Addressing Microaggressions in the Classroom

Tuesday, June 13, 2023, 4:55 PM - Saturday, June 13, 2026, 5:55 PM

Target Audience: This module is applicable to any specialty in which a physician teaches trainees in a classroom setting.

This module, comprised of the Introduction and Four Scenarios, will take approximately 30 minutes to complete. Your work may be saved, and you may return to complete the module in multiple sittings.

Connecticut Department of Public Health requires that licensed physicians/surgeons participate in continuing medical education (CME) activities pursuant to Connecticut General Statutes, and for registration periods beginning on and after October 1, 2010, CME coursework in cultural competency is required. This tutorial module helps you fulfill this requirement. Successful completion of this module will allow you to earn necessary CME credit in cultural competency.

TERMINOLOGY

Diversity 
Refers to unique aspects of each individual patient, including gender, age, socioeconomic status, culture, race, religion, disabilities, and sexual orientation.

Microaggressions
Term used for commonplace daily verbal, behavioral or environmental slights, whether intentional or unintentional, that communicate hostile, derogatory, or negative attitudes toward stigmatized or culturally marginalized groups (Chester)
Antiracist - one who is supporting an antiracist policy through their actions or expressing an antiracist idea.

Name-based Microaggressions
Name-based microaggressions constitute a specific category of microaggressions that capture the subtle discriminatory comments that minority individuals experience when interacting with others given their first and last names of ethnic origin. 

Stereotype
An attitude, belief, feeling, or assumption about a person or group of people that are widespread and socially sanctioned - though stereotypes can be positive and negative, they all have negative effects because they support institutionalized oppression by validating oversimplified beliefs that are often not based on facts.

Racism
A form of oppression in which one group dominates others. In the United States, the dominant group is white, therefore racism is white racial and cultural prejudice and discrimination, supported intentionally or unintentionally by institutional power and authority, and used to the advantage of whites and disadvantage of people of color (DiAngelo, 2016).

Antiracism
Anti-Racism is the practice of actively identifying and opposing racism. The goal of anti-racism is to actively change policies, behaviors, and beliefs that perpetuate racist ideas and actions.

Racist Ideas
Any idea that suggests one racial group is inferior or superior to another racial group in any way. Racist ideas argue that the inferiorities and superiorities of racial groups explain racial inequities in society.

Racist language
Any word, phrase or symbolism that have demeaning racist connotations related to gender, age, socioeconomic status, culture, race, religion, disabilities, and sexual orientation.
Prejudice - Preconceived opinion that is not based on reason or actual experience and might lead to discrimination.

Blacklist, whitelist, black sheep
Examples of racial language

Colorblindness
Is the racial ideology that posits the best way to end discrimination is by treating individuals as equally as possible, without regard to race, culture, or ethnicity (Williams, 2011)

Predatory publishing
Predatory journals and publishers are entities that prioritize self-interest at the expense of scholarship and are characterized by false or misleading information, deviation from best editorial and publication practices, a lack of transparency, and/or the use of aggressive and indiscriminate solicitation practices.

Confronting discrimination
The Science of Changing Minds and Behaviors focuses on confrontation as a strategy for reducing bias and discrimination.

Bystander
A person who is present at an event or incident but does not take part. Bystanders are important when confronting discrimination in strategies to reduce it.

Online racial discrimination
Denigrating or excluding individuals or groups on the basis of race through the use of symbols, voice, video, images, text and graphic representations. Like its offline counterpart, these experiences include racial epithets and unfair treatment by others due to a person’s racial or ethnic background, such as being excluded from an online space (Tynes, B. M.2015). The most frequent contexts for these experiences were social networking sites like Facebook and text messaging.


INTRODUCTION
The inappropriate use of humor, racist references, outdated language, and misuse of a person’s name in the classroom and when writing academic papers perpetuates discrimination harming minoritized and under sourced groups. This module features real scenarios shared by medical students in a classroom exemplifying offensive and racist language to provide a forum to discuss the damaging effects of these microaggressions and how to address them.  Microaggressions is a term described initially by Chester Pierce as “subtle and stunning” daily racial offenses. (Pierce, 1970). Later Sue et al. (2007) defined them as subtle, daily, and unintentional racial slights.

Disclaimer
All individuals whose images are used in this module are acting to portray the microaggression scenario being presented. The scripts for each scenario were taken from actual reports by students and faculty about their microaggression experience. The actors in this module have no connection to the microaggression experiences in the scenarios they are portraying.

Learning Objectives 
After completing these modules, learners will be able to:

• Identify language and descriptions that are discriminatory, prejudiced, and racist 
• Describe the consequences of microaggressions
• Explain the challenges and benefits of addressing microaggressions
• Explore strategies to prevent microaggressions in your teaching 
• Explore interventions to stop the use of offensive language in medical education

SCENARIO 1 – Is that Really Necessary? It is not funny.
I want to share an experience that I had in a workshop during my first year of medical school. Workshops are taught in a small group with about five of us. At this particular one when the teacher was reviewing slides that related to how a high BMI is a risk factor for the disease we were studying. I don’t want to give more specifics than that so I can keep the identity of the faculty who was teaching anonymous. I don’t want to get in trouble for telling you this.

The slide showed a cartoon of a very obese patient eating fast food while two slightly built hospital workers struggled trying to carry the patient on a stretcher. It felt like an attempt at humor and some of us looked around, confused and clearly uncomfortable but no one said anything. A few smirked and audibly chuckled.

