A deeper look at implicit weight bias in medical students.

The Implicit Relational Assessment Procedure (IRAP, Barnes-Holmes et al. in Psychol Rec 60:527-542, 2010) was utilized as a relatively new tool to measure implicit weight bias in first- and third-year medical students. To date, only two studies (Miller et al. in Acad Med 88:978-982, 2013; Phelan et al. in Med Educ 49:983-992, 2015) have investigated implicit weight bias with medical students and both have found pro-thin/anti-fat implicit attitudes, on average, using the Implicit Association Test (IAT, Greenwald and Banaji in Psychol Rev 102:4-27, 1995) as the assessment tool. The IRAP, however, allows for a deeper analysis of implicit attitudes with respect to both thin and fat in isolation, and it was found that medical students are, on average, actually both pro-thin and pro-fat, and on average are more pro-thin than pro-fat, as opposed to anti-fat. Additionally, it was found that medical students' implicit weight bias against fat/obese individuals improved over the first 2 years of medical training, and this improvement was specifically driven by improved implicit attitudes toward overweight and obese, while implicit attitudes toward thin remained constant over that time. The implications of more sensitive implicit bias assessment and specific changes in bias over time are discussed within the context of medical education curriculum development.

Medical nutrition: a comprehensive, school-wide curriculum review.

BACKGROUND: A school-wide nutrition program was established in 1982 and a required medical nutrition course (MNC) was established in 1985 at the University of Nevada School of Medicine. Emphasis was placed on developing an integrated curriculum and on using innovative methods to incorporate nutrition into the existing curriculum. OBJECTIVE: The objective of this review was to establish a baseline and make positive curricular changes to comply with the recommendations of the Liaison Committee on Medical Education for accreditation. The MNC and the nutrition curriculum were evaluated as part of this 3-y comprehensive, school-wide evaluation process. DESIGN: The MNC was invited for review (December 2004) because of its position in the curriculum (first year), special content and methods, and relation to other courses. A review team, which consisted of the Assistant Dean for Medical Education (who chaired the team), a curriculum coordinator, faculty representatives, and a medical student, was appointed. The MNC coordinator prepared a review book that included the requested documentation. The initial 3-h review meeting culminated in a formal evaluation and recommendations. Follow-up meetings at 1 mo and 1 y were scheduled. RESULTS: The review was a positive process that reaffirmed the uniqueness of the nutrition program at the University. It supported the MNC as an important part of the required curriculum. Recommendations included use of the Web, encouragement to identify new opportunities with interested faculty, and a structure to further integrate and align nutrition into existing courses. CONCLUSIONS: A positive, proactive review process supports the importance of nutrition in the medical school curriculum and encourages further integration.

A novel stress and coping workplace program reduces illness and healthcare utilization.

OBJECTIVE: The purpose of this study was to determine if a novel workplace stress management program, delivered either face-to-face or by self-help, would reduce illness and health services utilization among participants. METHODS: Five hundred one volunteers were randomly allocated to one of three groups: full intervention, which received assessment and personalized self-study feedback and was offered six face-to-face, small-group sessions; partial intervention, a self-help group that received assessment and personalized feedback by mail; and a wait-list control group. All participants completed questionnaires for stress, anxiety, and coping at the start of the study and 6 and 12 months later. Health reports were completed at 0, 3, 6, 9, and 12 months. A subsample of subjects who subscribed to a single health maintenance organization provided objectively recorded doctor visit data across the study year. RESULTS: All three groups reported significant improvement in their stress, anxiety, and coping across the year. Full intervention participants showed a more rapid reduction in negative responses to stress than did participants from the other groups. Full-intervention subjects also reported fewer days of illness than subjects in the other groups. Objectively measured physician visits showed a large (34%) reduction in healthcare utilization for full intervention subjects in the HMO subsample. CONCLUSIONS: These results indicated that a work-site program that focuses on stress, anxiety, and coping measurement along with small-group educational intervention can significantly reduce illness and healthcare utilization.