The e-module was developed by an interprofessional team of health care students and faculty. It consisted of a 15-minute video containing five clinical vignettes that depicted instances of explicit and implicit obesity bias in a patient-centered medical home (PCMH) model. Family medicine residents viewed the e-module as part of a dedicated one-hour didactic on obesity bias. Surveys were administered prior to and following the viewing of the e-module. They assessed previous education on obesity care, comfort in working with patients with obesity, residents' understanding of their own biases in working with this population, and the anticipated impact of the module on future patient care. RESULTS A total of 83 residents from three family medicine residency programs viewed the e-module and 56 completed both the pre and post survey. There was a significant improvement in residents' comfort in working with patients with obesity as well as their understanding of their own biases. CONCLUSION This teaching e-module is a short, interactive, web-based educational intervention that is free and open-sourced. The first-person patient perspective allows learners to better understand the patient's point of view and its PCMH setting illustrates interactions with a variety of healthcare professionals. It was engaging and well received by family medicine residents. This module can begin the conversation around obesity bias, leading to improved patient care.
Collapse
Affiliation(s)
- Jessica Koran-Scholl
- Department of Family Medicine, University of Nebraska Medical Center, 983075 Nebraska Medical Center, Omaha, NE, 68198-3075, USA.
| | - Jenenne Geske
- Department of Family Medicine, University of Nebraska Medical Center, 983075 Nebraska Medical Center, Omaha, NE, 68198-3075, USA
| | - Karl R Khandalavala
- Mayo Clinic College of Medicine and Science, 200 First ST SW, 55905, Rochester, MN, USA
| | - Birgit Khandalavala
- Department of Family Medicine, University of Nebraska Medical Center, 983075 Nebraska Medical Center, Omaha, NE, 68198-3075, USA
| |
Collapse
|
15
|
Jayawickrama RS, O'Connor M, Flint SW, Hemmingsson E, Lawrence BJ. Explicit and implicit weight bias among health care students: a cross-sectional study of 39 Australian universities. EClinicalMedicine 2023; 58:101894. [PMID: 37181412 PMCID: PMC10166782 DOI: 10.1016/j.eclinm.2023.101894] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 03/08/2023] Open
Abstract
Background Weight bias exhibited by health care students may continue into their future practice, compromising the provision of care that people living with overweight or obesity receive. This highlights the need to comprehensively examine the extent to which weight bias is present among health care students and the factors that may be associated with students' weight bias. Methods In this cross-sectional study, Australian university students enrolled in health care courses were invited via social media advertisements, snowball and convenience sampling, and by making direct contact with universities to complete an online survey. Students provided demographic information including discipline of study, perceived weight status, and state of residence. Students then completed several measures which assessed their explicit and implicit weight bias, and empathy. Descriptive statistics established the presence of explicit and implicit weight bias, and ANCOVAs, ANOVA, and multiple regression analyses were conducted to examine the potential factors associated with students' exhibited weight bias. Findings Between March 08, 2022, and March 15, 2022, 900 eligible health care students attending 39 Australian universities participated in the study. Students reported varying levels of explicit and implicit weight bias, with minimal differences between disciplines on most outcome measures. Students who identified as men (vs. women) exhibited higher of both explicit and implicit bias (Beliefs About Obese Persons (BAOP): p = 0.0002, Antifat Attitudes Questionnaire (AFA)-Dislike: p = 0.019, AFA Willpower p < 0.0001, Empathy for Obese Patients: p = 0.0011, Implicit Association Test: p = 0.022), and students who displayed greater (vs. less) empathic concern exhibited lower levels of explicit bias (BAOP, AFA Dislike and Willpower, and Empathy for Obese Patients: p < 0.0001). Having witnessed the enactment of weight stigma sporadically (vs. regularly) by role models was associated with greater attribution of the causes of obesity to willpower (a few times a month vs. daily: p = 0.020, a few times a year vs. daily: p = 0.022), and less time spent with people living with overweight or obesity outside of study was associated with more dislike (a few times a month vs. daily: p = 0.0048, once a month vs. daily: p = 0.0002) and less fear of fat (once a month vs. daily: p = 0.036, and once a month vs. a few times a week: p = 0.0028). Interpretation Results demonstrate the presence of both explicit and implicit weight bias among Australian health care students. Several characteristics and experiences of students were associated with their weight bias. Validity of the exhibited weight bias should be established in practical interactions with people living with overweight or obesity and novel interventions should be developed to ameliorate weight bias. Funding Research Training Program (RTP) Scholarship, Australian Government, Department of Education.
Collapse
Affiliation(s)
| | - Moira O'Connor
- School of Population Health, Curtin University, Western Australia, Australia
| | - Stuart W. Flint
- School of Psychology, University of Leeds, Yorkshire, United Kingdom
- Scaled Insights, Nexus, University of Leeds, Yorkshire, United Kingdom
| | - Erik Hemmingsson
- GIH - The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Blake J. Lawrence
- School of Population Health, Curtin University, Western Australia, Australia
| |
Collapse
|
16
|
Koh EYH, Koh KK, Renganathan Y, Krishna L. Role modelling in professional identity formation: a systematic scoping review. BMC MEDICAL EDUCATION 2023; 23:194. [PMID: 36991373 PMCID: PMC10052869 DOI: 10.1186/s12909-023-04144-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 03/08/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Role modelling's pivotal part in the nurturing of a physician's professional identity remains poorly understood. To overcome these gaps, this review posits that as part of the mentoring spectrum, role modelling should be considered in tandem with mentoring, supervision, coaching, tutoring and advising. This provides a clinically relevant notion of role modelling whilst its effects upon a physician's thinking, practice and conduct may be visualised using the Ring Theory of Personhood (RToP). METHODS A Systematic Evidence Based Approach guided systematic scoping review was conducted on articles published between 1 January 2000 to 31 December 2021 in the PubMed, Scopus, Cochrane, and ERIC databases. This review focused on the experiences of medical students and physicians in training (learners) given their similar exposure to training environments and practices. RESULTS 12,201 articles were identified, 271 articles were evaluated, and 145 articles were included. Concurrent independent thematic and content analysis revealed five domains: existing theories, definitions, indications, characteristics, and the impact of role modelling upon the four rings of the RToP. This highlights dissonance between the introduced and regnant beliefs and spotlights the influence of the learner's narratives, cognitive base, clinical insight, contextual considerations and belief system on their ability to detect, address and adapt to role modelling experiences. CONCLUSION Role modelling's ability to introduce and integrate beliefs, values and principles into a physician's belief system underscores its effects upon professional identity formation. Yet, these effects depend on contextual, structural, cultural and organisational influences as well as tutor and learner characteristics and the nature of their learner-tutor relationship. The RToP allows appreciation of these variations on the efficacy of role modelling and may help direct personalised and longitudinal support for learners.
Collapse
Affiliation(s)
- Eugene Yong Hian Koh
- Singapore Armed Forces, 303 Gombak Drive, Singapore, 669645, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Kai Kee Koh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Yaazhini Renganathan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Lalit Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore 8 College Road, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, UK.
- Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Duke-NUS Medical School, National University of Singapore, College Rd, Singapore, 169857, Singapore.
- Centre of Biomedical Ethics, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore.
- The Palliative Care Centre for Excellence in Research and Education, PalC, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
| |
Collapse
|
17
|
Renold C, Deferm NP, Hauser R, Gerber P, Bueter M, Thalheimer A, Gero D. The Effect of a Multifaceted Intervention Including Classroom Education and Bariatric Weight Suit Use on Medical Students' Attitudes toward Patients with Obesity. Obes Facts 2023; 16:381-391. [PMID: 36977399 PMCID: PMC10427925 DOI: 10.1159/000530405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/23/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION Weight bias refers to negative attitudes toward individuals because of their weight. Evidence-based strategies to successfully reduce weight bias in medical students are lacking. The purpose of this study was to investigate the impact of a multifaceted intervention on medical students' attitudes toward patients with obesity. METHODS Third and fourth year medical students (n = 79), who enrolled in an 8-week graduate course focusing on the various epidemiologic, physiological, and clinical aspects of obesity, including a gamification task with bariatric weight suits (BWSs), were asked to complete the Nutrition, Exercise and Weight Management (NEW) Attitudes Scale questionnaire pre- and post-course. The inclusion period was between September 2018 and June 2021 and covered 4 consecutive groups of students. RESULTS The overall NEW Attitudes Scale scores did not change significantly pre- versus post-intervention (pre-course: 19.59, post-course: 24.21, p value = 0.24). However, the subgroup of 4th year medical students showed a significant improvement in their attitudes (pre-course: 16.4, post-course: 26.16, p value = 0.02). The Thurstone rating of 9 out of 31 individual survey items changed significantly from pre- to post-course with a moderate strength (Cramer's V >0.2), including 5 items showing weight bias reduction. The disagreement with the statement "overweight/obese individuals lack willpower" increased from 37 to 68%. CONCLUSION These findings suggest that in medical students with a low level of weight bias at baseline, a semester course on obesity combined with BWS use affects only a limited number of items of the NEW Attitudes Scale questionnaire. The sensitization of medical students to weight stigma has the potential to improve quality of healthcare for patients with obesity.
