Equity in medical education: Addressing microaggressions and discrimination on the wards

Abstract

Purpose

Existing frameworks to address instances of microaggressions and discrimination in the clinical environment have largely been developed for faculty and resident physicians, creating a lack of resources for medical students.

Methods

We implemented a workshop to prepare pre-clinical medical/dental students to recognize and respond to microaggressions. Participants in three cohorts from 2018 to 2020 completed pre- and post-workshop surveys assessing the prevalence of exposure to clinical microaggressions and the workshop’s effect on mitigating commonly perceived barriers to addressing microaggressions.

Results

Of 461 first-year medical and dental students who participated, 321 (69.6%) provided survey responses. Over 80% of students reported experiencing microaggressions, with women and URM students over-represented. After the workshop, participants reported significant reductions in barriers to addressing microaggressions and discrimination, including recognizing incidents, uncertainty of what to say or do, lack of allies, lack of familiarity with institutional policies, and uncertainty of clinical relevance. The workshop was similarly effective in-person and virtual formats.

Conclusions

Most medical/dental student respondents reported experiencing microaggressions in the clinical setting, particularly female and URM students. Our workshop mitigated most perceived challenges to responding to microaggressions. Future interventions across institutions should continue to equip students with the tools they need to address and respond to microaggressions.

Keywords:

• Ethics/attitudes
• medical education research
• professionalism
• medicine
• instructional design

Glossary

Microaggression: defined by Sue et al. as ‘brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional’ most often targeting marginalized groups (Sue et al. 2007). In clinical settings, examples include a female trainee receiving unwanted comments about her appearance, or an under-represented in medicine (URM) student being mistaken for an interpreter or custodial staff member.

Acknowledgements

Ethical approval: Harvard Medical School IRB exempt.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article. Thank you to for the assistance to Dr. Amy Sullivan, director of research at the Carl J. Shapiro Institute for Education and Research at Beth Israel Deaconess Medical Center in Boston for the creation of the pre and post workshop surveys.

Additional information

Notes on contributors

Raquel Sofia Sandoval

Raquel Sofia Sandoval, Medical Student, Harvard Medical School and Harvard Kennedy School of Government, Boston, MA, USA.

Spencer Dunleavy

Spencer Dunleavy, MSc, MSc, Medical Student, Columbia University College of Physicians and Surgeons, New York City, NY, USA.

Titilayo Afolabi

Titilayo Afolabi, MD, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.

Jordan Taylor Said

Jordan Taylor Said, Medical Student, Harvard Medical School, Boston, MA, USA.

Jade Connor

Jade Connor, Medical Student, Harvard Medical School, Boston, MA, USA.

Azfar Hossain

Azfar Hossain, Medical Student, Harvard Medical School, Boston, MA, USA.

Bina Kassamali

Bina Kassamali, Medical Student, Harvard Medical School, Boston, MA, USA.

Tamina Kienka

Tamina Kienka, Medical Student, Harvard Medical School, Boston, MA, USA.

Maahika Srinivasan

Maahika Srinivasan, Medical Student, Harvard Medical School, Boston, MA, USA.

Anita Cheng

Anita Cheng, MD, Clinical Instructor in Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Daniele Ölveczky

Daniele Ölveczky, MD, MS, Assistant Professor of Medicine, Harvard Medical School; Inclusion Officer, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Avik Chatterjee

Avik Chatterjee, MD, MPH, Physician, Boston Health Care for the Homeless Program; Associate Epidemiologist, Division of Global Health Equity, Brigham and Women’s Hospital; Lecturer, Part-time, Harvard Medical School, and Assistant Professor, Boston University School of Medicine, Boston, MA, USA.