LGBTQ+ Microaggressions in Health Care: Piloting an Observation Framework in a Standardized Patient Assessment

ABSTRACT

Microaggressions are subtle derogatory behaviors that unintentionally communicate hostility toward marginalized social groups. This article describes the preliminarily validation of a framework for observing LGBTQ+ microaggressions in health care, which can lead to distrust and disengagement from the healthcare system. Coders used the framework to observe microaggressions in video-recorded clinical-skills assessments with medical students who elicited health histories from standardized patients. Microaggression classifications were reviewed to determine construct reliability and the presence/absence among eight framework categories. Among 177 encounters with sexual and gender minority standardized patients, heteronormative/cisnormative language and assumptions occurred in the largest proportion of encounters (85.3%). Only identity-based referrals decreased significantly after a clinical skills intervention (20.0% to 4.9%, p = .01). These outcomes show that LGBTQ+ healthcare microaggressions are pervasive and will likely require nuanced training to address them. This groundwork can also be used to develop scales for patients and observers to identify microaggressions and assess perceived impact.

KEYWORDS:

• LGBTQ+ bias
• sexual and gender minority
• transgender health
• medical education
• communication skills
• LGBTQ+ microaggressions

Acknowledgments

The authors would like to thank the LGBTQ+ community in Louisville who dedicate time and expertise to educate our medical students and providers. The clinical skills assessment analyzed for this work was made possible with help from the staff in our standardized patient program, the University of Louisville LGBT Center, the Medical Education Research Unit, and the Office of Undergraduate Medical Education.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The Medical Education Research Award (MERA) program through the University of Louisville College of Arts and Sciences funded video coders who helped us collect these data. Primary data collection for the standardized patient case that was analyzed secondarily in this study was supported by the National Institute for Health Care Management (NIHCM) Foundation.