Is an obesity simulation suit in an undergraduate medical communication class a valuable teaching tool? A cross-sectional proof of concept study

Clinical observations of weight stigma among nursing students: A descriptive approach

Background

Mistreatment of individuals due to their body size or weight stigma has been described as a source of stress and as a deterrent for engagement in the healthcare system. Efforts to reduce weight stigma have included curricular interventions to reduce weight bias among future healthcare professionals. However, few studies have examined students' observations of weight stigma and subsequent socialization to healthcare environmental norms.

Aims

The purpose of this study is to evaluate observed weight stigma among pre-licensure nursing students and recent graduates during clinical rotations and its effect on the perceived ability to provide respectful care to people in larger bodies.

Materials and Methods

A cross-sectional, descriptive study was conducted from February to March 2023. Participants answered questions related to personal weight bias (Fat Phobia Scale), observations of weight stigma, and perceived ability to provide respectful care.

Results

Ninety-one participants completed the survey, of whom half (n = 48) held a high level of weight bias. A quarter of participants (n = 23) reported that they engaged in weight stigma behaviors and a quarter (n = 24) of participants observed weight stigma behaviors from two or more healthcare professional roles. Almost one-third (n = 10) of participants who observed weight stigma behaviors perceived that it impacted their ability to provide respectful care to patients in larger bodies.

Conclusions

These findings describe that weight stigma enacted by multiple healthcare professional roles is observed by nursing students during clinical rotations and is perceived to impact their ability to provide respectful care. Efforts to improve healthcare professionals' sensitivity to the effects of weight bias and weight stigma should include addressing the role of socialized norms on weight bias among future healthcare professionals.

Nurses' Role in Obesity Management in Adults in Primary Healthcare Settings Worldwide: A Scoping Review

Obesity is a chronic, prevalent, and complex health condition that adversely impairs physical and mental health. The World Health Organization calls for integrating obesity care into existing chronic disease management programs within primary healthcare services. This scoping review aimed to examine registered nurses' roles in the primary healthcare management of individuals with obesity. A scoping review was conducted using the Johanna Briggs Institute methodology framework. Thematic analysis was used to identify and categorize nurses' roles in primary healthcare obesity management of adults. Of 1142 documents included in this review, 15 papers met the inclusion criteria. Thematic analysis yielded the following six themes representing nurses' major roles: patient-centred care, patient assessments, therapeutic interventions, care management, patient education, and professional development. This review identified that the literature on nurses' roles primarily described their focus on lifestyle interventions (mainly nutrition and physical activity), anthropometric measurements, health planning, goal setting, supportive care, monitoring progress, and arranging follow-up. The Discussion highlights the importance of determining RN knowledge gaps and biases. More research is required to determine the need for additional RN pre-and or post-education related to obesity as a complex chronic disease.

A scoping review to identify and organize literature trends of bias research within medical student and resident education

BACKGROUND

Physician bias refers to the unconscious negative perceptions that physicians have of patients or their conditions. Medical schools and residency programs often incorporate training to reduce biases among their trainees. In order to assess trends and organize available literature, we conducted a scoping review with a goal to categorize different biases that are studied within medical student (MS), resident (Res) and mixed populations (MS and Res). We also characterized these studies based on their research goal as either documenting evidence of bias (EOB), bias intervention (BI) or both. These findings will provide data which can be used to identify gaps and inform future work across these criteria.

METHODS

Online databases (PubMed, PsycINFO, WebofScience) were searched for articles published between 1980 and 2021. All references were imported into Covidence for independent screening against inclusion criteria. Conflicts were resolved by deliberation. Studies were sorted by goal: 'evidence of bias' and/or 'bias intervention', and by population (MS or Res or mixed) andinto descriptive categories of bias.

RESULTS

Of the initial 806 unique papers identified, a total of 139 articles fit the inclusion criteria for data extraction. The included studies were sorted into 11 categories of bias and showed that bias against race/ethnicity, specific diseases/conditions, and weight were the most researched topics. Of the studies included, there was a higher ratio of EOB:BI studies at the MS level. While at the Res level, a lower ratio of EOB:BI was found.

CONCLUSIONS

This study will be of interest to institutions, program directors and medical educators who wish to specifically address a category of bias and identify where there is a dearth of research. This study also underscores the need to introduce bias interventions at the MS level.

Effects of weight bias training on student nurse empathy: A quasiexperimental study

AIM

This study aimed to identify the efficacy of weight bias training on the empathy skills of student nurses when working with a person with obesity.

BACKGROUND

Weight bias with nurses harboring negative attitudes towards patients with obesity results in inferior care and patients' reluctance to seek medical care. Empathy is a communication skill used in nursing to build trust and rapport with patients to provide optimal patient-centered care.

METHODS

This study used a quasi-experimental design with 121 undergraduate nursing students in their first semester of the nursing program. The students completed learning activities on weight bias, including reading an article on weight bias, watching a video showing an individual with obesity's experiences in the healthcare setting and participating in a group discussion and reflection on the article and video. In addition, students completed the Jefferson Scale of Empathy-Health Professions Students' version before and after the learning activities. Following the learning activities, students participated in a simulation activity with a standardized patient wearing an obesity suit. The standardized patient completed the Jefferson Scale of Patient Perceptions of Nurse Empathy to rate the patient's perception of the nursing student's level of empathy based on their interactions in the simulation scenario.

