Microaggressions and Implicit Bias in Surgical Training: An Undocumented but Pervasive Phenomenon

Alimi, Yewande; Bevilacqua, Lisa A.; Snyder, Richard A.; Walsh, Danielle S.; Jackson, Patrick G.; DeMaria, Eric J.; Tuttle‐Newhall, Janet E.; Altieri, Maria S.

doi:10.1097/sla.0000000000004917

Cited by 32 publications

(31 citation statements)

References 19 publications

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“…Microaggressions have previously been reported in surgical specialties. 6,13,14 A 2020 survey completed by 1624 general surgery residents (estimated response rate: 10.2%) and surgical subspecialty residents (estimated response rate: 10.2%) in the United States identified that microaggressions more commonly came from patients, followed by staff, faculty, and coresidents. 13 Only 7% of the trainees reported these events to the graduate medical education office or program director.…”

Section: Discussionmentioning

confidence: 99%

Assessing the Prevalence of Microaggressions in Plastic Surgery Training: A National Survey

Goulart

Huayllani

Samora

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: There has been increased awareness of microaggressions occurring during medical training. However, the prevalence and characteristics of microaggressions specifically in plastic surgery residency remain unknown. We aimed to fill this literature gap by conducting a nationwide survey to better understand and characterize microaggressions in plastic surgery training. Methods: A survey was distributed between March and May 2021 via the American Society of Plastic Surgeons Resident Representatives to 1014 integrated and 214 independent track plastic surgery trainees in the United States. Multiple Pearson’s chi-square of independence and Fisher exact tests evaluated comparisons of microaggressions by sex, race, Hispanic origin, sexual orientation, and year in training. A multivariate regression analysis assessed associations between variables. Results: One hundred twenty-five participants responded to the survey (response rate: 10.2%). Of those who responded, 68.8% had experienced microaggressions in the past year. Female trainees experienced microaggressions more frequently than male trainees ( P < 0.05). Asian trainees had higher odds to be a target of microaggressions compared with White trainees ( P = 0.013). Nonheterosexual trainees were more likely to have experienced microaggressions compared with heterosexual trainees ( P < 0.05). Independent trainees were more likely to experience microaggressions than PGY 1–2 and 3–4 integrated residents ( P < 0.05). Conclusions: Approximately seven in every 10 trainees stated that they experienced microaggressions in the past year. Females, racial minorities, sexual minorities, and independent trainees had higher odds of reporting that they experienced microaggressions. Further studies are needed to assess the implementation of strategies that address this problem to resolve inequities.

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Section: Discussionmentioning

confidence: 99%

Assessing the Prevalence of Microaggressions in Plastic Surgery Training: A National Survey

Goulart

Huayllani

Samora

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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“…While findings of high rates of microaggressions by specialty were found in surgery and surgical subspecialties (82.3%), followed by medical (30.1%) and dentistry (12.9%), these findings were consistent with reports from regions outside the Gulf/ME region. Microaggression and implicit bias in surgical training has been reported, in an American study by Alimi Yewande et al, in a national survey with a majority (72.2%, n = 1173) of respondents reported experiencing microaggressions, most commonly from patients (64.1%), followed by staff (57.5%), faculty (45.3%), and co-residents (38.8%), while only a small proportion ( n = 109, 7.0%) of residents reported these events to the graduate medical education office/program director, and nearly one-third (30.8%) of residents said they experienced retaliation after reporting a microaggression ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

“…Microaggressions occur in medicine and healthcare as reported in the literature ( 11 – 20 ), and they have been mentioned as one of the factors that negatively impact the workplace environment and medical education in different regions of the world ( 16 – 18 ). There is expanding literature on the prevalence of microaggressions in the healthcare setting.…”

Section: Introductionmentioning

confidence: 99%

Microaggressions: Prevalence and Perspectives of Residents and Fellows in Post-Graduate Medical Education in Kuwait

