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Sukhera J, Atkinson TM, Bullock JL. It is Challenging to Shift the Norm: Exploring how to Anticipate and Address Microaggressions in Clinical Learning Environments. PERSPECTIVES ON MEDICAL EDUCATION 2023; 12:575-583. [PMID: 38144673 PMCID: PMC10742249 DOI: 10.5334/pme.1251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/26/2023]
Abstract
Purpose Increased attention to improving a culture of belonging in clinical learning environments has led to various approaches to addressing microaggressions. However, most approaches in the literature focus on responding or reacting to microaggressions with insufficient attention to building trust before microaggressions might occur. Research on microaggressions in clinical learning environments suggests anticipatory or pre-emptive conversations about microaggressions may foster greater trust. In this study, the authors explored how diverse participants perceived the experience of anticipatory conversations about potential microaggressions. Overall, the authors sought to gain a deeper understanding of how pre-emptive and anticipatory conversations may influence an organization's approach to addressing microaggressions in clinical learning environments. Methods The authors utilized constructivist grounded theory methodology and conducted individual qualitative interviews with 21 participants in an academic department within a larger health sciences center in the United States. Results Findings suggest that anticipatory conversations about microaggressions were challenging due to existing norms in dynamic clinical learning and working environments. Participants shared that the idea of anticipating microaggressions elicited dissonance. Conversations about microaggressions could potentially be facilitated through leaders who role model vulnerability, organizational supports, and an individualized approach for each team member and their role within a complex hierarchical organization. Discussion Anticipating and addressing microaggressions in clinical learning environments holds tremendous potential, however, any conversations about personal identity remain challenging in medical and healthcare environments. This study suggests that any attempts to address microaggressions requires attention to cultural norms within healthcare environments and the ways that hierarchical organizations can constrain individual agency.
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Affiliation(s)
- Javeed Sukhera
- Hartford Hospital and the Institute of Living, Hartford, Connecticut, USA
| | | | - Justin L. Bullock
- University of Washington School of Medicine, Division of Nephrology, Seattle, WA, USA
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
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Sukhera J, Ölveczky D, Colbert-Getz J, Fernandez A, Ho MJ, Ryan MS, Young ME. Digging Deeper, Zooming Out: Reimagining Legacies in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S6-S9. [PMID: 37983391 DOI: 10.1097/acm.0000000000005372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Although the wide-scale disruption precipitated by the COVID-19 pandemic has somewhat subsided, there are many questions about the implications of such disruptions for the road ahead. This year's Research in Medical Education (RIME) supplement may provide a window of insight. Now, more than ever, researchers are poised to question long-held assumptions while reimagining long-established legacies. Themes regarding the boundaries of professional identity, approaches to difficult conversations, challenges of power and hierarchy, intricacies of selection processes, and complexities of learning climates appear to be the most salient and critical to understand. In this commentary, the authors use the relationship between legacies and assumptions as a framework to gain a deeper understanding about the past, present, and future of RIME.
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Affiliation(s)
- Javeed Sukhera
- J. Sukhera is chair/chief of psychiatry, Hartford Hospital and the Institute of Living, and associate clinical professor of psychiatry, Yale School of Medicine, Hartford, Connecticut; ORCID: https://orcid.org/0000-0001-8146-4947
| | - Daniele Ölveczky
- D. Ölveczky is assistant professor of medicine and codirector, Health Equity and Anti-Racism Theme, Harvard Medical School, and physician director, Office of Diversity, Equity and Inclusion, Beth Israel Deaconess Medical Center, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-8972-4483
| | - Jorie Colbert-Getz
- J. Colbert-Getz is assistant dean of education quality improvement and associate professor, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah; ORCID: https://orcid.org/0000-0001-7419-7588
| | - Andres Fernandez
- A. Fernandez is assistant professor, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, and a PhD student, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0001-5389-6232
| | - Ming-Jung Ho
- M.-J. Ho is professor of family medicine, associate director, Center for Innovation and Leadership in Education, and director of education research, MedStar Health, Georgetown University, Washington, DC; ORCID: https://orcid.org/0000-0003-1415-8282
| | - Michael S Ryan
- M.S. Ryan is associate dean for assessment, evaluation, research and scholarly innovation, and professor, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, and a PhD student, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0003-3266-9289
| | - Meredith E Young
- M.E. Young is associate professor, Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada; ORCID: https://orcid.org/0000-0002-2036-2119
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