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MITE Monthly Tip
October 2023
Emily Erickson, MD

Addressing microaggressions in medical education

Microaggression (noun): a comment or action that subtly and often unconsciously or unintentionally expresses a prejudiced attitude toward a member of a marginalized group (such as a racial minority)1

Clinical encounters are complex interpersonal interactions, full of power hierarchies, communication challenges, competing agendas, and time constraints. Adding a learner into the mix often further complicates the dynamic. Microaggressions in medical education can both be committed by and negatively affect any of the individuals involved.

Microaggressions can target any number of traditionally nondominant group identities, including race, gender, socioeconomic class, ability, and sexuality. They typically come from a place of unconscious bias, meaning that “we are all socialized to commit microaggressions, even if we have good intentions.”2 This 5-minute video clip highlights some examples of microaggressions.

When you witness a microaggression, what can you do?

Reflect and clarify ·       “I think I heard you say ___. Can you please say more about that?”

·       “I don’t understand; can you explain what makes that funny?”

·       “I’m curious about ____.”
Uplift the target ·       “The medical student caring for you is going to be an excellent physician.”

·       “I understand you are feeling ____, but you cannot use that language when talking to my colleague.”

·       “I think [team member being ignored/interrupted] brings up a good point, but I didn’t get a chance to hear all of it. Let’s listen to them again.”
Identify the microaggression ·       “I know you may not realize it, but when you said ____, it made me feel _____.”

·       “I feel uncomfortable when you use words like ____. I’d like everyone to speak with respect.”

·       “I believe a more inclusive term is _____.”
Circle back/readdress ·       “I thought about what you said earlier, and I want to talk more about…”

·       “I’d like to revisit something that occurred on rounds yesterday…”
Table adapted from references 3-5.

Addressing microaggressions does take time, which is often at a premium in clinical teaching encounters. However, not addressing them reinforces negative stereotypes and can cause real harm to those targeted; we can all strive to be allies in countering microaggressions in medical education settings.

Further reading

References

  1. Merriam-Webster Dictionary
  2. https://teaching.washington.edu/topics/inclusive-teaching/inclusive-teaching-strategies/creating-inclusive-classrooms/addressing-microaggressions-in-the-classroom/
  3. Walker VP, Hodges L, Perkins M, Sim M, Harris C. Taking the VITALS to Interrupt Microaggressions. MedEdPORTAL. 2022 Jan 19;18:11202. doi: 10.15766/mep_2374-8265.11202.
  4. Ehie O, Muse I, Hill L, Bastien A. Professionalism: microaggression in the healthcare setting. Curr Opin Anaesthesiol. 2021 Apr 1;34(2):131-136. doi: 10.1097/ACO.0000000000000966.
  5. Acholonu RG, Cook TE, Roswell RO, Greene RE. Interrupting Microaggressions in Health Care Settings: A Guide for Teaching Medical Students. MedEdPORTAL. 2020 Jul 31;16:10969. doi: 10.15766/mep_2374-8265.10969.

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