I know it made me and several of my classmates uncomfortable. It was completely unnecessary as a teaching point and was seriously ridiculing and belittling of people who are overweight.

SCENARIO 1: Comment
Weight bias is common and has adverse health consequences. There is evidence that shaming individuals for their body weight does not motivate positive behavior change. We must be aware that public health interventions, if not carefully thought out, can perpetuate weight bias, and this can be a manifestation of social inequity. 
Citation: Alberga AS, Russell-Mayhew S, von Ranson KM, McLaren L. Weight bias: a call to action. J Eat Disord. 2016 Nov 7;4:34. doi: 10.1186/s40337-016-0112-4. PMID: 27826445; PMCID: PMC5100338.

SCENARIO 2 – Words are Important – Update your Terminology
I am very aware that language and terminology have been changing quickly as our culture becomes sensitive to labels that we put on people. I am telling you this because in a lot of classes that I am attending this block, teachers are still using demeaning language to talk about people who use substances…saying terms like ‘addict’, ‘alcoholic,’ and ‘substance abuse’. These are, putting it mildly, inappropriate, really... If these terms are used when teaching us in lectures, then the assumption is that it is okay to use them when we talk with patients and that is just not right. Think about this, a patient who has infective endocarditis as a result of IV drug use has to be sure that they can talk openly with their cardiologist who will treat them with kindness and without judgment. Teachers need to get up to date on the correct way to talk about patients with substance use disorders.

SCENARIO 2: Comment 
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) no longer uses the terms substance abuse and substance dependence. Rather, it refers to substance use disorders, which are classified as mild, moderate, or severe. Apr 22, 2022

SCENARIO 3 – Scientifically Speaking 
I was really surprised to hear some terms and remarks made in several genetics lectures about Jews and people of African descent. It is difficult for me to be more specific than the fact that they used the terms ashkenazi and sephardic when talking about Jews. I just want our lecturers to keep their references within the terms of science, not cultural or religious sub contexts.

SCENARIO 3: Comment  
Racism has infiltrated and impacted health care delivery and outcomes in this country for more than 400 years. The inclusion of race in algorithms and guidelines that direct clinical practice explicitly acknowledges this connection. We need to highlight that race-based practices in medical education and clinical care may exacerbate health inequities.  

Citations: Joseph L. Wright, Wendy S. Davis, Madeline M. Joseph, Angela M. Ellison, Nia J. Heard-Garris, Tiffani L. Johnson, the AAP Board Committee on Equity; Eliminating Race-Based Medicine. Pediatrics July 2022; 150 (1): e2022057998. 10.1542/peds.2022-057998
Jessica P Cerden~a, Marie V Plaisime, Jennifer Tsai. From race-based to race-conscious medicine: how anti-racist uprisings call us to act. The Lancet – Viewpoint 2020;396:1125-28

SCENARIO 4 - What’s in a Name
I was really excited about being asked by a senior faculty mentor to give a talk at a conference. However, I was disappointed when the faculty spelled my name incorrectly multiple times on conference materials. When I asked them politely to correct the spelling, they apologized but then continued to misspell it on further materials. Having a long name that people often misspell and mispronounce, I didn’t want to be a burden and make a big deal. My feelings were particularly hurt because this was a faculty member who I thought would be an advocate for me. Worse yet, after asking again to correct the spelling again, they lamented being too busy and talked about how their name (which is much shorter and easier to spell) is mixed up, too. Their response made me feel like I was not worth their time and that my feelings were a common experience.

SCENARIO 4: Comment
Name-based microaggressions are described as subtle discriminatory comments that minority individuals experience when interacting with others given their first and last names of ethnic origin. Names are prominent identifiers that can often tell the story of one’s ethnicity, cultural background, and familial lineage. There is a tendency for White European names to be perceived as normative, whereas racial minorities with names of religious and ethnic origins may be seen as an inconvenience. 
Citation:  Dali S, Atasuntseva A, Shankar M, Ayeroff E, Holmes M, Johnson C, Terkawi AS, Beadle B, Chang J, Boyd K, Dunn T. Say My Name: Understanding the Power of Names, Correct Pronunciation, and Personal Narratives. MedEdPORTAL. 2022;18:11284. https://doi.org/10.15766/mep_2374-8265.11284
Srinivasan, Ranjana. Doctoral Thesis.  Experiences of Name-Based Microaggressions within the South Asian American Population. Columbia Academic Commons. DOI https://doi.org/10.7916/d8-3ym2-0m78

AUTHORS
Andrea Mendiola Iparraguirre, MD
Dorothy DeBernardo
Gary Leydon

Senior Authors
Janet P. Hafler, EdD
Esperanza Diaz, MD

Visual and Audio Actors
Kate Kelly
Tyger Lin
Matthew Ponticello
Adriana Purcell

Acknowledgements – YSM Communications Department
Anthony DeCarlo – Photography
Abbey Campbell – Photo Editor

Registration Fees:

• Non-Yale Professionals - $35.00

• Yale Faculty and Staff - Complimentary*

*In order to receive complimentary access, Yale participants must login to their Yale CloudCME profile using their YSM netid/password.

The Yale School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation Statement
The Yale School of Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

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AMA PRA Category 1 Credits™ (0.25 hours), Non-Physician Attendance (0.25 hours)

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Additional Resources:

Additional Resources.pdf