Collapse
Affiliation(s)
- Carlo Renold
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nathalie Phyllis Deferm
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Renward Hauser
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Philipp Gerber
- Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marco Bueter
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Surgery, Männedorf Hospital, Männedorf, Switzerland
| | - Andreas Thalheimer
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Surgery, Männedorf Hospital, Männedorf, Switzerland
| | - Daniel Gero
- Faculty of Medicine, University of Zurich, Zurich, Switzerland,
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland,
| |
Collapse
|
18
|
Checketts TR, Miyairi M. Ready to treat patients with obesity?: Evaluation of undergraduate students’ body image, disordered eating attitudes & behaviors, and anti-fat attitudes. COGENT PSYCHOLOGY 2022. [DOI: 10.1080/23311908.2022.2080317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Affiliation(s)
- T. Rees Checketts
- School of Medicine, Creighton University, 7500 Mercy Road, Omaha, NE 68124, USA
| | - Maya Miyairi
- Care Access, 33 Arch Street, 17th Floor Boston, MA 02110, USA
| |
Collapse
|
19
|
Mandelbaum J, Harrison SE. Primary Care Clinicians' Perceived Role in Addressing Childhood Obesity in the Southern United States. South Med J 2022; 115:824-830. [PMID: 36318948 DOI: 10.14423/smj.0000000000001468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Primary care is an opportune setting to promote healthy behaviors for children and families. In 2007, an expert committee recommended that pediatric primary care clinicians assess nutrition and physical activity at wellness visits and offer recommendations; however, little is known about what pediatric primary care clinicians perceive their role as in childhood weight management. This qualitative study aimed to describe the perceived role of pediatric primary care clinicians in the prevention and treatment of childhood obesity in South Carolina, a state in the southern United States with high rates of childhood obesity. METHODS Pediatric primary care clinicians (n = 23) from South Carolina were recruited for two focus groups. Participants were asked semistructured, open-ended questions, and audio recordings were transcribed verbatim. Themes and subthemes were identified through an iterative coding and consensus-building process with two coders. Excerpts coded under the parent code of "clinician role" centered on three themes: conducting assessments, making referrals, and providing education. RESULTS Pediatric primary care clinicians in South Carolina coalesced around the important role of addressing childhood obesity within primary care. Notably, clinicians primarily discussed treatment rather than prevention strategies and described changes in the scope of their practice over time as a result of the increasing numbers of pediatric patients with obesity. CONCLUSIONS Addressing childhood obesity within primary care is a critical component of obesity prevention and treatment in the southern United States. Effective, sustainable prevention and treatment within primary care will depend on the involvement of pediatric clinicians, thus emphasizing the importance of understanding how they perceive their role within this setting.
Collapse
Affiliation(s)
- Jennifer Mandelbaum
- From the Departments of Health Promotion, Education, and Behavior and Psychology, University of South Carolina, Columbia
| | - Sayward E Harrison
- From the Departments of Health Promotion, Education, and Behavior and Psychology, University of South Carolina, Columbia
| |
Collapse
|
20
|
Talumaa B, Brown A, Batterham RL, Kalea AZ. Effective strategies in ending weight stigma in healthcare. Obes Rev 2022; 23:e13494. [PMID: 35934011 PMCID: PMC9540781 DOI: 10.1111/obr.13494] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 12/11/2022]
Abstract
Weight stigma impacts negatively healthcare quality and hinders public health goals. The aim of this review was to identify strategies for minimizing weight bias among healthcare professionals and explore future research directions. An electronic search was performed in PubMed, PsycINFO and Scopus (until June 2020). Studies on weight stigma reduction in healthcare students, trainees and professionals were assessed based on specific inclusion and exclusion criteria. A narrative synthesis was undertaken to analyze emerging themes. We identified five stigma reduction strategies in healthcare: (i) increased education, (ii) causal information and controllability, (iii) empathy evoking, (iv) weight-inclusive approach, and (v) mixed methodology. Weight stigma needs to be addressed early on and continuously throughout healthcare education and practice, by teaching the genetic and socioenvironmental determinants of weight, and explicitly discussing the sources, impact and implications of stigma. There is a need to move away from a solely weight-centric approach to healthcare to a health-focused weight-inclusive one. Assessing the effects of weight stigma in epidemiological research is equally important. The ethical argument and evidence base for the need to reduce weight stigma in healthcare and beyond is strong. Although evidence on long-term stigma reduction is emerging, precautionary action is needed.
Collapse
Affiliation(s)
- Britta Talumaa
- Division of Medicine, University College London, London, UK
| | - Adrian Brown
- Division of Medicine, University College London, London, UK.,Centre for Obesity Research, University College London, London, UK.,Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital NHS Trust, London, UK.,UCLH Biomedical Research Centre, National Institute of Health Research, London, UK
| | - Rachel L Batterham
- Division of Medicine, University College London, London, UK.,Centre for Obesity Research, University College London, London, UK.,Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital NHS Trust, London, UK.,UCLH Biomedical Research Centre, National Institute of Health Research, London, UK
| | - Anastasia Z Kalea
- Division of Medicine, University College London, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| |
Collapse
|
21
|
Cuda S, Censani M, Kharofa R, Williams DR, O'Hara V, Karjoo S, Paisley J, Browne NT. Social consequences and genetics for the child with overweight and obesity: An obesity medicine association (OMA) clinical practice statement 2022. OBESITY PILLARS (ONLINE) 2022; 3:100032. [PMID: 37990726 PMCID: PMC10662046 DOI: 10.1016/j.obpill.2022.100032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) clinical practice statement (CPS) covers two topics: 1) genetics and 2) social consequences for the child with overweight and obesity. This CPS is intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices greater than or equal to the 85th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA. Methods The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors. Results This OMA clinical practice statement details two topics: 1) genetics and 2) social consequences for the child with overweight and obesity. Conclusions This OMA clinical practice statement on genetics and social consequences for the child with overweight and obesity is an overview of current literature. The literature provides a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.
Collapse
Affiliation(s)
- Suzanne Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145 San Antonio, TX, 78218, USA
| | - Marisa Censani
- Associate Professor of Clinical Pediatrics, Division of Pediatric Endocrinology, Department of Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 103, New York, NY, 10021, USA
| | - Roohi Kharofa
- Center for Better Health & Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Dominique R. Williams
- The Ohio State University College of MedicineCenter for Healthy Weight and Nutrition, Nationwide Children's Hospital 700 Children's Drive LA, Suite 5F Columbus, OH, 43215, USA
| | - Valerie O'Hara
- Medical Director, WOW 4 Wellness Clinic/ PCHC, 6 Telcom Drive, Bangor, ME, 04401, USA
| | - Sara Karjoo
- Johns Hopkins All Children's Hospital Pediatric Gastroenterology, 501 6th Ave S, St. Petersburg, FL, 33701, USA
| | - Jennifer Paisley
- St Elizabeth Physician's Group Primary Care 98 Elm Street Lawrenceburg, IN, 47025-2048, USA
| | | |
Collapse
|
22
|
FitzGerald C, Mumenthaler C, Berner D, Schindler M, Brosch T, Hurst S. How is physicians' implicit prejudice against the obese and mentally ill moderated by specialty and experience? BMC Med Ethics 2022; 23:86. [PMID: 36002822 PMCID: PMC9400557 DOI: 10.1186/s12910-022-00815-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background Implicit prejudice can lead to disparities in treatment. The effects of specialty and experience on implicit obesity and mental illness prejudice had not been explored. The main objective was to examine how specializing in psychiatry/general medicine and years of experience moderated implicit obesity and mental illness prejudice among Swiss physicians. Secondary outcomes included examining the malleability of implicit bias via two video interventions and a condition of cognitive load, correlations of implicit bias with responses to a clinical vignette, and correlations with explicit prejudice.
Methods In stage 1, participants completed an online questionnaire including a clinical vignette. In stage 2, implicit prejudice pre- and post- intervention was tested using a 4 × 4 between-subject design including a control group. In stage 3, explicit prejudice was tested with feeling thermometers and participants were debriefed. Participants were 133 psychiatrists and internists working in Geneva, hospital-based and private practice. Implicit prejudice was assessed using a Weight IAT (Implicit Association Test) and a Mental Illness IAT. Explicit feelings towards the obese and the mentally ill were measured using Feeling Thermometers. A clinical vignette assessed the level of concern felt for a fictional patient under four conditions: control, obese, depression, obese and depression. Linear regression was conducted to test for association of gender, experience, and specialty with responses to vignettes, pre-intervention IATs and explicit attitudes, and to test for association of interventions (or control) with post-intervention IATs and explicit attitudes. Reported effect sizes were computed using Cohen’s d. Two-tailed p < 0.05 was selected as the significance threshold. Results Compared to internists, psychiatrists showed significantly less implicit bias against mentally vs. physically ill people than internists and warmer explicit feelings towards the mentally ill. More experienced physicians displayed warmer explicit feelings towards the mentally ill and a greater level of concern for the fictional patients in the vignette than the less experienced, except when the patient was described as obese. Conclusions Specialty moderates both implicit and explicit mental illness prejudice. Experience moderates explicit mental illness bias and concern for patients. The effect of specialty on implicit prejudice seems to be based principally on self-selection. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-022-00815-7.
