Supporting Learners from Diverse Backgrounds – Recognizing and Addressing Microaggressions in Clinical Learning Environments

Contributors: Tejal Patel and Nirosha BalakuAR

Summary:

Microaggressions are common, everyday subtle words, actions or behaviours that communicate a bias against individuals or groups from equity deserving communities.  Recognizing microaggressions can be a challenge for those not targeted by them, and sometimes even for those at their target.  In clinical learning environments, learners can experience microaggressions from preceptors, staff, their colleagues, and/or patients. Overtime, the message sent via microaggressions can be internalized and contribute to loss of confidence, engagement, and a drive to succeed.  This in turn, further perpetuates the othering, ongoing trauma, and inequities (such as differential attainment) we see in medicine and throughout society at large.  For these reasons, it is important to consider the role this form of often “hidden” racism, sexism, ablism, and other “isms” play when attempting to understand a learner’s less than satisfactory performance.

The first step in helping to support learners is in recognizing when microaggressions occur.  This often requires understanding our own biases and positionality so we can better appreciate what our privileges allow us to ignore.  Becoming more mindful of our language and that used by our teams and patients is vital.  Upon recognizing microaggressions when they occur, the next step is to challenge yourself from being a bystander who just observes what happens, to becoming an upstander, someone who responds in ways that support the recipient and attempt to disarm the microaggression.  As is the case for many skills in our educational toolkit, responding to microaggressions is a skill that takes time to develop comfort with and practice to become proficient at.

Key Take Aways:

1. Microaggressions are common, often subtle, and unconscious events that learners from equity deserving groups experience regularly.
2. Repeated exposure to microaggressions can lead to poor self-confidence and motivation.  This can contribute to a learner being seen as not engaging in learning or disinterest.
3. Gaining a better understanding of our biases, positionalities and privileges is an important first step in becoming more aware of microaggressions when they occur.
4. Responding to disarm microaggressions takes skill and practice.

Link To Resources:

1. Recognizing Microaggressions:
   • Recognizing Microaggressions and the Messages they Send
   • Scholarly Article – Towards equitable learning environments for medical education: Bias and the intersection of social identities
2. Approaches to disarming microaggressions:
   • NRP interview – Microaggressions are a big deal: How to talk them out and when to walk away
   • Scholarly Article – The Microaggressions Triangle Model: A Humanistic Approach to Navigating Microaggressions in Health Professions Schools  Scholarly Article – Recognizing and Reacting to Microaggressions in Medicine and Surgery
   • CPSO eDialogue Treating Patient Bias
3. Podcast
   • Cultural Humility Podcast, Season 1 Episode 12: Racial Microaggressions and Political Correctness   
4. Infographic
   • Addressing Microaggressions In Academic Medicine