Matharu Kabir, Shapiro Johanna F, Hammer Rachel R, Kravitz R L, Wilson Machelle D, Fitzgerald Faith T
Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
Educ Health (Abingdon). 2014 Sep-Dec;27(3):231-7. doi: 10.4103/1357-6283.152176.
Healthcare worker attitudes toward obese individuals facilitate discrimination and contribute to poor health outcomes. Previous studies have demonstrated medical student bias toward obese individuals, but few have examined effects of the educational environment on these prejudicial beliefs. We sought to determine whether an innovative educational intervention (reading a play about obesity) could diminish obesity prejudice relative to a standard medical lecture.
We conducted a randomized, controlled trial enrolling medical students (n = 129) from three universities. Students were assigned to play-reading or a standard lecture. Explicit attitudes and implicit bias toward obese individuals were assessed prior to intervention and after four months.
At baseline, students demonstrated moderate explicit and implicit bias toward obese people despite high scores on empathy. Students randomized to the play-reading group had significantly decreased explicit fat bias (P = 0.01) at follow-up, while students in the lecture group showed increased endorsement of a prescriptive model of care at the expense of a patient-centered approach (P = 0.03). There was a significant increase in empathy for those in both the theater (P = 0.007) and lecture group (P = 0.02). The intervention had no significant effect on implicit bias or regard for obesity as a civil rights issue.
Dramatic reading may be superior to traditional medical lectures for showcasing patient rights and preferences. The present study demonstrates for the first time that play-reading diminishes conscious obesity bias. Further research should determine whether nontraditional methods of instruction promote improved understanding of and care for obese patients.
医护人员对肥胖个体的态度助长了歧视，并导致不良健康结果。先前的研究已证明医学生对肥胖个体存在偏见，但很少有研究考察教育环境对这些偏见性观念的影响。我们试图确定一种创新的教育干预措施（阅读一部关于肥胖的戏剧）相对于标准医学讲座，是否能减少对肥胖的偏见。
我们进行了一项随机对照试验，招募了来自三所大学的医学生（n = 129）。学生被分配到阅读戏剧组或标准讲座组。在干预前和四个月后评估对肥胖个体的明确态度和隐性偏见。
在基线时，尽管同理心得分较高，但学生对肥胖者表现出中度的明确和隐性偏见。随机分配到阅读戏剧组的学生在随访时明确的肥胖偏见显著降低（P = 0.01），而讲座组的学生以牺牲以患者为中心的方法为代价，对一种规范性护理模式的认可增加（P = 0.03）。戏剧组（P = 0.007）和讲座组（P = 0.02）的学生对他人的同理心都有显著增加。该干预对隐性偏见或将肥胖视为民权问题的看法没有显著影响。
戏剧阅读在展示患者权利和偏好方面可能优于传统医学讲座。本研究首次表明戏剧阅读能减少有意识的肥胖偏见。进一步的研究应确定非传统教学方法是否能促进对肥胖患者的更好理解和护理。
