A Scoping Review of Recommendations and Training to Respond to Patient Microaggressions

Wittkower, L David; Bryan, Jennifer L.; Asghar-Ali, Ali Abbas

doi:10.1007/s40596-021-01533-9

Cited by 13 publications

(17 citation statements)

References 56 publications

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“…These objectives expand existing microaggression response faculty development efforts which focus heavily on employing response frameworks. 6…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5] Existing literature addressing patient microaggressions includes expert commentaries and trainings on response approaches emphasizing observation, inquiry, sharing opinions, feelings, microaggression impact, and requests for next steps. 6 However, a gap remains in understanding how faculty implement microaggression response skills in clinical settings. [6][7][8] Interpersonal microaggressions manifest as microinvalidations, microinsults, or microassaults (Supplemental Digital Appendix 1 at http://links.lww.com/ ACADMED/B459).…”

Section: Discussionmentioning

confidence: 99%

“…2–5 Existing literature addressing patient microaggressions includes expert commentaries and trainings on response approaches emphasizing observation, inquiry, sharing opinions, feelings, microaggression impact, and requests for next steps. 6 However, a gap remains in understanding how faculty implement microaggression response skills in clinical settings. 6–8…”

mentioning

confidence: 99%

“…6 However, a gap remains in understanding how faculty implement microaggression response skills in clinical settings. 6–8…”

mentioning

confidence: 99%

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From Eggshells to Action: A Qualitative Study of Faculty Experience Responding to Microaggressions Targeting Medical Students

O’Brien,

Bullock,

Minhas

et al. 2023

Academic Medicine

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Purpose: Microaggressions targeting clinical learners cause harm and threaten learning. Clinical supervisors can be powerful allies by intervening when microaggressions occur. This study explored general and student-nominated skilled supervisors’ perspectives on responding to microaggressions targeting clinical learners. Method: This single institution, qualitative study within a constructivist paradigm explored faculty supervisor experiences with bystander response to microaggressions targeting learners. Clinical supervisors in medicine and surgery departments and those across departments nominated by students as skilled microaggression responders were invited to discuss microaggression scenarios targeting students in semi-structured focus groups in the U.S. in 2020-2021. Investigators applied the framework method of thematic analysis to identify themes. Results: Forty-two faculty (31 medicine and surgery (“general”), 11 “student-nominated” as skilled responders) joined 10 focus groups (6 “general,” 3 “student-nominated,” 1 mixed). Four themes characterized experiences responding to microaggressions targeting learners: bystander goals, noticing, acting, and continuous learning. Participants’ response goals were protecting learners, safeguarding learning, and teaching microaggression response skills. Noticing was influenced by past experiences with microaggressions and acculturation to clinical environments. Bystander action stemmed from (1) microaggression type, (2) personal emotional vulnerability, (3) knowledge of student preferences for supervisor response, and (4) clinical and educational context. Bystander action was more common when participants regarded all microaggressions as harmful, understood student preferences for faculty response, expected to err (growth mindset), and framed microaggressions as opportunities for humble reflection, intellectual candor, and teaching. Microaggression response required continuous learning through informal and formal skills development. Conclusions: Complex factors govern faculty bystander response to microaggressions targeting clinical learners. Efforts to strengthen faculty bystander response should incorporate skill-building around pre-emptive discussions with learners and using intellectual candor to promote psychological safety, learning, and bystander action. Additional investigation is needed on how to incorporate these skills into team workflows and to assess outcomes of specific response strategies.

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“…These objectives expand existing microaggression response faculty development efforts which focus heavily on employing response frameworks. 6…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…6 However, a gap remains in understanding how faculty implement microaggression response skills in clinical settings. 6–8…”

mentioning

confidence: 99%

See 2 more Smart Citations

From Eggshells to Action: A Qualitative Study of Faculty Experience Responding to Microaggressions Targeting Medical Students

O’Brien,

Bullock,

Minhas

et al. 2023

Academic Medicine

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“…18(p79) There are 27 established training programs for addressing racism, including the ACTION model; the ERASE framework; the OTFD tool; Stop, Talk, and Roll; and XYZ (Table ). 19 These tools remind individuals to advocate for themselves by stopping a racial conversation, talking through a tough patient encounter with a peer or supervisor, and, after a shift, "rolling on out" by seeking support through mentorship or an employee assistant program. 20 The tools provide scripts for effective communication, which help to foster awareness and reduce defensiveness.…”

Section: Potential Solutionsmentioning

confidence: 99%

Racial Discrimination in Patient Care—Preserving Relationships With Integrity

Fahey¹

2022

J Hosp Palliat Nurs

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The following case study describes what is known as the health care system's open secret of allowing a patient or family to refuse care from a clinician of another race. This article explores the ethical tension between autonomy, nonmaleficence, justice, and duty to treat as it relates to racism and the potential harm to clinicians, health care teams, and organizations. When racism is experienced within the clinical setting, clinician knowledge, organizational training, and moral character are essential for identifying and addressing it effectively. Racial discrimination and related mistreatment are not part of a responsive and proactive moral community. This article explores creative solutions that preserve patient-clinician relationships without sacrificing personal integrity when racism is encountered.

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