Pediatrics, General & Community Pediatrics, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Department of Psychology, American University, Washington, DC, USA.
Teach Learn Med. 2023 Apr-May;35(2):143-156. doi: 10.1080/10401334.2022.2041421. Epub 2022 Mar 3.
Bias against individuals with obesity in medical settings has negative implications for patients, including stigmatization, poor health outcomes, and reduced healthcare utilization. This study explored reflections of medical students when confronted with their own implicit obesity bias. A group of 188 pre-clinical second-year medical students from George Washington University School of Medicine and Health Sciences completed the Weight Implicit Association Test (IAT) in 2020 and were instructed to write a reflective response based on their results. Participants reflected upon their preferences ("fat" vs. "thin") and described the factors that influenced their perceptions of obesity. Inductive coding techniques were used to generate themes from medical students' responses using Dedoose Version 8.3.35 (SocioCultural Research Consultants LLC, Los Angeles, California). Regarding IAT results, 7% of medical students preferred "fat over thin," 14% had no preference, and 78% preferred "thin over fat." Reflection themes highlighted medical students' difficulty accepting IAT results, perspectives on the origins of obesity in individuals, personal and family challenges with obesity and body image, medical training's perceived influence on bias, reservations about discussing obesity with patients, and desires to change current and future practices. Many medical students expressed a desire to provide optimal care for patients of all weight classes despite demonstrating a strong unconscious bias against individuals with obesity on the IAT. Medical school should provide targeted opportunities to acknowledge and mitigate obesity bias by expanding on medical students' pre-established and often harmful understandings of obesity and highlighting the complexities of this disease. Such training would better equip medical students to facilitate successful interactions with patients as future physicians.
医疗环境中对肥胖个体的偏见会对患者产生负面影响，包括污名化、不良健康结果和减少医疗保健利用。本研究探讨了医学生面对自身隐性肥胖偏见时的反思。来自乔治华盛顿大学医学院和健康科学学院的一组 188 名临床前二年级医学生于 2020 年完成了体重内隐联想测试（IAT），并被指示根据测试结果撰写反思性回应。参与者反思了他们的偏好（“胖”与“瘦”），并描述了影响他们对肥胖看法的因素。使用 Dedoose 版本 8.3.35（加利福尼亚州洛杉矶的社会文化研究顾问有限责任公司），采用归纳编码技术从医学生的回答中生成主题。关于 IAT 结果，7%的医学生更喜欢“胖于瘦”，14%没有偏好，78%更喜欢“瘦于胖”。反思主题突出了医学生对 IAT 结果的难以接受，对个体肥胖起源的看法，个人和家庭对肥胖和身体形象的挑战，医学培训对偏见的感知影响，对与患者讨论肥胖的保留意见，以及改变当前和未来实践的愿望。尽管医学生在 IAT 上对肥胖个体表现出强烈的无意识偏见，但许多医学生表示希望为所有体重类别的患者提供最佳护理。医学院应提供有针对性的机会，承认并减轻肥胖偏见，方法是扩大医学生对肥胖的既定且往往有害的理解，并强调这种疾病的复杂性。这种培训将使医学生更好地为未来的医生与患者进行成功互动做好准备。
