What Happened and Why: Responding to Racism, Discrimination, and Microaggressions in the Clinical Learning Environment

• Published in: MedEdPORTAL 2022-11, Vol.18, p.11280-11280
• Main Authors: Neves da Silva, Helio V., Heery, Lauren M., Cohen, William R., Mahalingam, Vikasini S., Adebiyi, Oluwatosin A., Lee, Rita S., Netsanet, Adom N., Ogundipe, Eniola A., Dakhama, Yasmine, Wang, Mary L., Vrolijk, M. Aaron, Garcia, Mackenzie W., Ward-Gaines, Jacqueline, Neumeier, Anna T.
• Format: Article
• Language: English
• Subjects: Case-Based Learning; Cultural Competence; Curriculum Development; Diversity; Equity; Health Equity; Original Publication
• ISSN: 2374-8265; 2374-8265
• DOI: 10.15766/mep_2374-8265.11280

IntroductionWithin clinical learning environments, medical students are uniquely faced with power differentials that make acts of racism, discrimination, and microaggressions (RDM) challenging to address. Experiences of microaggressions and mistreatment are correlated with higher rates of positive depression screening and lower satisfaction with medical training. We developed a curriculum for medical students beginning clerkship rotations to promote the recognition of and response to RDM. MethodsGuided by generalized and targeted needs assessments, we created a case-based curriculum to practice communication responses to address RDM. The communication framework, a 6Ds approach, was developed through adaptation and expansion of established and previously learned communication upstander frameworks. Cases were collected through volunteer submission and revised to maintain anonymity. Faculty and senior medical students cofacilitated the small-group sessions. During the sessions, students reviewed the communication framework, explored their natural response strategies, and practiced all response strategies. ResultsOf 196 workshop participants, 152 (78%) completed the evaluation surveys. Pre- and postsession survey cohort comparison demonstrated a significant increase in students' awareness of instances of RDM (from 34% to 46%), knowledge of communication strategies to mitigate RDM (presession M = 3.4, postsession M = 4.6, p < .01), and confidence to address RDM (presession M = 3.0, postsession M = 4.4, p < .01). DiscussionStudents gained valuable communication skills from interactive sessions addressing RDM using empathy, reflection, and relatability. The workshop empowered students to feel prepared to enter professional teams and effectively mitigate harmful discourse.