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