Collapse
Affiliation(s)
- Chloë FitzGerald
- iEH2 (Institute for Ethics, History and the Humanities), Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Christian Mumenthaler
- Department of Information Science, Geneva School of Business Administration, Geneva, Switzerland.,University of Applied Sciences and Arts, Western Switzerland, Delémont, Switzerland
| | - Delphine Berner
- iEH2 (Institute for Ethics, History and the Humanities), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mélinée Schindler
- iEH2 (Institute for Ethics, History and the Humanities), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Tobias Brosch
- CISA (Swiss National Centre for Affective Sciences), University of Geneva, Geneva, Switzerland.,Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Samia Hurst
- iEH2 (Institute for Ethics, History and the Humanities), Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| |
Collapse
|
23
|
Freizinger M, Recto M, Jhe G, Lin J. Atypical Anorexia in Youth: Cautiously Bridging the Treatment Gap. CHILDREN 2022; 9:children9060837. [PMID: 35740774 PMCID: PMC9221982 DOI: 10.3390/children9060837] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022]
Abstract
Atypical anorexia nervosa (AAN) is a restrictive eating disorder (ED) that describes individuals who may be normal weighted or overweight; many have a premorbid history of obesity. Pediatric care providers are trained to identify and provide best practices for youth with pediatric obesity; however, most pediatric care providers are not trained to assess and treat restrictive EDs which typically present in youth aged 10 and 14 years. Although individuals with AAN may appear to be within a ‘healthy weight’, many experience malnutrition, psychological symptoms, and severe physiological complications after weight loss. These individuals are presenting to pediatric services at an increasing rate and exhibit acute medical instability along with severe ED psychopathology. One complicating factor is youth with AAN may take longer to be identified by pediatric providers and may be reluctant to engage in treatment. Delayed treatment for AAN, along with all EDs often results in poorer treatment outcomes. A greater understanding of this complex illness is essential to inform medical decisions, such as labs, vitals, hospital admissions, and psychological therapy. Currently, there are no standardized guidelines for treating AAN in youths. This review is designed to present evidence-based treatment to inform and guide best treatment practices.
Collapse
Affiliation(s)
- Melissa Freizinger
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (G.J.); (J.L.)
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Correspondence:
| | - Michelle Recto
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA
| | - Grace Jhe
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (G.J.); (J.L.)
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Jessica Lin
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (G.J.); (J.L.)
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA
| |
Collapse
|
24
|
Meadows A, Barreto M, Dovidio JF, Burke SE, Wittlin NM, Herrin J, Ryn M, Phelan SM. Signaling hostility: The relationship between witnessing weight‐based discrimination in medical school and medical student well‐being. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1111/jasp.12847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Angela Meadows
- School of Psychology University of Exeter Exeter UK
- Department of Psychology Western University London Ontario Canada
| | | | - John F. Dovidio
- Department of Psychology Yale University New Haven Connecticut USA
| | - Sara E. Burke
- Department of Psychology Syracuse University Syracuse New York USA
| | | | - Jeph Herrin
- School of Medicine Yale University New Haven Connecticut USA
| | - Michelle Ryn
- Division of Health Care Delivery Research Mayo Clinic Rochester Minnesota USA
| | - Sean M. Phelan
- Division of Health Care Delivery Research Mayo Clinic Rochester Minnesota USA
| |
Collapse
|
25
|
Lawrence BJ, Kerr D, Pollard CM, Theophilus M, Alexander E, Haywood D, O'Connor M. Weight bias among health care professionals: A systematic review and meta-analysis. Obesity (Silver Spring) 2021; 29:1802-1812. [PMID: 34490738 DOI: 10.1002/oby.23266] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/22/2021] [Accepted: 07/10/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Weight-biased attitudes and views held by health care professionals can have a negative impact on the patient-provider relationship and the provision of care, but studies have found mixed results about the extent and nature of bias, which warrants a review of the evidence. METHODS A systematic review and random-effects meta-analysis were conducted by including studies up to January 12, 2021. RESULTS A total of 41 studies met inclusion criteria, with 17 studies providing sufficient data to be meta-analyzed. A moderate pooled effect (standardized mean difference = 0.66; 95% CI: 0.37-0.96) showed that health care professionals demonstrate implicit weight bias. Health care professionals also report explicit weight bias on the Fat Phobia Scale, Antifat Attitudes Scale, and Attitudes Towards Obese Persons Scale. Findings show that medical doctors, nurses, dietitians, psychologists, physiotherapists, occupational therapists, speech pathologists, podiatrists, and exercise physiologists hold implicit and/or explicit weight-biased attitudes toward people with obesity. A total of 27 different outcomes were used to measure weight bias, and the overall quality of evidence was rated as very low. CONCLUSIONS Future research needs to adopt more robust research methods to improve the assessment of weight bias and to inform future interventions to address weight bias among health care professionals.
Collapse
Affiliation(s)
- Blake J Lawrence
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Western Australia Cancer Prevention Research Unit, Curtin University, Perth, Western Australia, Australia
| | - Deborah Kerr
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Christina M Pollard
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Mary Theophilus
- St John of God Hospital, Perth, Western Australia, Australia
| | - Elise Alexander
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Western Australia Cancer Prevention Research Unit, Curtin University, Perth, Western Australia, Australia
| | - Darren Haywood
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Western Australia Cancer Prevention Research Unit, Curtin University, Perth, Western Australia, Australia
| | - Moira O'Connor
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Western Australia Cancer Prevention Research Unit, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
26
|
McCarty D, Shanahan M. Theory-Informed Clinical Practice: How Physical Therapists Can Use Fundamental Interventions to Address Social Determinants of Health. Phys Ther 2021; 101:6308777. [PMID: 34174078 DOI: 10.1093/ptj/pzab158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/14/2021] [Accepted: 04/25/2021] [Indexed: 11/14/2022]
Abstract
UNLABELLED The American Physical Therapy Association's Vision Statement for the profession is guided by principles of innovation, access, equity, and advocacy, and calls on physical therapists to stretch their influence beyond the walls of the clinic and the individuals they treat. Access and equity are problems that span multiple health care professions and entities; yet, addressing social determinants of health is a paradigm shift that clinicians need continued support to achieve. This article has 2 objectives: (1) to define the Fundamental Cause Theory and the Socioecological Model within the context of physical therapy in order to promote best clinical practice, and (2) to apply the concept of "fundamental interventions" in clinical practice to mitigate the negative impact of downstream effects of social determinants of health across levels of the Socioecological Model-individual, interpersonal, institutional, community, and societal. This theoretical lens provides the conceptual framework necessary for physical therapists to think creatively about ways to change their practice in their own contexts to impact the life of individual patients and transform the movement health of society. IMPACT As health care providers, physical therapists have a responsibility to make every effort to meet the needs of their patients and optimize movement health in society; yet significant structural and systemic barriers often prevent patients from reaching their fullest potential. Clinicians can no longer subscribe to a narrow scope of practice focused on individual attainment of therapy goals. This Perspective discusses Fundamental Cause Theory and the Socioecological Model theoretical frameworks that can help physical therapists develop, test, and implement functional interventions to address the needs of society as a whole.
Collapse
Affiliation(s)
- Dana McCarty
- Division of Physical Therapy, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Meghan Shanahan
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
27
|
Williamson G, Osa ML, Budd E, Kelly NR. Weight-related teasing is associated with body concerns, disordered eating, and health diagnoses in racially and ethnically diverse young men. Body Image 2021; 38:37-48. [PMID: 33831652 DOI: 10.1016/j.bodyim.2021.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022]
Abstract
Research suggests that weight-related teasing is associated with body concerns and disordered eating in male and female adolescents and women. Yet, little is known about these associations for young men with diverse racial and ethnic identities. This study examined the association of weight-related teasing frequency and distress with body concerns, loss of control (LOC) eating, dietary restraint, and history of psychiatric and medical diagnoses in racially and ethnically diverse young men. Racial and ethnic identity was examined as a potential moderator. Participants (N = 1,069; 18-30 years; Mage = 24.1 ± 3.6 years) completed an online survey and reported on general demographics; weight-related teasing; body concerns; LOC eating frequency in the last 28 days; dietary restraint; and history of psychiatric and medical diagnoses. All models adjusted for BMI, income, education, and history of psychiatric diagnoses (when not the dependent variable). Both weight-related teasing frequency and distress were significantly and positively linked with all dependent variables, and these associations did not significantly vary by racial and ethnic identity. These findings suggest that, much like in prior research with adolescents and women, experiences with weight-related teasing are associated with body concerns, disordered eating, and poorer health in racially and ethnically diverse young men, regardless of body size.
