The mixed impact of medical school on medical students' implicit and explicit weight bias

Sean M. Phelan, Rebecca M. Puhl, Sara E. Burke, Rachel Hardeman, John F. Dovidio, David B. Nelson, Julia Przedworski, Diana J. Burgess, Sylvia Perry, Mark W. Yeazel, Michelle van Ryn

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Context: Health care trainees demonstrate implicit (automatic, unconscious) and explicit (conscious) bias against people from stigmatised and marginalised social groups, which can negatively influence communication and decision making. Medical schools are well positioned to intervene and reduce bias in new physicians. Objectives: This study was designed to assess medical school factors that influence change in implicit and explicit bias against individuals from one stigmatised group: people with obesity. Methods: This was a prospective cohort study of medical students enrolled at 49 US medical schools randomly selected from all US medical schools within the strata of public and private schools and region. Participants were 1795 medical students surveyed at the beginning of their first year and end of their fourth year. Web-based surveys included measures of weight bias, and medical school experiences and climate. Bias change was compared with changes in bias in the general public over the same period. Linear mixed models were used to assess the impact of curriculum, contact with people with obesity, and faculty role modelling on weight bias change. Results: Increased implicit and explicit biases were associated with less positive contact with patients with obesity and more exposure to faculty role modelling of discriminatory behaviour or negative comments about patients with obesity. Increased implicit bias was associated with training in how to deal with difficult patients. On average, implicit weight bias decreased and explicit bias increased during medical school, over a period of time in which implicit weight bias in the general public increased and explicit bias remained stable. Conclusions: Medical schools may reduce students' weight biases by increasing positive contact between students and patients with obesity, eliminating unprofessional role modelling by faculty members and residents, and altering curricula focused on treating difficult patients. Discuss ideas arising from the article at www.mededuc.com discuss.

Original languageEnglish (US)
Pages (from-to)983-992
Number of pages10
JournalMedical Education
Volume49
Issue number10
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Medical Schools
Medical Students
medical student
Weights and Measures
Obesity
trend
school
Curriculum
Students
contact
Climate
Linear Models
Decision Making
Cohort Studies
Communication
Prospective Studies
Delivery of Health Care
Physicians
curriculum
private school

ASJC Scopus subject areas

  • Medicine(all)
  • Education

Cite this

Phelan, S. M., Puhl, R. M., Burke, S. E., Hardeman, R., Dovidio, J. F., Nelson, D. B., ... van Ryn, M. (2015). The mixed impact of medical school on medical students' implicit and explicit weight bias. Medical Education, 49(10), 983-992. https://doi.org/10.1111/medu.12770

The mixed impact of medical school on medical students' implicit and explicit weight bias. / Phelan, Sean M.; Puhl, Rebecca M.; Burke, Sara E.; Hardeman, Rachel; Dovidio, John F.; Nelson, David B.; Przedworski, Julia; Burgess, Diana J.; Perry, Sylvia; Yeazel, Mark W.; van Ryn, Michelle.

In: Medical Education, Vol. 49, No. 10, 01.01.2015, p. 983-992.

Research output: Contribution to journalArticle

Phelan, SM, Puhl, RM, Burke, SE, Hardeman, R, Dovidio, JF, Nelson, DB, Przedworski, J, Burgess, DJ, Perry, S, Yeazel, MW & van Ryn, M 2015, 'The mixed impact of medical school on medical students' implicit and explicit weight bias', Medical Education, vol. 49, no. 10, pp. 983-992. https://doi.org/10.1111/medu.12770
Phelan SM, Puhl RM, Burke SE, Hardeman R, Dovidio JF, Nelson DB et al. The mixed impact of medical school on medical students' implicit and explicit weight bias. Medical Education. 2015 Jan 1;49(10):983-992. https://doi.org/10.1111/medu.12770
Phelan, Sean M. ; Puhl, Rebecca M. ; Burke, Sara E. ; Hardeman, Rachel ; Dovidio, John F. ; Nelson, David B. ; Przedworski, Julia ; Burgess, Diana J. ; Perry, Sylvia ; Yeazel, Mark W. ; van Ryn, Michelle. / The mixed impact of medical school on medical students' implicit and explicit weight bias. In: Medical Education. 2015 ; Vol. 49, No. 10. pp. 983-992.
@article{7ba0a1a8922e4625b2a2074641c1fff8,
title = "The mixed impact of medical school on medical students' implicit and explicit weight bias",
abstract = "Context: Health care trainees demonstrate implicit (automatic, unconscious) and explicit (conscious) bias against people from stigmatised and marginalised social groups, which can negatively influence communication and decision making. Medical schools are well positioned to intervene and reduce bias in new physicians. Objectives: This study was designed to assess medical school factors that influence change in implicit and explicit bias against individuals from one stigmatised group: people with obesity. Methods: This was a prospective cohort study of medical students enrolled at 49 US medical schools randomly selected from all US medical schools within the strata of public and private schools and region. Participants were 1795 medical students surveyed at the beginning of their first year and end of their fourth year. Web-based surveys included measures of weight bias, and medical school experiences and climate. Bias change was compared with changes in bias in the general public over the same period. Linear mixed models were used to assess the impact of curriculum, contact with people with obesity, and faculty role modelling on weight bias change. Results: Increased implicit and explicit biases were associated with less positive contact with patients with obesity and more exposure to faculty role modelling of discriminatory behaviour or negative comments about patients with obesity. Increased implicit bias was associated with training in how to deal with difficult patients. On average, implicit weight bias decreased and explicit bias increased during medical school, over a period of time in which implicit weight bias in the general public increased and explicit bias remained stable. Conclusions: Medical schools may reduce students' weight biases by increasing positive contact between students and patients with obesity, eliminating unprofessional role modelling by faculty members and residents, and altering curricula focused on treating difficult patients. Discuss ideas arising from the article at www.mededuc.com discuss.",
author = "Phelan, {Sean M.} and Puhl, {Rebecca M.} and Burke, {Sara E.} and Rachel Hardeman and Dovidio, {John F.} and Nelson, {David B.} and Julia Przedworski and Burgess, {Diana J.} and Sylvia Perry and Yeazel, {Mark W.} and {van Ryn}, Michelle",
year = "2015",
month = "1",
day = "1",
doi = "10.1111/medu.12770",
language = "English (US)",
volume = "49",
pages = "983--992",
journal = "Medical Education",
issn = "0308-0110",
publisher = "Wiley-Blackwell",
number = "10",

