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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Phelan, Sean M; Rajjo, Tamim I (2017) Trainees' experiences and attitudes and the delivery of patient-centred care for obesity. Med Educ 51:775-777
Phelan, Sean M; Burke, Sara E; Hardeman, Rachel R et al. (2017) Medical School Factors Associated with Changes in Implicit and Explicit Bias Against Gay and Lesbian People among 3492 Graduating Medical Students. J Gen Intern Med 32:1193-1201
Meadows, Angela; Higgs, Suzanne; Burke, Sara E et al. (2017) Social Dominance Orientation, Dispositional Empathy, and Need for Cognitive Closure Moderate the Impact of Empathy-Skills Training, but Not Patient Contact, on Medical Students' Negative Attitudes toward Higher-Weight Patients. Front Psychol 8:504
van Ryn, Michelle; Phelan, Sean M (2016) Response to Dr. Westfall. J Gen Intern Med 31:715
Hardeman, Rachel R; Przedworski, Julia M; Burke, Sara et al. (2016) Association Between Perceived Medical School Diversity Climate and Change in Depressive Symptoms Among Medical Students: A Report from the Medical Student CHANGE Study. J Natl Med Assoc 108:225-235
Puhl, Rebecca M; Phelan, Sean M; Nadglowski, Joseph et al. (2016) Overcoming Weight Bias in the Management of Patients With Diabetes and Obesity. Clin Diabetes 34:44-50
Burgess, Diana J; Burke, Sara E; Cunningham, Brooke A et al. (2016) Medical students' learning orientation regarding interracial interactions affects preparedness to care for minority patients: a report from Medical Student CHANGES. BMC Med Educ 16:254
Hardeman, Rachel R; Perry, Sylvia P; Phelan, Sean M et al. (2016) Racial Identity and Mental Well-Being: The Experience of African American Medical Students, A Report from the Medical Student CHANGE Study. J Racial Ethn Health Disparities 3:250-8
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, 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

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