Collapse
Affiliation(s)
- Gina Williamson
- Counseling Psychology and Human Services, University of Oregon, 1215 University of Oregon, Eugene, OR 97403, United States; The Prevention Science Institute, University of Oregon, 1600 Millrace Dr, Eugene, OR 97403, United States
| | - Maggie L Osa
- Counseling Psychology and Human Services, University of Oregon, 1215 University of Oregon, Eugene, OR 97403, United States; The Prevention Science Institute, University of Oregon, 1600 Millrace Dr, Eugene, OR 97403, United States
| | - Elizabeth Budd
- Counseling Psychology and Human Services, University of Oregon, 1215 University of Oregon, Eugene, OR 97403, United States; The Prevention Science Institute, University of Oregon, 1600 Millrace Dr, Eugene, OR 97403, United States
| | - Nichole R Kelly
- Counseling Psychology and Human Services, University of Oregon, 1215 University of Oregon, Eugene, OR 97403, United States; The Prevention Science Institute, University of Oregon, 1600 Millrace Dr, Eugene, OR 97403, United States.
| |
Collapse
|
28
|
McLean ME, McLean LE, McLean‐Holden AC, Campbell LF, Horner AM, Kulkarni ML, Melville LD, Fernandez EA. Interphysician weight bias: A cross-sectional observational survey study to guide implicit bias training in the medical workplace. Acad Emerg Med 2021; 28:1024-1034. [PMID: 33914377 DOI: 10.1111/acem.14269] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/14/2021] [Accepted: 04/24/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Implicit bias contributes to both health care disparities and professional limitations, and it exists among physicians. Prior literature has described physician weight bias (WB) toward patients, but little research has investigated interphysician WB. This study describes the prevalence of interphysician implicit WB and investigates the relationships between implicit, explicit, and professional biases. The authors hypothesized that the majority of physicians possess interphysician implicit WB and that the degree of implicit bias has a direct relationship with explicit and professional WB. METHODS In this cross-sectional study, a survey was used to measure interphysician implicit, explicit, and professional WB. It included adaptations of two previously validated measures (the Implicit Association Test and the Crandall Anti-fat Attitudes Questionnaire) and an investigator developed and tested Professional Weight Bias Scale. The survey was distributed electronically via medical society message boards, email lists, and social media groups. RESULTS A total of 620 physicians and medical students participated. Fifty-eight percent were female, ages ranged from 22 to 83 years (mean = 44 years), and body mass index (BMI) ranged from 16 to 59 (mean = 26). Descriptive analyses revealed that 87% had some degree of implicit interphysician antifat bias, with 31% and 34% categorized as moderate and severe, respectively. Correlation and multiple regression analyses revealed that male sex, increased age, and decreased BMI were related to increased implicit bias, controlling for all other factors. Furthermore, implicit, explicit, and professional bias all had significant, direct relationships with each other. CONCLUSIONS Our findings highlight the prevalence of interphysician implicit WB; the strong correlations between implicit, explicit, and professional WB; and the potential disparities faced by physicians with obesity. These results may be used to guide implicit bias training for a more inclusive medical workplace.
Collapse
Affiliation(s)
- Mary E. McLean
- Department of Emergency Medicine St. John’s Riverside Hospital Yonkers New York USA
| | - Leigh E. McLean
- School of Social and Family Dynamics Arizona State University Tempe Arizona USA
| | - Annie C. McLean‐Holden
- Department of Oral and ENT Pathology Emory University Hospital Atlanta Georgia USA
- Department of Pathology University of Texas Southwestern Medical Center Dallas Texas USA
| | - Linelle F. Campbell
- Department of Emergency Medicine Jacobi/Montefiore Medical Center Bronx New York USA
| | - Adriana M. Horner
- Department of Emergency Medicine St. John’s Riverside Hospital Yonkers New York USA
| | - Miriam L. Kulkarni
- Department of Emergency Medicine St. John’s Riverside Hospital Yonkers New York USA
| | - Laura D. Melville
- Department of Emergency Medicine NYP Brooklyn Methodist Hospital Brooklyn New York USA
| | | |
Collapse
|
29
|
Ganesan A, Carter-Sowell AR. Buffering anti-fat attitudes using contact: The roles of contact quantity, duration, favorability, and intergroup anxiety. Body Image 2021; 38:120-126. [PMID: 33887561 DOI: 10.1016/j.bodyim.2021.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 03/27/2021] [Accepted: 03/27/2021] [Indexed: 01/25/2023]
Abstract
Decades of intergroup contact research have found that contact with outgroups reduces negative attitudes. Yet, few studies have examined the association between contact and anti-fat attitudes. Furthermore, testing different facets of contact, namely contact quantity versus contact duration, provides more precise theoretical predictions for their effectiveness in this under-tested context. This study examined whether intergroup anxiety was indirectly related to and contact favorability moderated the relationship between contact and anti-fat attitudes, tested through the constructs of contact quantity (i.e., how many individuals interacted with) and contact duration (i.e., how often time was spent). Undergraduates (N = 343; 260 women) based in the United States completed an online survey assessing intergroup contact, contact favorability, intergroup anxiety, and anti-fat attitudes. Analyses of conditional indirect effects showed that longer contact but not more contact reduced intergroup anxiety, which lowered anti-fat attitudes. The indirect paths for both contact types were not conditional upon contact favorability. Contact favorability moderated the association between contact duration and anti-fat attitudes such that longer and more favorable contact lowered anti-fat attitudes. Findings are discussed within the contact hypothesis, and future research should explore the distinct elements of the hypothesis as applicable to anti-fat prejudice in in-person and online contexts.
Collapse
Affiliation(s)
- Asha Ganesan
- Department of Psychological & Brain Sciences, Texas A&M University, TX, USA.
| | - Adrienne R Carter-Sowell
- Department of Psychological & Brain Sciences and the Interdisciplinary Critical Studies Program, Texas A&M University, TX, USA
| |
Collapse
|
30
|
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; 104:1962-1969. [PMID: 33487507 DOI: 10.1016/j.pec.2021.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/30/2020] [Accepted: 01/02/2021] [Indexed: 06/12/2023]
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.
Collapse
Affiliation(s)
- Sean M Phelan
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
| | - Rebecca M Puhl
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT, USA; Department of Human Development & Family Studies, University of Connecticut, Storrs, CT, USA
| | - Diana J Burgess
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Neena Natt
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Manpreet Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | | | - Somnath Saha
- VA Portland Health Care System, Portland, OR, USA; Department of Internal Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kristin Fischer
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Michelle van Ryn
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
31
|
Dyrbye LN, West CP, Herrin J, Dovidio J, Cunningham B, Yeazel M, Lam V, Onyeador IN, Wittlin NM, Burke SE, Hayes SN, Phelan SM, van Ryn M. A Longitudinal Study Exploring Learning Environment Culture and Subsequent Risk of Burnout Among Resident Physicians Overall and by Gender. Mayo Clin Proc 2021; 96:2168-2183. [PMID: 34218879 DOI: 10.1016/j.mayocp.2020.12.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/02/2020] [Accepted: 12/14/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To explore the relationship between learning environment culture and the subsequent risk of developing burnout in a national sample of residents overall and by gender. METHODS From April 7 to August 2, 2016, and May 26 to August 5, 2017, we surveyed residents in their second (R2) and third (R3) postgraduate year. The survey included a negative interpersonal experiences scale (score range 1 to 7 points, higher being worse) assessing psychological safety and bias, inclusion, respect, and justice; an unfair treatment scale (score range 1 to 5 points, higher being worse), and two items from the Maslach Burnout Inventory. Individual responses to the R2 and R3 surveys were linked. RESULTS The R2 survey was completed by 3588 of 4696 (76.4%) residents; 3058 of 3726 (82.1%) residents completed the R3 survey; and 2888 residents completed both surveys. Women reported more negative interpersonal experiences (mean [SD], 3.00 [0.83] vs 2.90 [0.85], P<.001) and unfair treatment (66.5% vs. 58.7%, P<.001) than men at R2. On multivariable analysis, women at R3 were more likely than their male counterparts to have burnout (odds ratio, 1.23; 95% CI, 1.02 to 1.48; P=.03). Both men and women who reported more negative interpersonal experiences at R2 were more likely to have burnout at R3 (odds ratio, 1.32; 95% CI, 1.14 to 1.52; P<.001). The factors contributing to burnout did not vary in effect magnitude by gender. CONCLUSION These findings indicate women residents are more likely to have burnout relative to men in the third year of residency. Negative culture predicted subsequent burnout 1 year later among both men and women. Differences in burnout were at least partly due to differing levels of exposure to negative interactions for men versus women rather than a negative interaction having a differential impact on the well-being of men versus women.
Collapse
Affiliation(s)
- Liselotte N Dyrbye
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Colin P West
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Jeph Herrin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | | | - Brooke Cunningham
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - Mark Yeazel
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | | | - Ivuoma N Onyeador
- Department of Management and Organizations, Kellogg School of Management, Northwestern University, Kirkland, WA
| | | | - Sara E Burke
- Department of Psychology, Syracuse University, Syracuse, NY
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Sean M Phelan
- Division of Health Care Policy & Research, Mayo Clinic, Rochester, MN
| | - Michelle van Ryn
- School of Nursing, Oregon Health & Science University, Portland, OR
| |
Collapse
|
32
|
Thompson N, Adams EL, Tkacz Browne N, Bean MK. Pediatric Surgery and School Nurse Attitudes Regarding Children with Obesity. J Pediatr Nurs 2021; 59:75-80. [PMID: 33497956 PMCID: PMC8292152 DOI: 10.1016/j.pedn.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Weight bias towards individuals with obesity exists among medical professionals; yet, there is less evidence of the extent to which weight biases exist in different types of nursing professions. This study aimed to describe pediatric surgery and school nurses' weight biases towards children with obesity and examine factors associated with weight biases. DESIGN AND METHODS Pediatric surgery (n = 108) and school nurses (n = 177) completed a single online survey that assessed their attitudes towards weight regarding children with obesity. Responses were categorized as % agreement (responded "agree" or "strongly agree" to a given statement). Nurses also reported % time spent working with children who had obesity. RESULTS Almost all nurses (>93%) agreed it was important to treat patients with obesity with compassion and respect. However, many nurses endorsed statements stating that patients with obesity are often non-compliant with treatment recommendations (47%) and can be difficult to deal with (35%). Only about half of school nurses (53%) and surgical nurses (56%) felt professionally prepared to effectively treat patients with obesity. Nurses commonly reported hearing/witnessing other professionals in their field make negative comments (69%) or convey negative stereotypes (55%) about patients with obesity. School nurses who spent a greater % of time working with children with overweight had more positive weight attitudes (p = 0.04). CONCLUSIONS Negative attitudes towards patients with obesity were relatively prevalent in this population of pediatric surgery and school nurses. PRACTICE IMPLICATIONS There is a need for more educational opportunities, professional trainings, and policy initiatives to reduce weight bias among nurses.