}

TY - JOUR

T1 - The mixed impact of medical school on medical students' implicit and explicit weight bias

AU - Phelan, Sean M.

AU - Puhl, Rebecca M.

AU - Burke, Sara E.

AU - Hardeman, Rachel

AU - Dovidio, John F.

AU - Nelson, David B.

AU - Przedworski, Julia

AU - Burgess, Diana J.

AU - Perry, Sylvia

AU - Yeazel, Mark W.

AU - van Ryn, Michelle

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Context: Health care trainees demonstrate implicit (automatic, unconscious) and explicit (conscious) bias against people from stigmatised and marginalised social groups, which can negatively influence communication and decision making. Medical schools are well positioned to intervene and reduce bias in new physicians. Objectives: This study was designed to assess medical school factors that influence change in implicit and explicit bias against individuals from one stigmatised group: people with obesity. Methods: This was a prospective cohort study of medical students enrolled at 49 US medical schools randomly selected from all US medical schools within the strata of public and private schools and region. Participants were 1795 medical students surveyed at the beginning of their first year and end of their fourth year. Web-based surveys included measures of weight bias, and medical school experiences and climate. Bias change was compared with changes in bias in the general public over the same period. Linear mixed models were used to assess the impact of curriculum, contact with people with obesity, and faculty role modelling on weight bias change. Results: Increased implicit and explicit biases were associated with less positive contact with patients with obesity and more exposure to faculty role modelling of discriminatory behaviour or negative comments about patients with obesity. Increased implicit bias was associated with training in how to deal with difficult patients. On average, implicit weight bias decreased and explicit bias increased during medical school, over a period of time in which implicit weight bias in the general public increased and explicit bias remained stable. Conclusions: Medical schools may reduce students' weight biases by increasing positive contact between students and patients with obesity, eliminating unprofessional role modelling by faculty members and residents, and altering curricula focused on treating difficult patients. Discuss ideas arising from the article at www.mededuc.com discuss.

AB - Context: Health care trainees demonstrate implicit (automatic, unconscious) and explicit (conscious) bias against people from stigmatised and marginalised social groups, which can negatively influence communication and decision making. Medical schools are well positioned to intervene and reduce bias in new physicians. Objectives: This study was designed to assess medical school factors that influence change in implicit and explicit bias against individuals from one stigmatised group: people with obesity. Methods: This was a prospective cohort study of medical students enrolled at 49 US medical schools randomly selected from all US medical schools within the strata of public and private schools and region. Participants were 1795 medical students surveyed at the beginning of their first year and end of their fourth year. Web-based surveys included measures of weight bias, and medical school experiences and climate. Bias change was compared with changes in bias in the general public over the same period. Linear mixed models were used to assess the impact of curriculum, contact with people with obesity, and faculty role modelling on weight bias change. Results: Increased implicit and explicit biases were associated with less positive contact with patients with obesity and more exposure to faculty role modelling of discriminatory behaviour or negative comments about patients with obesity. Increased implicit bias was associated with training in how to deal with difficult patients. On average, implicit weight bias decreased and explicit bias increased during medical school, over a period of time in which implicit weight bias in the general public increased and explicit bias remained stable. Conclusions: Medical schools may reduce students' weight biases by increasing positive contact between students and patients with obesity, eliminating unprofessional role modelling by faculty members and residents, and altering curricula focused on treating difficult patients. Discuss ideas arising from the article at www.mededuc.com discuss.

UR - http://www.scopus.com/inward/record.url?scp=84942068654&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84942068654&partnerID=8YFLogxK

U2 - 10.1111/medu.12770

DO - 10.1111/medu.12770

M3 - Article

C2 - 26383070

AN - SCOPUS:84942068654

VL - 49

SP - 983

EP - 992

JO - Medical Education

JF - Medical Education

SN - 0308-0110

IS - 10

ER -