The proposed study is part of a research and training plan that will enable Dr. Sean Phelan to reach his goal of improving health care quality and disease outcomes for obese individuals by identifying and eliminating barriers to high-quality health care. One such barrier that may negatively affect the quality and content of communication with obese patients is bias or prejudice against obese people. Obesity bias is pervasive in both public and health care provider populations. The implications of high levels of bias in medical students and other health care providers are not known; however, there is considerable evidence that bias against a social group negatively impacts behavior toward members of that group. Health care provider bias against stigmatized groups may contribute to disparities in patient-centered care and provider decision-making. The direct impact of implicit and explicit bias against obese patients on provider behavior has not been investigated. This represents a significant gap in our knowledge of how patient obesity influences quality of care. Potential areas of behavior in the clinical encounter that may be negatively influenced by obesity bias include (i) patient-centered communication, which predicts better patient outcomes, satisfaction, and adherence; and (ii) initiation of discussion of health behavior changes, a practice consistent with clinical guidelines.
The specific aims of this study are to 1) evaluate th association between advanced medical students' implicit and explicit obesity bias and their patient-centered communication in treatment encounters with obese standardized patients; and 2) evaluate the association between advanced medical students' implicit and explicit obesity bias and clinical decision-making in treating obese patients. Validated interaction analysis strategies will be applied to videotaped encounters between medical students and obese standardized patients in order to measure patient-centered communication and decision-making. A survey will be used to assess implicit and explicit obesity bias and other attitudes in order to achieve the aims of this study. This proposal includes a comprehensive training plan that combines didactic learning with collaborative research experiences. Mentors for this project are productive researchers with expertise in obesity bias, patient- centered communication, and the role of provider bias in health disparities. This research and training plan will take place inan extremely supportive research environment at the Department of Family Medicine at the University of Minnesota Medical School.

Public Health Relevance

This study will examine the impact of medical student implicit and explicit bias against obese people on patient-centered communication and clinical decision-making in encounters with obese patients. Results will guide interventions to improve patient-centered quality of care for obese and overweight patients. The training plan will further enable the PI to develop research that improves health care quality and outcomes for obese individuals by identifying and eliminating barriers to high-quality health care.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Scientist Development Award - Research & Training (K01)
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Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
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Podskalny, Judith M,
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Mayo Clinic, Rochester
United States
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Przedworski, Julia M; Dovidio, John F; Hardeman, Rachel R et al. (2015) A Comparison of the Mental Health and Well-Being of Sexual Minority and Heterosexual First-Year Medical Students: A Report From the Medical Student CHANGE Study. Acad Med 90:652-9
Phelan, Sean M; Burgess, Diana J; Puhl, Rebecca et al. (2015) The Adverse Effect of Weight Stigma on the Well-Being of Medical Students with Overweight or Obesity: Findings from a National Survey. J Gen Intern Med 30:1251-8
Phelan, Sean M; Puhl, Rebecca M; Burke, Sara E et al. (2015) The mixed impact of medical school on medical students' implicit and explicit weight bias. Med Educ 49:983-92
Burke, Sara E; Dovidio, John F; Przedworski, Julia M et al. (2015) Do Contact and Empathy Mitigate Bias Against Gay and Lesbian People Among Heterosexual First-Year Medical Students? A Report From the Medical Student CHANGE Study. Acad Med 90:645-51
Phelan, S M; Burgess, D J; Yeazel, M W et al. (2015) Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev 16:319-26
Phelan, Sean M; Burgess, Diana J; Burke, Sara E et al. (2015) Beliefs about the causes of obesity in a national sample of 4th year medical students. Patient Educ Couns 98:1446-9
Hardeman, Rachel R; Przedworski, Julia M; Burke, Sara E et al. (2015) Mental Well-Being in First Year Medical Students: A Comparison by Race and Gender: A Report from the Medical Student CHANGE Study. J Racial Ethn Health Disparities 2:403-13
Hardeman, Rachel R; Burgess, Diana; Phelan, Sean et al. (2015) Medical student socio-demographic characteristics and attitudes toward patient centered care: do race, socioeconomic status and gender matter? A report from the Medical Student CHANGES study. Patient Educ Couns 98:350-5
Phelan, Sean M; Hardeman, Rachel R (2015) Health professionals' pain management decisions are influenced by their role (nurse or physician) and by patient gender, age and ethnicity. Evid Based Nurs 18:58
Phelan, Sean M; Dovidio, John F; Puhl, Rebecca M et al. (2014) Implicit and explicit weight bias in a national sample of 4,732 medical students: the medical student CHANGES study. Obesity (Silver Spring) 22:1201-8

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