Collapse
Affiliation(s)
- Nancy Thompson
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA.
| | - Elizabeth L Adams
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA.
| | - Nancy Tkacz Browne
- Northern Light Health, Eastern Maine Medical Center, Department of Pediatrics, WOW Pediatric & Adolescent Weight & Cardiometabolic Clinic, Bangor, ME, USA
| | - Melanie K Bean
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA.
| |
Collapse
|
33
|
Nestorowicz S, Saks N. Addressing Bias Toward Overweight Patients: a Training Program for First-Year Medical Students. MEDICAL SCIENCE EDUCATOR 2021; 31:1115-1123. [PMID: 34457955 PMCID: PMC8368903 DOI: 10.1007/s40670-021-01282-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 05/29/2023]
Abstract
BACKGROUND Physicians may have biases toward overweight patients which likely influences clinical judgments and can lead to disparities in patient care. An increasing number of adults are considered overweight/obese, so it is important to address these biases in training future physicians. METHODS Forty-five first-year medical students participated in art museum programs and physician presentations, or were part of the control group. Four validated measures Beliefs About Obese Persons Scale, Attitudes Toward Obese Persons Scale, Fat Phobia Scale, and the Harvard Implicit Association Test (IAT) and researcher-generated questions, measured levels of bias before and after study activities. RESULTS All participants demonstrated decreased bias. ANCOVA analysis did not reveal significant differences between the experimental and control groups. However, prior to the study 75% of participants had "preference for thin individuals." Forty percent of those participating in study activities indicated a positive change by associating more positive traits with obese body shapes, compared to 29% of the control group. Study activities were rated positively. DISCUSSION/CONCLUSION The art museum was an engaging/relaxing place for reflection on body types and biases. Physicians provided important instruction for normalization/de-stigmatization of patient care. Although there were no significant findings, the study has raised questions for continuing this work. What are most effective ways/times to address weight bias within the medical school curriculum? Could this work extend to other marginalized patient groups? The diversity in art and humanities creates a rich resource for discussing viewpoints and experiences. The small number of participants and the timing/lack of focus in museum sessions are noted as limitations.
Collapse
Affiliation(s)
| | - Norma Saks
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ USA
| |
Collapse
|
34
|
Cullin JM. Implicit and explicit fat bias among adolescents from two US populations varying by obesity prevalence. Pediatr Obes 2021; 16:e12747. [PMID: 33191643 DOI: 10.1111/ijpo.12747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Research shows that explicit (reported) and implicit (unconscious) bias are distinct constructs varying by socioecological context. Implicit bias better predicts poor health outcomes related to chronic psychosocial stress. OBJECTIVES Variation in fat bias was identified in two populations of adolescents in Indiana counties with relatively high (Lawrence) and low (Monroe) obesity prevalence. METHODS Adolescents (n = 185) aged 14-18 years were recruited October 2017-2018. Explicit fat bias was measured using the Attitudes Towards Obese Persons (ATOP) scale. Implicit fat bias was measured using the obesity attitude implicit association test (IAT). RESULTS Both samples scored high on the ATOP, indicating more positive reported attitudes towards persons with obesity, and scores did not differ between counties (P > .05) after adjusting for age, sex, ethnicity, and BMI-for-age percentile. Both samples demonstrated unconscious anti-fat bias, with Monroe exhibiting significantly higher IAT scores (ie, greater anti-fat bias) than Lawrence after controlling for confounders (P = .039). CONCLUSION Differences between explicit and implicit fat-bias were observed. Both samples reported positive attitudes towards obesity but also demonstrated unconscious anti-fat bias. Unconscious anti-fat bias was significantly higher in the county with lower prevalence of obesity, suggesting epidemiological context may influence implicit fat bias. Higher obesity prevalence may reduce unconscious anti-fat bias in a population or, alternatively, lower obesity prevalence may increase such bias.
Collapse
Affiliation(s)
- Jennifer M Cullin
- Department of Anthropology, Indiana University, Bloomington, Indiana, USA
| |
Collapse
|
35
|
Goss AL, Rethy L, Pearl RL, DeLisser HM. The "difficult" cadaver: weight bias in the gross anatomy lab. MEDICAL EDUCATION ONLINE 2020; 25:1742966. [PMID: 32182202 PMCID: PMC7144266 DOI: 10.1080/10872981.2020.1742966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 06/10/2023]
Abstract
Background: The prevalence of overweight and obesity continues to rise and is associated with increased morbidity and mortality. Weight bias is common among physicians and medical students and limits the therapeutic alliance between providers and patients with overweight and obesity.Objective: The authors sought to explore the relationship between the gross anatomy course and medical student attitudes towards weight and obesity.Design: The authors employed a mixed-methods approach consisting of semi-structured interviews and anonymous web-based surveys of first-year medical students taking gross anatomy at one USA medical school. They analyzed transcripts of interviews and free-text survey responses using a grounded theory approach and performed tests of association to investigate the relationship between demographic information, responses to multiple-choice survey questions and weight bias.Results: A total of 319 (52%) first-year medical students (2015-2018) completed the survey and 33 participated in interviews. Of survey respondents, 71 (22%) responded that the course had changed how they felt about people with overweight/obesity. These respondents were also more likely to affirm that the course had affected their views toward their own bodies (p < 0.001). Qualitative data analysis identified three overarching themes within students' descriptions of the effects of the gross anatomy lab on attitudes toward bodies perceived to have excess weight: these bodies were described as 1) difficult, 2) unhealthy, and 3) evoking disgust. Students extrapolated from their experiences with cadavers to imagined interactions with future patients, relying heavily on the narrative of the difficult patient.Conclusions: At one USA medical school, students perceived their experiences in gross anatomy as shaping their attitudes toward individuals with overweight or obesity. Efforts to reduce medical student weight bias ought to target this previously unexplored potential site of weight bias.
Collapse
Affiliation(s)
| | - Leah Rethy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca L. Pearl
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Horace M. DeLisser
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
36
|
Gallucci A, Del Mauro L, Pisoni A, Lauro LJR, Mattavelli G. A Systematic Review Of Implicit Attitudes And Their Neural Correlates In Eating Behaviour. Soc Cogn Affect Neurosci 2020; 18:nsaa156. [PMID: 33219691 PMCID: PMC10074774 DOI: 10.1093/scan/nsaa156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 09/17/2020] [Accepted: 11/20/2020] [Indexed: 12/15/2022] Open
Abstract
An increasing number of studies suggests that implicit attitudes toward food and body shape predict eating behaviour and characterize patients with eating disorders (EDs). However, literature has not been previously analysed, thus differences between patients with EDs and healthy controls and the level of automaticity of the processes involved in implicit attitudes are still matters of debate. The present systematic review aimed to synthetize current evidence from papers investigating implicit attitudes towards food and body in healthy and EDs populations. PubMed, EMBASE (Ovid), PsycINFO, Web of Science and Scopus were systematically screened and 183 studies using different indirect paradigms were included in the qualitative analysis. The majority of studies reported negative attitudes towards overweight/obese body images in healthy and EDs samples and weight bias as a diffuse stereotypical evaluation. Implicit food attitudes are consistently reported as valid predictors of eating behaviour. Few studies on the neurobiological correlates showed neurostimulation effects on implicit attitudes, but the automaticity at brain level of implicit evaluations remains an open area of research. In conclusion, implicit attitudes are relevant measures of eating behaviour in healthy and clinical settings, although evidence about their neural correlates is limited.
