Two out of five medical students have an unconscious bias against obese people, according to a new study by researchers at Wake Forest Baptist Medical Center. The study is published online ahead of print in the Journal of Academic Medicine.
"Bias can affect clinical care and the doctor-patient relationship, and even a patient's willingness or desire to go see their physician, so it is crucial that we try to deal with any bias during medical school," said David Miller, M.D., associate professor of internal medicine at Wake Forest Baptist and lead author of the study.
"Previous research has shown that on average, physicians have a strong anti-fat bias similar to that of the general population. Doctors are more likely to assume that obese individuals won't follow treatment plans, and they are less likely to respect obese patients than average weight patients," Miller said.
Miller and colleagues conducted the study as part of their efforts to update the medical school's curriculum on obesity. The goal was to measure the prevalence of unconscious weight-related biases among medical students and to determine whether the students were aware of those biases.
The three-year study included more than 300 third-year medical students at a medical school in the southeastern United States from 2008 through 2011. The students were geographically diverse, representing at least 25 different states and 12 countries outside the United States.
The researchers used a computer program called the Weight Implicit Association Test (IAT) to measures students' unconscious preferences for "fat" or "thin" individuals. Students also answered a survey assessing their conscious weight-related preferences. The authors determined if the students were aware of their bias by seeing if their IAT results matched their stated preferences.
Overall, 39 percent of medical students had a moderate to strong unconscious anti-fat bias as compared to 17 percent who had a moderate to strong anti-thin bias. Less than 25 percent of students were aware of their biases.
"Because anti-fat stigma is so prevalent and a significant barrier to the treatment of obesity, teaching medical students to recognize and mitigate this bias is crucial to improving the care for the two-thirds of American adults who are now overweight or obese," Miller said. "Medical schools should address weight bias as part of a comprehensive obesity curriculum."
While this study did not address which teaching strategies are most effective, Miller said that a prerequisite to combating prejudice is to first acknowledge its existence. At Wake Forest Baptist, all third-year medical students in the family medicine clerkship must complete the online IAT, and then participate in an in-class discussion of their experience with bias. In addition, students must accept that their bias could affect their actions and adopt new strategies to mitigate bias, he said.
As part of their efforts to reform curriculum, the Wake Forest Baptist team created an on-line educational module about fat bias and stigmatization, which is freely available at www.newlifestyle.org.
The study was funded by grant 1R25CA117887-01A from the National Cancer Institute.
Co-authors of the study are John Spangler, M.D., Mara Vitolins, Dr.PH., Stephen Davis, M.S., Edward Ip, Ph.D., Gail Marion, Ph.D., and Sonia Crandall, Ph.D., of Wake Forest Baptist.
- David P. Miller, John G. Spangler, Mara Z. Vitolins, Stephen W. Davis, Edward H. Ip, Gail S. Marion, Sonia J. Crandall. Are Medical Students Aware of Their Anti-obesity Bias? Academic Medicine, 2013; DOI: 10.1097/ACM.0b013e318294f817
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