Medical student bias and care recommendations for an obese versus non-obese virtual patient.
OBJECTIVE
This study examined the independent effect of a patient's weight on medical students' attitudes, beliefs and interpersonal behavior toward the patient, in addition to the clinical recommendations they make for her care.


METHODS
A total of 76 clinical-level medical students were randomly assigned to interact with a digital, virtual female patient who was visibly either obese or non-obese.


METHODS
Interactions with the patient took place in an immersive virtual (virtual reality) clinical environment that allowed standardization of all patient behaviors and characteristics except for weight. Visual contact behavior was automatically recorded during the interaction. Afterward, participants filled out a battery of self-report questionnaires.


RESULTS
Analyses revealed more negative stereotyping, less anticipated patient adherence, worse perceived health, more responsibility attributed for potentially weight-related presenting complaints and less visual contact directed toward the obese version of a virtual patient than the non-obese version of the patient. In contrast, there was no clear evidence of bias in clinical recommendations made for the patient's care.


CONCLUSIONS
Biases in attitudes, beliefs and interpersonal behavior have important implications because they can influence the tone of clinical encounters and rapport in the patient-provider relationship, which can have important downstream consequences. Gaining a clear understanding of the nature and source of weight bias in the clinical encounter is an important first step toward the development of strategies to address it.
Persky
S
S
Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD 20892, USA. perskys@mail.nih.gov
Eccleston
C P
CP
D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D003198:Computer Simulation; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D009765:Obesity / Q000523:psychology* / Q000628:therapy; D013240:Stereotyping; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires
Health Psychol. 2005 Sep;24(5):517-25
16162046
Obesity (Silver Spring). 2008 Nov;16 Suppl 2:S69-74
18978766
Int J Obes Relat Metab Disord. 2001 Aug;25(8):1246-52
11477511
Int J Obes (Lond). 2006 Jan;30(1):147-55
16231037
Obes Res. 2004 Oct;12(10):1587-95
15536222
IEEE Trans Vis Comput Graph. 2007 May-Jun;13(3):443-57
17356212
Am Fam Physician. 2005 Apr 15;71(8):1529-37
15864893
Obes Res. 2001 Nov;9 Suppl 4:228S-233S
11707546
Health Educ Res. 2008 Apr;23(2):347-58
17884836
Obes Res. 2000 Sep;8(6):459-66
11011913
Br J Gen Pract. 2006 Sep;56(530):666-72
16953998
Appl Nurs Res. 2011 Aug;24(3):127-37
20974067
J Gen Intern Med. 2006 Jan;21 Suppl 1:S28-34
16405706
Osteoarthritis Cartilage. 2008 Feb;16(2):137-62
18279766
Pers Soc Psychol Bull. 2003 Jul;29(7):819-33
15018671
Patient Educ Couns. 2001 Sep;44(3):227-33
11553423
Health Expect. 2008 Dec;11(4):321-30
18684133
Obes Res. 2003 Sep;11(9):1033-9
12972672
Soc Sci Med. 2007 Aug;65(3):586-98
17462801
Patient Educ Couns. 2009 Mar;74(3):295-301
19150199
J Gen Intern Med. 2001 Apr;16(4):262-5
11318928
Am J Surg. 2007 Jun;193(6):756-60
17512291
J Adv Nurs. 2008 Oct;64(2):139-46
18764854
J Am Acad Nurse Pract. 2002 Dec;14(12):554-61
12567923
J Health Soc Behav. 2005 Sep;46(3):244-59
16259147
Soc Justice Res. 2008 Sep;21(3):263-396
24052687
Obes Res. 2003 Oct;11(10):1168-77
14569041
Obesity (Silver Spring). 2009 May;17(5):941-64
19165161
Soc Sci Med. 1996 Mar;42(5):769-76
8685745
Int J Obes Relat Metab Disord. 2001 Aug;25(8):1253-61
11477512
Am J Prev Med. 2007 Jun;32(6):525-31
17533069
Health Commun. 2009 Dec;24(8):677-82
20183376
J Pers. 1990 Jun;58(2):365-80
2213472
JAMA. 1999 Oct 27;282(16):1523-9
10546691
Int J Obes Relat Metab Disord. 1992 Nov;16(11):859-68
1337340
J Appl Psychol. 2007 Jan;92(1):239-49
17227165
J Pers Soc Psychol. 2002 Jan;82(1):62-8
11811635
Patient Educ Couns. 2006 Sep;62(3):347-54
16859867
Am J Prev Med. 1987 Nov-Dec;3(6):339-45
3452374