Collapse
Affiliation(s)
- Alessia Gallucci
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore, 48--20900, Monza, Italy
- NeuroMi (Neuroscience Center), University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1--20126, Milan, Italy
| | - Lilia Del Mauro
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1--20126, Milan, Italy
| | - Alberto Pisoni
- NeuroMi (Neuroscience Center), University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1--20126, Milan, Italy
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1--20126, Milan, Italy
| | - Leonor J Romero Lauro
- NeuroMi (Neuroscience Center), University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1--20126, Milan, Italy
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1--20126, Milan, Italy
| | - Giulia Mattavelli
- NETS, School of Advanced Studies, IUSS, Piazza della Vittoria n.15, 27100, Pavia, Italy
| |
Collapse
|
37
|
Khandalavala B, Koran-Scholl J, Geske J. Comprehensive Obesity Education for Family Medicine Residents. PRIMER (LEAWOOD, KAN.) 2020; 4:25. [PMID: 33111052 PMCID: PMC7581191 DOI: 10.22454/primer.2020.525629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Family medicine residents receive limited education on obesity management and obesity bias. Weight stigmatization is prevalent in primary care providers and trainees, and early mitigation is critical to optimize patient-centered care. Recent Provider Competencies for the Prevention and Management of Obesity include obesity bias. This report is intended to fill a current gap in obesity education for family medicine residents. METHODS An interprofessional obesity teaching half day for family medicine residents incorporated the Provider Competencies and focused on five modules that addressed complexities of obesity and its clinical management. The obesity bias module focused on both explicit and implicit bias, assessment of implicit bias, preferential language usage, and mitigation strategies. An obesity-simulation empathy suit was available, and a public health expert described successful obesity care in a patient-centered medical home. Family medicine residents were surveyed prior to, immediately after the half-day of obesity teaching, and 15 months later. RESULTS Survey results indicated 39.3% of residents had no previous biopsychosocial obesity education. Residents believed the content moderately (68.8%) or mostly (12.5%) impacted their approach to working with patients with obesity. Residents' comfort in working with patients with obesity as well as their perceived understanding of their own biases increased immediately after the intervention and was sustained 15 months later. CONCLUSIONS Our results suggest that a half day of obesity teaching can have a positive and sustained impact on family medicine residents. Additionally, this educational experience allowed for greater individual awareness building and insight regarding implicit bias. Such education for family medicine residents fills an identified gap in obesity education.
Collapse
Affiliation(s)
- Birgit Khandalavala
- Department of Family Medicine, University of Nebraska Medical Center, Omaha, NE
| | | | - Jenenne Geske
- Department of Family Medicine, University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
38
|
VanPuymbrouck L, Friedman C, Feldner H. Explicit and implicit disability attitudes of healthcare providers. Rehabil Psychol 2020; 65:101-112. [PMID: 32105109 PMCID: PMC9534792 DOI: 10.1037/rep0000317] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
PURPOSE/OBJECTIVE Health care providers' attitudes of marginalized groups can be key factors that contribute to health care access and outcome disparities because of their influence on patient encounters as well as clinical decision-making. Despite a growing body of knowledge linking disparate health outcomes to providers' clinical decision making, less research has focused on providers' attitudes about disability. The aim of this study was to examine providers' explicit and implicit disability attitudes, interactions between their attitudes, and correlates of explicit and implicit bias. Research Method/Design: We analyzed secondary data from 25,006 health care providers about their disability attitudes. In addition to analyzing people's explicit and implicit attitudes (Disability Attitudes Implicit Association Test), we used Son Hing, Chung-Yan, Hamilton, & Zanna's (2008) model of two-dimensional prejudice to compare provider's explicit and implicit attitudes. Finally, we used linear regression models to examine correlates of providers' explicit and implicit attitudes. RESULTS While on average, provider's explicit attitudes (M = 4.41) indicated little prejudice, their implicit attitudes (M = 0.54) revealed they moderately preferred nondisabled people-they were aversive ableists. Correlates of providers' explicit and implicit attitudes also included age, gender, political orientation, and having relationships with disability (friends, family, and being a person with disability). CONCLUSIONS/IMPLICATIONS This study revealed that despite a majority of providers self-reporting not being biased against people with disabilities, implicitly, the overwhelming majority were biased. This study's findings can be used to better understand how provider disability bias can contribute to inequitable health care access and health outcomes for people with disabilities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
|
39
|
Hyer S, Conner NE. Concept of overweight bias among healthcare professionals: An evolutionary concept analysis. Nurs Forum 2020; 55:395-402. [PMID: 32124459 DOI: 10.1111/nuf.12442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this concept analysis was to identify the attributes of overweight bias among healthcare providers (HCPs) and create a clear definition to guide the recognition of overweight bias among HCPs. Settings within the healthcare system are not exempt from bias and the stigmatization of persons with obesity. Overweight bias among HCPs may negatively impact health care and health outcomes. Rodger's evolutionary method was used to guide this concept analysis. The databases CINAHL Plus with Full Text, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE, and PsycINFO were searched. The analysis provided clarification of the concept to facilitate HCP self-awareness of overweight bias. A definition of the concept of overweight bias among HCPs is provided along with its attributes, antecedents, and consequences.
Collapse
Affiliation(s)
- Suzanne Hyer
- College of Nursing, University of Central Florida, Orlando, Florida
| | - Norma E Conner
- College of Nursing, University of Central Florida, Orlando, Florida
| |
Collapse
|
40
|
Brochu PM. Testing the effectiveness of a weight bias educational intervention among clinical psychology trainees. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2020. [DOI: 10.1111/jasp.12653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Paula M. Brochu
- Department of Clinical and School Psychology Nova Southeastern University Fort Lauderdale FL USA
| |
Collapse
|
41
|
Breland JY, Wong MS, Frayne SM, Hoggatt KJ, Steers WN, Saechao F, Washington DL. Obesity and Health Care Experiences among Women and Men Veterans. Womens Health Issues 2019; 29 Suppl 1:S32-S38. [PMID: 31253240 DOI: 10.1016/j.whi.2019.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 03/29/2019] [Accepted: 04/05/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Obesity is highly stigmatized, especially for women, and therefore may negatively affect health care experiences. Past findings on the relationship between obesity and health care experiences are mixed, perhaps because few studies examine relationships by gender and obesity class. Our objective was to evaluate whether women and men with more severe obesity report worse health care experiences related to Veterans Health Administration (VA) care. METHODS Health care experiences (self-management support, mental health assessments, office staff courtesy, communication with providers) and overall provider ratings were assessed with the 2014 VA Survey of Health Care Experiences of Patients. Using multiple regression analyses (n = 13,462 women, n = 268,180 men), we assessed associations among obesity classes, health care experiences, and overall provider ratings, adjusting for sociodemographic, health, and primary care use characteristics. RESULTS The greatest differences in health care experiences between patients with and without obesity were in self-management support experiences, which were more favorable among women and men of all obesity classes. There were gender differences in associations between obesity and mental health assessments: for men, but not women, those in any obesity class gave higher ratings than those without obesity. For most other health care experiences and provider ratings, men with obesity reported slightly less favorable experiences than those without. There was no consistent pattern for women. CONCLUSIONS It is promising that VA patients with obesity report more self-management support, given the behavior change required for weight management. Lower health care experience and provider ratings among men with obesity suggest a need to further investigate possible obesity-related stigma in VA primary care.
Collapse
Affiliation(s)
- Jessica Y Breland
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California.
| | - Michelle S Wong
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Susan M Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Katherine J Hoggatt
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - W Neil Steers
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California; Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Fay Saechao
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California
| | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California; Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
42
|
Mastrocola MR, Roque SS, Benning LV, Stanford FC. Obesity education in medical schools, residencies, and fellowships throughout the world: a systematic review. Int J Obes (Lond) 2019; 44:269-279. [PMID: 31551484 DOI: 10.1038/s41366-019-0453-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/20/2019] [Accepted: 07/31/2019] [Indexed: 11/09/2022]
Abstract
Obesity is pandemic throughout the world, and there is concern that physicians are inadequately trained to treat their patients with obesity despite its prevalence. This review explores obesity education in medical students, resident, and fellow physicians throughout the world from 2005 to 2018. Previous reviews on obesity education were conducted before 2011, focused solely on medical students, and only explored obesity education in the United States. We systematically searched MEDLINE, EMBASE, PsycINFO, and ERIC databases for studies which included the search terms "obesity education" AND either "medical students", "residency", or "fellowship" that met PICOS (Population, Interventions, Comparators, Outcomes, Study Design) criteria for articles published in English for obesity education and evaluation of outcomes. Our initial search yielded 234 articles, and 27 studies met criteria for our review. We described and analyzed these studies for their study design and graded quality, quantity, and consistency for each measured outcome. We applied an evidence grading system that has been previously applied in the literature in which each outcome measure was graded on a scale from A to D. We evaluated obesity education programs for outcomes regarding implicit and explicit bias, changes in attitude towards obesity, weight change, obesity knowledge, counseling confidence, intent to counsel, and counseling quality. There was a significant degree of heterogeneity in the studies included. While obesity knowledge was most frequently studied, counseling confidence was the only outcome with an overall grade A. There is currently a paucity of obesity education programs for medical students, residents, and fellow physicians in training programs throughout the world despite high disease prevalence. However, these programs often improve outcomes when they are administered. Our review suggests that more obesity education should be administered in undergraduate and graduate medical education to ensure optimal treatment of patients with obesity.
Collapse
Affiliation(s)
| | | | - Lauren V Benning
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | - Fatima Cody Stanford
- Department of Medicine-Division of Endocrinology-Neuroendocrine Department of Pediatrics-Division of Endocrinology, Massachusetts General Hospital, MGH Weight Center, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
43
|
Unconscious Weight Bias Among Nursing Students: A Descriptive Study. Healthcare (Basel) 2019; 7:healthcare7030106. [PMID: 31547359 PMCID: PMC6787661 DOI: 10.3390/healthcare7030106] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 11/26/2022] Open
Abstract
There has been both an increase in obesity and anti-obesity bias in the United States. The Harvard Weight Implicit Association Test (IAT) is a reliable, valid test that can measure unconscious weight bias. First semester Bachelor of Science in Nursing (BSN) students were surveyed anonymously mid-semester and at the end of the semester after completing the Harvard Weight IAT. Sixty-nine out of 77 students completed pre- and post-surveys. Weight preference towards others was not shown to be related to the respondent’s own self-reported body mass index (BMI). The majority of respondents exhibited more weight-related bias on the IAT than they realized. The three qualitative themes that emerged included Awareness of Personal Beliefs and Stereotypes, Reminder to be Impartial, and Skepticism about the IAT. It is important for undergraduate nursing students to be aware of possible unconscious weight bias in order to provide high-quality care to patients.
