title: Medical student bias and care recommendations for an obese versus non-obese virtual patient.
abstract: 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.
authors.affiliation: Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD 20892, USA. perskys@mail.nih.gov
authors.forename: S
authors.initials: S
authors.lastname: Persky
authors.forename: C P
authors.initials: CP
authors.lastname: Eccleston
mesh_terms: 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
references.citation: Health Psychol. 2005 Sep;24(5):517-25
references.pmid: 16162046
references.citation: Obesity (Silver Spring). 2008 Nov;16 Suppl 2:S69-74
references.pmid: 18978766
references.citation: Int J Obes Relat Metab Disord. 2001 Aug;25(8):1246-52
references.pmid: 11477511
references.citation: Int J Obes (Lond). 2006 Jan;30(1):147-55
references.pmid: 16231037
references.citation: Obes Res. 2004 Oct;12(10):1587-95
references.pmid: 15536222
references.citation: IEEE Trans Vis Comput Graph. 2007 May-Jun;13(3):443-57
references.pmid: 17356212
references.citation: Am Fam Physician. 2005 Apr 15;71(8):1529-37
references.pmid: 15864893
references.citation: Obes Res. 2001 Nov;9 Suppl 4:228S-233S
references.pmid: 11707546
references.citation: Health Educ Res. 2008 Apr;23(2):347-58
references.pmid: 17884836
references.citation: Obes Res. 2000 Sep;8(6):459-66
references.pmid: 11011913
references.citation: Br J Gen Pract. 2006 Sep;56(530):666-72
references.pmid: 16953998
references.citation: Appl Nurs Res. 2011 Aug;24(3):127-37
references.pmid: 20974067
references.citation: J Gen Intern Med. 2006 Jan;21 Suppl 1:S28-34
references.pmid: 16405706
references.citation: Osteoarthritis Cartilage. 2008 Feb;16(2):137-62
references.pmid: 18279766
references.citation: Pers Soc Psychol Bull. 2003 Jul;29(7):819-33
references.pmid: 15018671
references.citation: Patient Educ Couns. 2001 Sep;44(3):227-33
references.pmid: 11553423
references.citation: Health Expect. 2008 Dec;11(4):321-30
references.pmid: 18684133
references.citation: Obes Res. 2003 Sep;11(9):1033-9
references.pmid: 12972672
references.citation: Soc Sci Med. 2007 Aug;65(3):586-98
references.pmid: 17462801
references.citation: Patient Educ Couns. 2009 Mar;74(3):295-301
references.pmid: 19150199
references.citation: J Gen Intern Med. 2001 Apr;16(4):262-5
references.pmid: 11318928
references.citation: Am J Surg. 2007 Jun;193(6):756-60
references.pmid: 17512291
references.citation: J Adv Nurs. 2008 Oct;64(2):139-46
references.pmid: 18764854
references.citation: J Am Acad Nurse Pract. 2002 Dec;14(12):554-61
references.pmid: 12567923
references.citation: J Health Soc Behav. 2005 Sep;46(3):244-59
references.pmid: 16259147
references.citation: Soc Justice Res. 2008 Sep;21(3):263-396
references.pmid: 24052687
references.citation: Obes Res. 2003 Oct;11(10):1168-77
references.pmid: 14569041
references.citation: Obesity (Silver Spring). 2009 May;17(5):941-64
references.pmid: 19165161
references.citation: Soc Sci Med. 1996 Mar;42(5):769-76
references.pmid: 8685745
references.citation: Int J Obes Relat Metab Disord. 2001 Aug;25(8):1253-61
references.pmid: 11477512
references.citation: Am J Prev Med. 2007 Jun;32(6):525-31
references.pmid: 17533069
references.citation: Health Commun. 2009 Dec;24(8):677-82
references.pmid: 20183376
references.citation: J Pers. 1990 Jun;58(2):365-80
references.pmid: 2213472
references.citation: JAMA. 1999 Oct 27;282(16):1523-9
references.pmid: 10546691
references.citation: Int J Obes Relat Metab Disord. 1992 Nov;16(11):859-68
references.pmid: 1337340
references.citation: J Appl Psychol. 2007 Jan;92(1):239-49
references.pmid: 17227165
references.citation: J Pers Soc Psychol. 2002 Jan;82(1):62-8
references.pmid: 11811635
references.citation: Patient Educ Couns. 2006 Sep;62(3):347-54
references.pmid: 16859867
references.citation: Am J Prev Med. 1987 Nov-Dec;3(6):339-45
references.pmid: 3452374