simulation-based education. Adv Simul 2016;1:14. DOI: https://doi. org/10.1186/s41077-016-0015-0 7 Shacklady J, Holmes E, Mason G, Davies I, Dornan T. Maturity and medical students’ ease of transition into the clinical environment. Med Teach 2009;31 (7):621–6. 8 Doctors in Society: Medical professionalism in a changing world. Royal College of Physicians UK. 2005 http://www.rcplond on.ac.uk/publications/doctors- society. [Accessed 20 May 2017]. 9 Mole TB, Begum H, Cooper-Moss N, Wheelhouse R, MacKeith P, Sanders T, Wass V. Limits of ‘patient-centredness’: valuing contextually specific communication patterns. Med Educ 2016;50 (3): 359–69. 10 Tett G. The Silo Effect: why Putting Everything in Its Place Isn’t Such a Bright Idea. London, UK: Little, Brown 2015. 11 Harding A, Rosenthal J, Al-Seaidy M, Pereira Gray D, Robert K, McKinley RK. Provision of medical student teaching in UK general practices: a cross-sectional questionnaire study. Br J Gen Pract 2015; 65 (635):e409–17. 12 Yardley S, Cottrell E, Rees E, Protheroe J. Modelling successful primary care for multimorbidity: a realist synthesis of successes and failures in concurrent learning and healthcare delivery. BMC Fam Pract 2015;16 (1):1. Trainees’ experiences and attitudes and the delivery of patient-centred care for obesity Sean M Phelan & Tamim I Rajjo In this issue, Pearl et al. 1 present findings from a study of medical trainees’ attitudes about patients with obesity. The authors find that successful weight-loss history in trainees is associated with more negativity toward patients who have not had the same success. Specifically, medical trainees who have lost weight and maintained weight-loss in the past hold more negative attitudes about patients who have not lost weight or have lost and regained weight. Trainees who lost and regained weight hold more negative attitudes about patients who have not lost weight. These findings are especially striking given the broad range of attitudes found to be associated with trainee weight-loss history. Weight-loss history was associated with a measure of dislike of all obese people, in addition to the negative feelings directed specifically at the patient in the vignette. This points to the depth and breadth of explicit negativity toward obese people and the role that attribution may play in strengthening these attitudes. The stigma surrounding a socially undesirable condition is often greater when the acquisition of that condition can be blamed on the afflicted. 2 In this case, beliefs about the controllability of obesity are influenced by one’s own experience of control; attribution, and thus negativity, varies by trainee weight-loss history. Furthermore, given evidence suggesting that explicit attitudes and biases negatively affect the quality of patient- centered care, these attitudes may impact communication during the encounter, which may in turn harm patients by discouraging them from making follow-up appointments or impeding the patient’s own ability to make lifestyle changes that may contribute to weight-loss. 3,4 Or, in the more extreme psychological response, contribute to depression, anxiety or engagement in unhealthy behaviours, such as emotional and binge eating. 5 This points to the depth and breadth of explicit negativity toward obese people Evidence of variation in health care providers’ attitudes about patients with obesity suggests that clinical guidelines that recommend weight-loss behaviours be discussed at every point of contact in a primary care setting can create harm by ignoring variation between physicians in the ability to provide high-quality weight-loss counselling, perhaps influenced by personal history of weight-loss, as this study suggests, or by other experiences. Rochester, Minnesota, USA Correspondence: Sean M Phelan, Division of Health Care Policy and Research, Mayo Clinic, 200 First St SW, Rochester, Minnesota 55905, USA. Tel: 507 266 4885; E-mail: phelan.sean@mayo.edu doi: 10.1111/medu.13361 775 ª 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education; MEDICAL EDUCATION 2017 51: 773–775 commentaries