Collapse
|
44
|
Kimber M, Dimitropoulos G, Williams EP, Singh M, Loeb KL, Hughes EK, Garber A, Elliott A, Vyver E, Le Grange D. Tackling mixed messages: Practitioner reflections on working with adolescents with atypical anorexia and their families. Eat Disord 2019; 27:436-452. [PMID: 30415597 DOI: 10.1080/10640266.2018.1542888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The treatment of atypical anorexia nervosa (AN) poses new research and practice challenges for the field of eating disorders. The objective of this study was to describe frontline practitioners' perceptions of differences between adolescents living with atypical versus typical AN, as well as the intervention challenges they experience when working with these adolescents and their families. We followed the principles of fundamental qualitative description and recruited a purposeful sample of practitioners treating adolescent eating disorders to complete a one-on-one semi-structured interview. Conventional content analysis and the constant comparison technique were used for data analysis. A total of 23 practitioners from four countries participated in this study. Practitioners described that adolescents with atypical AN present with higher pre-morbid weights and rates of weight-based teasing compared to their AN peers. Clinical challenges perceived by practitioners to be specific to working with adolescents with atypical AN included: addressing conflicting messages about eating disorders and weight loss, empathizing with a justified fear of weight gain, and increased risk for parental and therapist collusion with the eating disorder. Findings have implications for delivering interventions to adolescents seeking care for atypical AN.
Collapse
Affiliation(s)
- Melissa Kimber
- Department of Psychiatry and Behavioural Neurosciences and Offord Centre for Child Studies, McMaster University , Hamilton , Canada
| | | | - Emily P Williams
- Faculty of Social Work, University of Calgary , Calgary , Canada
| | - Manya Singh
- Mathison Centre for Mental Health Research and Education , Calgary , Canada
| | - Katharine L Loeb
- School of Psychology, Fairleigh Dickinson University , Teaneck , USA
| | - Elizabeth K Hughes
- Murdoch Children's Research Institute and Centre for Adolescent Health, Royal Children's Hospital, Department of Pediatrics, University of Melbourne , Melbourne , Australia
| | - Andrea Garber
- Department of Pediatrics, University of California (San Francisco) , San Francisco , California , USA
| | - April Elliott
- Department of Pediatrics, University of Calgary , Calgary , Canada
| | - Ellie Vyver
- Department of Pediatrics, University of Calgary , Calgary , Canada
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Neuroscience (Emeritus), The University of Chicago,Department of Psychiatry,University of California (San Francisco) , San Francisco , California , USA
| |
Collapse
|
45
|
Wittlin NM, Dovidio JF, Burke SE, Przedworski JM, Herrin J, Dyrbye L, Onyeador IN, Phelan SM, van Ryn M. Contact and role modeling predict bias against lesbian and gay individuals among early-career physicians: A longitudinal study. Soc Sci Med 2019; 238:112422. [PMID: 31391147 DOI: 10.1016/j.socscimed.2019.112422] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 07/05/2019] [Accepted: 07/13/2019] [Indexed: 12/30/2022]
Abstract
RATIONALE Physician bias against sexual minorities can hinder the delivery of high-quality health care and thus contribute to the disproportionate prevalence of negative health outcomes within this population. Medical students' interpersonal experiences within the context of medical school may contribute to this bias. OBJECTIVE The goal of the current research was to examine the relationship between these interpersonal experiences, reported by heterosexual, cisgender medical students, and explicit and implicit bias against lesbians and gay individuals, reported two years later during second year of medical residency. METHOD Data were collected by surveying students (n = 2940) from a stratified sample of U.S. medical schools in fall 2010 (first semester of medical school), spring 2014 (final semester of medical school), and spring 2016 (second year of medical residency). RESULTS Amount and favorability of contact with LGBT individuals, reported during the final semester of medical school, predicted lower levels of explicit bias against lesbian and gay individuals during second year of medical residency. Additionally, exposure to negative role modeling, also reported during the final semester of medical school, predicted higher levels of explicit bias against lesbian and gay individuals during second year of medical residency. Amount of contact with LGBT individuals - and in particular, with LGBT medical students - predicted lower levels of implicit bias against lesbian and gay individuals during second year of medical residency. Neither favorability of contact with LGBT individuals nor exposure to negative role modeling predicted implicit bias against lesbian and gay individuals during second year of medical residency. CONCLUSION These results suggest that interpersonal experiences during medical school can systematically shape heterosexual, cisgender physicians' subsequent explicit and implicit bias against lesbian and gay individuals.
Collapse
Affiliation(s)
- Natalie M Wittlin
- Department of Psychology, Yale University, Kirtland Hall, 2 Hillhouse Ave., New Haven, CT 06511 United States.
| | - John F Dovidio
- Department of Psychology, Yale University, Kirtland Hall, 2 Hillhouse Ave., New Haven, CT 06511 United States.
| | - Sara E Burke
- Department of Psychology, Syracuse University, Huntington Hall, Syracuse, NY 13244, United States.
| | - Julia M Przedworski
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St. S.E., Minneapolis, MN 55455, United States; School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, United States.
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Yale School of Medicine, PO Box 2254, Charlottesville, VA 22902, United States.
| | - Liselotte Dyrbye
- Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States.
| | - Ivuoma N Onyeador
- Department of Psychology, Yale University, Kirtland Hall, 2 Hillhouse Ave., New Haven, CT 06511 United States.
| | - Sean M Phelan
- Division of Health Care Policy and Research, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States.
| | - Michelle van Ryn
- School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, United States.
| |
Collapse
|
46
|
Askew DA, Lyall VJ, Ewen SC, Paul D, Wheeler M. Understanding practitioner professionalism in Aboriginal and Torres Strait Islander health: lessons from student and registrar placements at an urban Aboriginal and Torres Strait Islander primary healthcare service. Aust J Prim Health 2019; 23:446-450. [PMID: 28807104 DOI: 10.1071/py16145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 05/27/2017] [Indexed: 11/23/2022]
Abstract
Aboriginal and Torres Strait Islander peoples continue to be pathologised in medical curriculum, leaving graduates feeling unequipped to effectively work cross-culturally. These factors create barriers to culturally safe health care for Aboriginal and Torres Strait Islander peoples. In this pilot pre-post study, the learning experiences of seven medical students and four medical registrars undertaking clinical placements at an urban Aboriginal and Torres Strait Islander primary healthcare service in 2014 were followed. Through analysis and comparison of pre- and post-placement responses to a paper-based case study of a fictitious Aboriginal patient, four learning principles for medical professionalism were identified: student exposure to nuanced, complex and positive representations of Aboriginal peoples; positive practitioner role modelling; interpersonal skills that build trust and minimise patient-practitioner relational power imbalances; and knowledge, understanding and skills for providing patient-centred, holistic care. Though not exhaustive, these principles can increase the capacity of practitioners to foster culturally safe and optimal health care for Aboriginal peoples. Furthermore, competence and effectiveness in Aboriginal health care is an essential component of medical professionalism.
