title: The mixed impact of medical school on medical students' implicit and explicit weight bias.
abstract: BACKGROUND
  Health care trainees demonstrate implicit (automatic, unconscious) and explicit (conscious) bias against people from stigmatised and marginalised social groups, which can negatively influence communication and decision making. Medical schools are well positioned to intervene and reduce bias in new physicians.
  
  
  OBJECTIVE
  This study was designed to assess medical school factors that influence change in implicit and explicit bias against individuals from one stigmatised group: people with obesity.
  
  
  METHODS
  This was a prospective cohort study of medical students enrolled at 49 US medical schools randomly selected from all US medical schools within the strata of public and private schools and region. Participants were 1795 medical students surveyed at the beginning of their first year and end of their fourth year. Web-based surveys included measures of weight bias, and medical school experiences and climate. Bias change was compared with changes in bias in the general public over the same period. Linear mixed models were used to assess the impact of curriculum, contact with people with obesity, and faculty role modelling on weight bias change.
  
  
  RESULTS
  Increased implicit and explicit biases were associated with less positive contact with patients with obesity and more exposure to faculty role modelling of discriminatory behaviour or negative comments about patients with obesity. Increased implicit bias was associated with training in how to deal with difficult patients. On average, implicit weight bias decreased and explicit bias increased during medical school, over a period of time in which implicit weight bias in the general public increased and explicit bias remained stable.
  
  
  CONCLUSIONS
  Medical schools may reduce students' weight biases by increasing positive contact between students and patients with obesity, eliminating unprofessional role modelling by faculty members and residents, and altering curricula focused on treating difficult patients.
authors.affiliation: Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Phelan
authors.affiliation: Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Puhl
authors.affiliation: Department of Psychology, Yale University, New Haven, Connecticut, USA.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Burke
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Hardeman
authors.affiliation: Department of Psychology, Yale University, New Haven, Connecticut, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Dovidio
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.|Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Nelson
authors.affiliation: Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Przedworski
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.|Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Diana J
authors.initials: DJ
authors.lastname: Burgess
authors.affiliation: Department of Psychological Science, University of Vermont, Burlington, Vermont, USA.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Perry
authors.affiliation: Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Yeazel
authors.affiliation: Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: van Ryn
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009765:Obesity; D011287:Prejudice; D012577:Schools, Medical; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult