Shannon Boardman University of Nottingham Develop and evaluate

Shannon Boardman University of Nottingham

• Develop and evaluate a studentled OER on obesity; • To challenge victim blaming attitudes towards obese people.

• Why choose obesity as a topic? • Why choose OER as a format?

Obesity is a big public health issue. .

Obese people are often victim blamed

Students regard obese people as fair game for cynical jokes in the healthcare setting because they view obesity as a self-inflicted condition¹

Students make less eye contact with a digitally simulated obese patient²

Students say they would be unlikely to recommend lifestyle changes to obese patients whom they perceive as noncompliant²

Students would be less keen to have obese patients registered at their practice³

Why choose obesity as a topic?

How can this be changed?

• Education about the wider determinants of obesity • Pitched at student level

Why choose OER as a format? • Dissemination • Victim blaming of obese people occurs in wider society as well • Limited evidence on student-led OER in medicine

OER Creation • Xerte Online Toolkits v. 2. 0

OER Creation • Xerte Online Toolkits v. 2. 0 • Factual content: • Public Health England NHS websites • Remixing • Creative commons licensed media • Author-made diagrams • Xpert Attribution service

Focus group • 6 BMed. Sci students • Judgement sampling • Informed consent • 1 h 30 audio-recorded focus group • Incentive

Thematic analysis • Qualitative analysis method • Braun & Clarke’s definitive paper 4 • Codes and themes • NVivo 10 • Three independent researchers

Theme Corresponding sub-themes Evaluation of the OER • Degree of enjoyment • Change of opinions • OER vs existing teaching methods Attitudes, values and beliefs about obesity • Value of personal prioritisation of health • Value of willpower and determination • Value of social norms • Value of education • Taking collective responsibility • Sensitivity when communicating with obese patients Knowledge about obesity • • The energy equation and BMI Obesity systems map Causes and determinants of obesity The intervention ladder

Evaluation of the OER Degree of enjoyment Change of opinions OER vs existing teaching methods

“It was very good” “I really like the drawings”

“I think it was really good in highlighting the fact that it’s not just like a fat person being really impulsive and not being able to stop themselves from eating; it did highlight that there are other issues involved …”

“I would say put up the package but then have this kind of talk after it… then you get a whole range of opinions and you can discuss it”.

Attitudes, values and beliefs about obesity Value of personal prioritisation of health Value of willpower and determination Value of social norms Value of education Taking collective responsibility Sensitivity when communicating with obese patients

“…why would you (worry about your weight) if you had to worry about getting kicked out of your house or having no job or feeding your family or someone that you knew was in prison? ”

“It’s about education isn’t it? ”

“…if their parents are overweight they’re likely to be overweight as well. . . ”

“…there’s still so much stigma surrounding it, I think because it does have that aspect of personal responsibility to it…”

“…we’ve got to work on stopping obesity somehow. Like the country as a whole, the world as a whole…”

“…treat them the same as someone who has another disease…you’re not going to tell someone off because they have cancer because they smoke too much…If a patient came in who had cancer you would give them their options and tell them where to go next and it should be the same if a patient came in and they were fat you’d tell them their options and what they could do. ”

Knowledge about obesity The energy equation and BMI Obesity systems map Causes and determinants of obesity The intervention ladder

“I needed a bit of updating…”

…. ”I didn’t know the difference between cause and determinant (before the package)”

“I really liked the page with the ladder. . ? We don’t really cover that in medicine”

Modified Kirkpatrick’s model for grading impact from peer-teaching on educational outcomes of medical student learners 5 Level 1 Reaction Level 2 A Learning: Change in attitudes Level 2 B Learning: Modification of knowledge or skills as a result of participating as a learner Level 3 Behaviour: Change in behaviours as a result of participating as a learner Level 4 A Results: Change in the system or organisational practice Level 4 B Results: Change in patient health outcomes

• Participant experience with this OER supports a role for students as producers • Further research could consolidate the place of OER in the undergraduate curriculum • Formal faculty support and funding could create more opportunities for students to produce OERs

Involvement in OER creation brings tangible benefits to the producer • Research skills • Creative skills • Domain knowledge • Professionalism

References 1. Wear D, Aultman JM, Varley JD, Zarconi J. Making fun of patients: medical students’ perceptions and use of derogatory and cynical humor in clinical settings. Acad Med 2006 May; 81(5): 454– 62. 2. Persky S, Eccleston CP. Medical Student Bias and Care Recommendations for an Obese versus Non-Obese Virtual Patient. Int J Obes. 2011; 35(5): 728– 35. 3. Wigton RS, Mc. Gaghie WC. The effect of obesity on medical students’ approach to patients with abdominal pain. J Gen Intern Med 2001 Apr; 16(4): 262– 5. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2008; 3(2): 77– 101. 4. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2008; 3(2): 77– 101 5. Yu T-C, Wilson NC, Singh PP, Lemanu DP, Hawken SJ, Hill AG. Medical students-as-teachers: a systematic review of peer-assisted teaching during medical school. Adv Med Educ 2011 Jan; 23(2): 157– 72.