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

Abstract

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.

It is Challenging to Shift the Norm: Exploring how to Anticipate and Address Microaggressions in Clinical Learning Environments

“…Faculty who had experienced microaggressions in their own personal and professional lives were sensitized to notice similar microaggressions, while some felt that they had to minimize these events. Emotional vulnerability also arose from multiple sources in such circumstances [19]. Our study provides an opportunity to learn more details about potential barriers, while shedding light on how address such barriers and advance more culturally sensitive and psychologically safe learning and working environments.…”

“…The role of emotional vulnerability is consistent with previous research on microaggressions in medical education. It is well established that medical faculty experience discomfort when discussing racism, discrimination, and microaggressions [19][20][21][22]. Faculty who had experienced microaggressions in their own personal and professional lives were sensitized to notice similar microaggressions, while some felt that they had to minimize these events.…”

“…Anticipatory approaches to fostering belonging or addressing microaggressions have been framed in the medical education literature as a form of intellectual candor that invites vulnerability while building credibility [19]. Although intellectual candor can build trust [25], such candor also requires a mutual form of trust within and between different roles, identities, and hierarchical statutes within an organization.…”