Collapse
Affiliation(s)
- Deborah A Askew
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Health, Qld 4077, Australia
| | - Vivian J Lyall
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Health, Qld 4077, Australia
| | - Shaun C Ewen
- Melbourne Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Vic. 3010, Australia
| | - David Paul
- Aboriginal Health, School of Medicine Fremantle, University of Notre Dame, WA 6959, Australia
| | - Melissa Wheeler
- Centre for Ethical Leadership, University of Melbourne, Vic. 3010, Australia
| |
Collapse
|
47
|
Dyrbye L, Herrin J, West CP, Wittlin NM, Dovidio JF, Hardeman R, Burke SE, Phelan S, Onyeador IN, Cunningham B, van Ryn M. Association of Racial Bias With Burnout Among Resident Physicians. JAMA Netw Open 2019; 2:e197457. [PMID: 31348503 PMCID: PMC6661712 DOI: 10.1001/jamanetworkopen.2019.7457] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/25/2019] [Indexed: 12/19/2022] Open
Abstract
Importance Burnout, a syndrome characterized by emotional exhaustion, depersonalization, and a decreased sense of efficacy, is common among resident physicians, and negative emotional states may increase the expression of prejudices, which are associated with racial disparities in health care. Whether racial bias varies by symptoms of burnout among resident physicians is unknown. Objective To assess the association between burnout and explicit and implicit racial biases toward black people in resident physicians. Design, Setting, and Participants This cohort study obtained data from surveys completed by first-year medical students and resident physicians in the United States as part of the Cognitive Habits and Growth Evaluation Study. Participants were followed up from enrollment in 2010 to 2011 through 2017. Participants completed questionnaires at year 4 of medical school as well as at the second and third years of residency. Only data from resident physicians who self-identified as belonging to a racial group other than black (n = 3392) were included in the analyses because of scarce evidence of racial bias in the care provided to black patients by black physicians. Resident physicians training in radiology or pathology were excluded because they provided less direct patient interaction. Main Outcomes and Measures Burnout symptoms were measured by 2 single-item measures from the Maslach Burnout Inventory. Explicit attitudes about white and black people were measured by a feeling thermometer (FT, from 0 to 100 points, ranging from very cold or unfavorable [lowest score] to very warm or favorable [highest score]; included in the second-year [R2] and third-year [R3] questionnaires). The R2 Questionnaire included a racial Implicit Association Test (IAT; range: -2 to 2). Results Among the 3392 nonblack resident physician respondents, 1693 (49.9%) were male, 1964 (57.9%) were younger than 30 years, and 2362 (69.6%) self-identified as belonging to the white race. In this cohort, 1529 of 3380 resident physicians (45.2%) had symptoms of burnout and 1394 of 3377 resident physicians (41.3%) had depression. From this group, 12 did not complete the burnout items and 15 did not complete the Patient-Reported Outcomes Measurement Information System (PROMIS) items. The mean (SD) FT score toward black people was 77.9 (21.0) and toward white people was 81.1 (20.1), and the mean (SD) racial IAT score was 0.4 (0.4). Burnout at the R2 Questionnaire time point was associated with greater explicit and implicit racial biases. In multivariable analyses adjusting for demographics, specialty, depression, and FT scores toward white people, resident physicians with burnout had greater explicit racial bias (difference in FT score, -2.40; 95% CI, -3.42 to -1.37; P < .001) and implicit racial bias (difference in IAT score, 0.05; 95% CI, 0.02-0.08; P = .002). A dose-response association was found between change in depersonalization from R2 to R3 Questionnaire and R3 Questionnaire explicit bias (for each 1-point increase the difference in R3 FT score decreased, -0.73; 95% CI, -1.23 to -0.23; P = .004) and change in explicit bias. Conclusions and Relevance Among resident physicians, symptoms of burnout appeared to be associated with greater explicit and implicit racial biases; given the high prevalence of burnout and the negative implications of bias for medical care, symptoms of burnout may be factors in racial disparities in health care.
Collapse
Affiliation(s)
- Liselotte Dyrbye
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jeph Herrin
- Department of Internal Medicine, Yale School of Medicine, Charlottesville, Virginia
| | - Colin P. West
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - John F. Dovidio
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Rachel Hardeman
- School of Public Health, Division of Health Policy and Management, University of Minnesota, Minneapolis
| | - Sara Emily Burke
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Sean Phelan
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
| | | | - Brooke Cunningham
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis
| | - Michelle van Ryn
- School of Nursing, Oregon Health and Science University, Portland
| |
Collapse
|
48
|
Abstract
PURPOSE OF REVIEW This review aims to evaluate current research findings relevant to weight stigmatization, to acknowledge the deleterious impact it has on the health of the paediatric population and to provide insight to optimize future guidelines for the treatment of individuals with overweight and obesity. RECENT FINDINGS Obesity prevalence continues to rise in the USA with estimates in children from ages 2-19 years of 18.5%, an all-time high. With the increase in obesity, there has been a concomitant increase in weight stigma, which affects both youth and general population across varied levels of socioeconomic status and body sizes. SUMMARY Weight stigma is a contributing phenomenon to the current obesity epidemic, as individuals with stigmatized experiences (weight-based teasing, bullying, victimization) have increased risks for acquiring adverse health outcomes that encompass the physical, behavioural and psychological. Weight stigma can also lead affected individuals to internalize such experiences which decrease their overall quality of life. Sources of stigma may come from peers, family, educators, media, as well as healthcare professionals, as highlighted in this review. Efforts to establish prevention and treatment strategies for weight stigma may generate further traction to help improve global obesity rates. VIDEO ABSTRACT.
Collapse
Affiliation(s)
- Carl J. Palad
- New York Medical College, Valhalla, New York, Massachusetts, USA
| | | | - Fatima Cody Stanford
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine-Division of Endocrinology- Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
49
|
Dyrbye LN, Wittlin NM, Hardeman RR, Yeazel M, Herrin J, Dovidio JF, Burke SE, Cunningham B, Phelan SM, Shanafelt TD, van Ryn M. A Prognostic Index to Identify the Risk of Developing Depression Symptoms Among U.S. Medical Students Derived From a National, Four-Year Longitudinal Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:217-226. [PMID: 30188367 DOI: 10.1097/acm.0000000000002437] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To determine baseline individual and school-related factors associated with increased risk of developing depression symptoms by year four (Y4) of medical school, and to develop a prognostic index that stratifies risk of developing depression symptoms (Depression-PI) among medical students. METHOD The authors analyzed data from 3,743 students (79% of 4,732) attending 49 U.S. medical schools who completed baseline (2010) and Y4 (2014) surveys. Surveys included validated scales measuring depression, stress, coping, and social support. The authors collected demographics and school characteristics and conducted multivariate analysis to identify baseline factors independently associated with Y4 depression symptoms. They used these factors to create a prognostic index for developing depression. They randomly divided the data into discovery (n = 2,455) and replication (n = 1,288) datasets and calculated c statistics (c). RESULTS The authors identified eight independent prognostic factors for experiencing depression symptoms during training within the discovery dataset: age; race; ethnicity; tuition; and baseline depression symptoms, stress, coping behaviors, and social support. The Depression-PI stratified four risk groups. Compared with the low risk group, those in the intermediate, high, and very high risk groups had an odds ratio of developing depression of, respectively, 1.75, 3.98, and 9.19 (c = 0.71). The replication dataset confirmed the risk groups. CONCLUSIONS Demographics; tuition; and baseline depression symptoms, stress, coping behaviors, and social support are independently associated with risk of developing depression during training among U.S. medical students. By stratifying students into four risk groups, the Depression-PI may allow for a tiered primary prevention approach.
Collapse
Affiliation(s)
- Liselotte N Dyrbye
- L.N. Dyrbye is professor of medicine and medical education, Program on Physician Well-Being, Department of Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-7820-704X. N.M. Wittlin is PhD student, Department of Psychology, Yale University, New Haven, Connecticut; ORCID: https://orcid.org/0000-0002-0858-3576. R.R. Hardeman is assistant professor, Division of Health Policy and Management, University of Minnesota, School of Public Health, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0003-3913-5933. M. Yeazel is associate professor, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota. J. Herrin is assistant professor of medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut; ORCID: https://orcid.org/0000-0002-3671-3622. J.F. Dovidio is Carl Iver Hovland Professor of Psychology and professor of public health, Department of Psychology, Yale University, New Haven, Connecticut; ORCID: https://orcid.org/0000-0002-6110-8344. S.E. Burke is assistant professor, Department of Psychology, Syracuse University, Syracuse, New York; ORCID: https://orcid.org/0000-0002-6952-924X. B. Cunningham is assistant professor of health disparities, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0002-3205-5538. S.M. Phelan is associate professor of health services research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2091-6297. T.D. Shanafelt is Jeanie and Stewart Ritchie Professor of Medicine and associate dean, Stanford School of Medicine, Stanford, California; ORCID: https://orcid.org/0000-0002-7106-5202. M. van Ryn is Grace Phelps Distinguished Professor, Oregon Health & Science University School of Nursing, Portland, Oregon; ORCID: https://orcid.org/0000-0002-4258-7319
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Doshi RS, Gudzune KA, Dyrbye LN, Dovidio JF, Burke SE, White RO, Perry S, Yeazel M, van Ryn M, Phelan SM. Factors influencing medical student self-competence to provide weight management services. Clin Obes 2019; 9:e12288. [PMID: 30358159 PMCID: PMC6411289 DOI: 10.1111/cob.12288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/28/2018] [Accepted: 09/20/2018] [Indexed: 11/27/2022]
Abstract
This study aimed to identify factors associated with high obesity care self-competence among US medical students. The authors performed a cross-sectional analysis of 2014 survey data on fourth year medical students collected online as part of the Medical Student Cognitive Habits and Growth Evaluation Study (CHANGES). Independent variables included quality and quantity of interaction with patients and peers with obesity; hours of communication and partnership skills training; negative remarks against patients with obesity by supervising physicians, and witnessed discrimination against patients with obesity. The dependent variable was self-competence in providing obesity care. Of 5823 students invited to participate, 3689 (63%) responded and were included in our analyses. Most students were white (65%), half were women and 42% had high self-competence in caring for patients with obesity. Factors associated with high self-competence included increased interaction with peers with obesity (39% vs. 49%, P < 0.001) and increased partnership skills training (32% vs. 61%, P < 0.001). Increased partnership skills training and quantity of interactions with peers with obesity were associated with high student self-competence in providing obesity-related care to patients. Medical schools might consider increasing partnership skills training to improve students' preparedness and skill in performing obesity-related care.
Collapse
Affiliation(s)
- R S Doshi
- Duke University Medical Center, Department of Internal Medicine-Pediatrics, Duke University Hospital, Durham, North Carolina, USA
| | - K A Gudzune
- Department of General Internal Medicine, Johns Hopkins University School of Medicine and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - L N Dyrbye
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - J F Dovidio
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - S E Burke
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - R O White
- Division of Community Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - S Perry
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - M Yeazel
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - M van Ryn
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - S M Phelan
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|