The association of direct observation of medical students with patient-centered care for obesity

Nathaniel E. Miller, Kurt Angstman, Michelle Van Ryn, Gregory M. Garrison, Kristin Fischer, Sean Phelan

Research output: Contribution to journalArticlepeer-review


BACKGROUND AND OBJECTIVES: Teaching medical students patient-centered approaches to weight loss counseling occurs in myriad ways. We examined lectures and direct faculty observation to see which was associated with better patient-centered care in medical students, measured by both selfperception and independent observer evaluation. METHODS: Third-and fourth-year students attending one medical school were surveyed regarding their education in (1) weight loss and health behavior counseling, (2) obesity stigma, and (3) whether they had experienced direct faculty observation of their weight loss counseling. Several weeks later, the students were observed during a standardized patient encounter for obesity and an obesity-relevant comorbidity. A postencounter survey assessed overall student satisfaction with the encounter and with the care they provided. Independent coders rated their patient-centered communication using a validated measure. RESULTS: There was no consistent association between any dependent variable and student ratings of adequacy of instruction, nor with instructional content. Direct faculty observation was not associated with overall encounter satisfaction or their overall patient-centeredness. However, experiences with direct faculty observation were significantly and positively associated with students’ perceptions of patient engagement (b=0.1, P=.05), and with independent coders’ ratings of student friendliness (b=0.13, P=.01), responsiveness (b=0.113, P=.03), and lower student anxiety (b=-0.1, P=.01). CONCLUSIONS: Independent observation and self-report of instruction adequacy and content had no consistent association with care quality. However, direct faculty observation predicted improvement in both student self-reports and independent observer ratings of students’ interpersonal quality of care. Further work is needed to define optimal methods of imparting patient-centered care.

Original languageEnglish (US)
Pages (from-to)271-277
Number of pages7
JournalFamily Medicine
Issue number4
StatePublished - Apr 2020

ASJC Scopus subject areas

  • Family Practice


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