Assumed or Assessed? The Affective Domain in Health Care Education

Supporting a patient’s dietary and lifestyle change requires more than just content knowledge and practical skill by health care providers. It requires an unbiased attitude that projects empathy and professionalism. While nutrition and other health care education programs ensure students acquire requisite knowledge and skill, are they also cultivating and assessing affective outcomes or are these values and unbiased attitudes merely assumed? Many studies have reported on the prevalence of racial bias and stereotyping among health care practitioners. A startling prevalence of bias toward obese patients exists among medical students and physicians, and even among dietitians and nutritionists. Harboring bias, and implicitly or explicitly demonstrating such negative attitudes, can have highly detrimental effects on patient outcomes including reinforcing obesogenic behaviors. However, teaching professionalism has proven to be a challenge in health care education. It is not easily placed within the objective paradigm of other health care competencies, as it is challenging to describe and assess. It is now time for a broader discussion and analysis of teaching and assessment of the affective domain in health care education. The significance of provider affect in health care necessitates that academic institutions prioritize the development of professional attitudes and values in their students. While an inadequate emphasis on learning outcomes in this domain might inform standards established by programmatic accreditors, institutions can have an immediate impact through the implementation of faculty development programs. Such programs should emphasize the importance of bias on patient outcomes, how to integrate professionalism into their courses (or clinical experiences), and how to assess it effectively.