2022

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ObjectiveMicroaggression prevalence in post-graduate medical education is unknown in Kuwait. The objective is to determine the prevalence of and capture the perspectives on microaggression among post-graduate trainees in Kuwait.Materials and MethodsThis is a cross-sectional study of an anonymous online survey targeting residents and fellows in Kuwait. Data collected included demographics, level of training, country of training, microaggression experience, types, and response. Univariate and multivariate analyses were performed using the Chi-square test and binary logistic regression, respectively.ResultsA total of 319 participants (69.1% females) included 52% junior residents, 39.2% senior residents, and 8.78% fellows. Forty-three percent were aware of the microaggression definition. The percentage was significantly higher in respondents from Gulf/Middle East Countries (57.9%) than from Kuwait. Approximately three-quarters experienced microaggressions. Senior residents were more likely to report exposure to microaggressions [Odds ratio (OR) = 2.4, P < 0.05] and had higher odds of exposure than juniors (OR = 9.85, P < 0.05). Exposure to microaggressions was highest in surgery/surgical specialties. The most common act of microaggression was verbal, followed by invalidation/dismissal of thoughts/ideas, and then acts of discrimination. Of those who experienced microaggressions, two-thirds thought that the experience had a psychological effect on them. Both groups reported low confidence in dealing with microaggressions (Gulf/Middle East Countries 18.8% and Kuwait 30.1%); the difference was not statistically significant.ConclusionsMicroaggressions are common among post-graduate medical trainees in Kuwait. Implementation of strategies to manage it is necessary. Further research on its impact on medical-training outcomes is needed.

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“…Existing efforts to expand and support implicit bias training have become a priority for physician residencies over the course of their training [14][15][16][17][18][19][20][21][22][23][24] It should be noted that there is ample research indicating that PAs and NPs provide excellent clinical care without postgraduate residency/fellowship training [25,26]; nevertheless, there has been an expanded interest in these postgraduate programs from both federal and public sectors due in part to projected shortfalls in physician specialties and a desire among some PAs and NPs to improve "clinical readiness" through transition-to-practice opportunities. Additionally, some academic health systems have adopted PA and joint PA/NP fellowship/residency training programs to bolster recruitment and retention strategies of qualified career staff [27].…”

Section: Introductionmentioning

confidence: 99%

A survey of implicit bias training in physician assistant and nurse practitioner postgraduate fellowship/residency programs

et al. 2022

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Background There has been renewed focus on advancing inclusivity within organized medicine to reduce health disparities and achieve health equity by addressing the deleterious effects of implicit bias in healthcare and clinical outcomes. It is well documented that negative implicit attitudes and stereotypes perpetuate inequity in healthcare. The aim of this study is to investigate implicit bias training in postgraduate physician assistant (PA) and nurse practitioner (NP) education; describe delivery of content to trainees; and detail program directors’ attitudes toward this type of training. Although there is research examining implicit bias training in physician residency education, there are no published studies on implicit bias training in postgraduate PA and NP postgraduate residency/fellowship programs. Method A non-experimental, descriptive study was designed to obtain information via survey from members of the Association of Postgraduate Physician Assistant Programs (APPAP). Results The response rate was 41%. The majority of respondents (76%) felt that PA and NP postgraduate programs should include implicit bias instruction. Educational strategies used by PA and joint PA/NP postgraduate programs or their sponsoring institution to deliver implicit bias content to trainees include: implicit bias training modules (50%), facilitated group discussions (36%), invited speaker on implicit bias (33%), case studies on implicit bias (16%), and implicit association test (10%); however, 30% of postgraduate programs do not provide implicit bias training to PA and/or NP trainees. Barriers to implementing implicit bias training expressed by some postgraduate programs include: uncertainty in how to incorporate implicit bias training (16%); lack of strategic alignment with training program or sponsoring institution (13%); time constraints (10%); financial constraints (6%); lack of access to content experts (6%); and unfamiliarity with evidence supporting implicit bias training (6%). Conclusion The present study sheds some light on the current state of implicit bias training in PA and joint PA/NP postgraduate residency/fellowship programs. While the majority of programs offer some sort of implicit bias training, there is a need to standardize this training in PA and joint PA/NP postgraduate education curricula using an actionable framework.

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Microaggressions and Implicit Bias in Surgical Training: An Undocumented but Pervasive Phenomenon

Cited by 32 publications

References 19 publications

Assessing the Prevalence of Microaggressions in Plastic Surgery Training: A National Survey

Assessing the Prevalence of Microaggressions in Plastic Surgery Training: A National Survey

Microaggressions: Prevalence and Perspectives of Residents and Fellows in Post-Graduate Medical Education in Kuwait

A survey of implicit bias training in physician assistant and nurse practitioner postgraduate fellowship/residency programs

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