Social Dominance Orientation, Dispositional Empathy, and Need for Cognitive Closure Moderate the Impact of Empathy-Skills Training, but Not Patient Contact, on Medical Students' Negative Attitudes toward Higher-Weight Patients

Abstract

Anti-fat bias in healthcare providers and medical students has serious implications for quality of care of higher-weight patients. Studies of interventions aimed at reducing anti-fat attitudes in medical students have generally been disappointing, with little enduring effect. It is possible that some students may be more receptive to prejudice-reducing influences than others, due to underlying differences in their personal characteristics. It is also possible that attitudes toward patients, specifically, may differ from anti-fat attitudes in general, and prejudice-reduction effectiveness on patient-specific attitudes has not yet been evaluated. The present study explored the effect on general and patient-specific anti-fat attitudes of (1) contact with higher-weight individuals prior to and during medical school; and (2) training designed to increase medical students' empathy toward patients by encouraging them to take the patient's perspective during clinical encounters. The moderating role of individual difference factors on effectiveness of contact and student-reported hours of empathy training on patient-specific attitudes was assessed. A total of 3,576 students enrolled across 49 US medical schools completed an online survey at the start of their first year of medical school and at the end of their fourth year. Favorable contact experience with higher-weight patients predicted improved attitudes toward heavier patients after 4 years of medical school, and appeared sufficient to partially offset the effects of dislike of higher-weight individuals at baseline. The impact of favorable contact on general anti-fat attitudes was less strong, highlighting the importance of using target-specific outcome measures. The positive effects of favorable contact on attitudes toward higher-weight patients did not differ based on students' baseline levels of social dominance orientation, dispositional empathy, or need for cognitive closure. In contrast, the effectiveness of training did vary by student characteristics, generally being more effective in students who were more egalitarian and empathic at baseline, with little effect, or even adverse effects in students low in these traits. Overall, however, perspective-taking training produced only small improvements in attitudes toward higher-weight patients.

Changing characteristics of the empathic communication network after empathy-enhancement program for medical students

“…For example, through nonverbal empathic behaviours such as an open body posture (uncrossed arms), eye contact, and smiling, physicians convey warmth, empathy, and competency to their patients 5 . Empathy can also foster among physicians a more understanding approach to issues related to social prejudice or stereotypes (e.g., in relation to obese patients) 6 . Physicians’ empathy-based communication should foster patients’ trust in and satisfaction with their doctors 7 , 8 , increase treatment adherence 9 , and improve diagnostic accuracy 10 , leading to a more successful treatment response 11 – 13 .…”

The Effects of Intelligence and Personality on Performance in Simulated Interrogation Scenarios

“…Low NFC individuals may have an advantage when it comes to predicting a suspect's response to their questions, as research suggests that those with high NFC are less empathic towards others because of their rigid interpretation of the situation (Nelson et al 2003). The cognitive adaptability associated with low NFC may, therefore, allow for flexibility in the conceptualisation of the situation, which, in turn, permits low need for closure individuals to empathise with the suspect's perspective (Meadows et al 2017).…”

<p>The Evolution of Social Beliefs 1960–2016 in the United States and Its Influence on Empathy and Prosocial Expression in Medicine</p>

“…137 Increased homophily during their freshman year 137 and the deliberate lack of significant interactions with "others" are postulated reasons. 138 Favorable contact with stigmatized groups can change attitudes overcoming students' baseline levels of social dominance orientation, dispositional empathy, or need for cognitive closure. 139 Both the amount and favorability of contact predicts positive implicit and explicit attitudes.…”