P3.O292: Difficult Conversations: Addressing Microaggressions in Healthcare Settings

Background: Racism in health professions often manifests in the form of microaggressions, which communicate hostile, derogatory, negative racial slights, and insults toward minorities or marginalized groups and can be intentional or unintentional. To help trainees recognize microaggressions, discuss their impact in healthcare settings and rehearse potential responses, we developed the “Microaggressions in Healthcare” workshop.

Methods: Two video-based cases illustrating microaggressions in healthcare with facilitated debriefings were developed and presented during a one-hour workshop for two separate groups: 4th-year medical students and pediatric residents. Case selection and design were informed by personal experience, literature review and consultation with local simulation and Diversity Equity and Inclusion experts. Demographics and pre-survey data were collected prior to the workshop. Microaggressions were first introduced and described. Video cases were viewed by the group and 4 facilitators guided small-group debriefings and conversational rehearsal using the Microaggressions Triangle Model. A video demonstrating a trainee speaking-up about the microaggression was also viewed and debriefed for each case. Trainees then independently completed a post-survey, which included a 5-point Likert scale. Trainees were invited to describe personal experience with microaggressions in healthcare in their pre- and post-surveys.

Results: 19 students and 16 residents completed the training and pre/post-surveys. Participating students and residents were majority female (52.6% and 75%) and white (94.7% and 68.7%) with 12.5% Black and 18.8% Asian in the resident group. Many (68.4% and 62%) had participated in prior microaggression training; 47.4% and 75% respectively had experienced microaggressions while 52.6% and 50% had responded to a microaggression. Before training, most students and residents knew the definition of microaggressions (85%, 87.6%), felt comfortable explaining microaggressions to colleagues (52.7%, 62.6%), and recognized when a microaggression occurred (52.7%, 75%), but very few participants (21%, 25%) felt comfortable responding to microaggressions in person. All categories improved to 100% in post-training survey for both students and residents (p < 0.001 for almost all values. Most (76%) students and all residents were satisfied with the lecture material, while 100% of students and residents were satisfied with the simulation training and the debriefing session. All participants would like future opportunities for simulations responding to microaggressions.

Conclusion: The “Microaggressions in Healthcare” workshop was positively evaluated by both medical students and pediatric residents. Both groups expressed interest in future simulation training related to responding to microaggressions. This workshop could be implemented during resident or student didactics with the aid of those familiar with facilitating small-group discussions.