RESULTS

A comparison of the scores on the Jefferson Scale of Empathy-HPS showed there was not a significant difference in the scores before learning activities (M = 15.45, SD = 12.7) and post-learning activities (M = 15.94, SD = 11.5); t(120) = 0.476, p = .635. Data analysis identified significant changes in empathy scores on the Jefferson Scale of Empathy-HPS in the accelerated second-degree cohort with differences in scores before learning activities (M = 113.7, SD = 10.5) and post-learning activities (M = 116.5, SD = 13.4); t(50) = 2.02, p = .049. The traditional cohort did not have a significant change in empathy scores. Empathy scores and the patient's perception of empathy scores showed no relationship. Most (79 %) of the patient's perception of empathy scores was moderate. Student comments in this study support the findings that some nursing students harbor weight bias towards individuals with obesity.

CONCLUSION

There is a need to identify learning activities that eliminate weight bias in the nursing student population and result in the student's ability to demonstrate appropriate communication skills and nursing behaviors in a nondiscriminatory manner to the patient with obesity. To improve empathy behaviors, students should practice communication skills throughout the nursing curriculum.

'Student tutors go online' - Investigation of cognitive and social congruence in online student tutorials - a longitudinal study

The concept of peer-assisted learning (PAL) has been implemented at many medical faculties. Due to the Covid-19 pandemic, parts of the medical education experience transitioned to digital formats. However, little is known about PAL and online student tutorials. PAL is effective due to cognitive and social congruence. This study aims to investigate these concepts in an online student tutorial on taking a patient's medical history. This longitudinal study took place in a preclinical communication course on how to take a patient's medical history. In an online student tutorial, the students learned how to take a patient's psychosocial medical history. Using standardised questionnaires, cognitive and social congruence were assessed. T-tests of independent samples were performed for data comparison. The participants included 128 second-year medical students and 5 student tutors. Cognitive congruence (M_student = 4.19 ± 0.56; M_studenttutor = 4.04 ± 0.57) and social congruence (M_Student = 4.25 ± 0.56; M_Studenttutor = 4.06 ± 0.57) were high for both students and student tutors in the online setting. In comparison to the face-to-face group, students in the online setting considered the student tutors to be significantly (p < .05) more socially congruent. Learning success increased during the course; however, it was not influenced by cognitive congruence. Cognitive and social congruence are high in an online setting. The students' learning success increased during the online tutorial. Based on the higher level of social congruence, student tutors might be very motivated to be open and approachable in an online setting. Simultaneously, students might pay more attention and participate actively in the online setting. Social and cognitive congruence contribute to the effectiveness of online student tutorials and, thus, online student tutorials should be integrated into medical training.

Online student tutorials for effective peer teaching in digital times: a longitudinal quantitative study

BACKGROUND

Peer-assisted learning represents a favoured method of teaching in universities. The COVID-19 pandemic has necessitated transferring medical education to digital formats, and subsequently, the question has arisen of whether online tutorials might be effective. This study, thus, investigated the efficacy of online tutorials in a communication course by assessing the interaction, verbal communication, and nonverbal communication of tutors and students.

METHODS

Second-year medical students were invited to participate in this longitudinal quantitative study. Validated and self-developed questionnaires (e.g., Jefferson Empathy Scale) including 39 questions (rated on a 7- or 5-point Likert scale) were used to assess the different variables including interaction, verbal and nonverbal communication and students' learning success.

RESULTS

Out of 165 medical students, 128 took part in the study. The students as well as tutors reported that they found each other likeable (M_students = 4.60±0.71; M_tutors = 4.38±0.53; p > .05). Learning success increased throughout the communication course (Cohen's d = 0.36-0.74). The nonverbal and verbal communication in the simulated patient (SP) encounter was also rated as high by all three groups (M_nonverbal = 3.90±0.83; M_verbal = 4.88±0.35).

CONCLUSIONS

Interaction as well as nonverbal and verbal communication occurred in the online format, indicating that online tutorials can be effective. The implementation of SPs increases the efficiency of synchronous online learning as it enhances the simulation of a real patient-physician encounter. Thus, online tutorials are a valuable amendment to medical education.

Changes in anti-fat attitudes among undergraduate nursing students

BACKGROUND

The number of people with obesity has been increasing significantly in recent decades. Nursing students play a role in the care of obese patients, but the presence of a stigma regarding this patient group reduces the quality of care due to a climate of mistrust and lack of expectations.

OBJECTIVES

To analyse if the anti-fat attitudes of nursing students at the Faculty of Nursing, Physiotherapy and Podiatry at Universidad de Sevilla (Spain) change during their degree training.

DESIGN

A cross-sectional study was carried out.

SETTINGS

Undergraduate nursing institution in Spain.

PARTICIPANTS

578 nursing students enrolled at the Faculty in all academic years, from the first through the fourth.

METHODS

Following ethical approval, each participant took part in an individual self-report via the Anti-Fat Attitudes (AFA) Questionnaire, in its validated Spanish version.

RESULTS

The mean standardised AFA total was 2.29.; by domains: 1.29 in Dislike, 2.87 in Fear of fat, and 3.73 in Willpower. Analysis of variance tests showed significant differences in the AFA total score and domains by sex and academic year. Multiple linear regression analysis demonstrated that the highest prejudices were shown by enrolled participants in their first year, particularly when the AFA total score was considered.

CONCLUSIONS

Nursing students at the Faculty do not have many prejudices towards obese people. Anti-obesity attitudes among nursing students decrease as the students progress in their degree, implying that the specific training received (degree curriculum) also enables students to develop their non-technical skills.