Twelve tips for responding to microaggressions and overt discrimination: When the patient offends the learner

Abstract

Microaggressions and expressions of overt discrimination negatively affect the experience of medical trainees at all levels. Mistreatment of trainees, including abusive and discriminatory behavior by patients and families, occurs commonly and is receiving increased attention in both the medical literature and popular press. Heightened awareness of the problem has sparked a call to engage in substantive conversations about bias in health professions education. The emphasis on direct observation in medical education makes the bedside a common setting for educators to witness these behaviors firsthand. Many educators are committed to developing a positive climate for learners but lack the training and skills to facilitate discussions about discrimination. As a result, these difficult but important conversations may not occur. The authors present a three-phase approach to responding to microaggressions and discrimination toward trainees from patients, and offer a communication toolkit that frontline medical educators can use in their daily practice.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Notes on contributors

Daniel J. Wheeler

Daniel J. Wheeler, MD, is an Assistant Professor of Medicine at the University of Minnesota Medical School. He is an academic hospitalist and core faculty member for the University of Minnesota’s internal medicine residency program.

Josué Zapata

Josué Zapata, MD, MBA, is an Assistant Clinical Professor of Medicine at UCSF and a hospitalist and Associate Chief of the Medical Service at the San Francisco VA. He is a medical educator and serves as a member of the Coaching Program at the UCSF School of Medicine.

Denise Davis

Denise L. Davis, MD, is Professor of Medicine at UCSF and practices general internal medicine at the San Francisco VA. She is a fellow of the Academy of Communication in Healthcare and serves as Specialist for Diversity for the UCSF School of Medicine.

Calvin Chou

Calvin Chou, MD, PhD, is Professor of Medicine at UCSF and a general internist at the San Francisco VA. He is Vice President for External Education and a fellow of the Academy of Communication in Healthcare.