Identifying Microaggressions & Discussing Responses

Tuesday, September 20, 2022, 1:48 PM - Saturday, September 20, 2025, 2:48 PM, Medical Campus, New Haven, CT

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

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

TERMINOLOGY

Microaggressions are the everyday verbal, nonverbal, and environmental slights, snubs, or insults, whether intentional or unintentional, that communicate hostile, derogatory, or negative messages to target persons based solely upon their marginalized group membership.
Micro assaults: verbal or non-verbal acts aiming to attack a person’s group or identity (name-calling, avoidance, and/or discriminatory actions).
Microinsults: subtle humiliations that convey a stereotype, insensitivity, or demeaning message about a person’s group identity.
Microinvalidations: comments or actions that exclude the thoughts, feelings, or experiential reality of an individual or a group.

INTRODUCTION - Identify Microaggressions 
Description:  This scenario is the first patient interaction with the attending and his new team including one PGY1 and a medical student. As you observe the scenario, think about the key elements that should be addressed in a first patient interaction with the team. Pay special attention to any possible micro aggressions and a reaction (or lack of) to it.

Learning Objectives
After completing this module, learners will be able to:

• Define the term micro aggression
• Recognize different types of micro aggressions in clinical life and academia
• Identify the impact of micro aggressions on one’s mental health
• Identify three strategies of responding to learners who have experienced micro aggressions
• Explore how to create a safe space for learners to report and discuss micro aggressions
  
  

SCENARIO 1 – “A Disturbing Interaction”
Description:  In the video we will see one possible result of the clinical encounter in which the student expresses concern about the quality of the encounter. As you listen, think about how you might respond in this scenario.

Learning Objectives
After completing this module, learners will be able to:

•  Increase awareness to others or oneself experiencing microaggressions
• Create a safe environment for trainees to bring up disturbing interactions
• Identify ways to respond to microaggressions appropriately
• Recognize how not responding to microaggressions appropriately could impact the education and clinical encounter.

SCENARIO 2 (audio only) “That didn’t go well.”
Description:  If you are not experiencing any situations currently in which residents and students are talking about their frustration with you as an attending. These discussions are likely happening when you are not in the room. Listen to the following dialogue, it is a portion of the two trainees in a private informal debrief on the session.  In this version of events, neither the resident nor the student brought up the challenge they experienced sitting through the patient encounter with the patient or the attending. 

Learning Objectives 
After completing this module, learners will be able to:

• Identify signs of a non-safe learning environment
• Describe challenges creating an appropriate learning environment
• Describe steps to address microaggressions
  

SCENARIO 3 – “How are you doing?”

Description:  While microaggression is not often addressed in the room with the patient, there are times when this is at least acknowledged by staff and attendings. This is an example of an interaction where the attending first addresses the disturbing behavior in a debrief with the learners away from the patient.

Learning Objectives
After completing this module, learners will be able to:

• Describe the harmful effects of microaggressions
• Name the steps to address microaggressions
• Practice the ACTION approach to microaggressions 

SCENARIO 4 – “Let’s Take a Step Back”
Description:  The attending clarifies the resident role and state the facts to the patient highlighting the Impact on the clinical care. The patient is able to say “I am sorry” but he is clearly not aware of the microaggression. The resident responds appropriately and feels supported. The bystander, the medical student, also contributes.

Learning Objectives
After completing this module, learners will be able to:

•  Increase confidence to take action about microaggressions
•  Identify the different roles in a microaggression
• Name the ARISE steps to address a bystander

SCENARIO 5 – "Let's Debrief with the Rest of the Team"
Description: In this scenario we see an ideal management of a clinical situation involving a microaggression. Observe the non-judgmental clinical team interactions with the patient and the debriefing after. Identify steps to take action.I

Learning Objectives
After completing this module, learners will be able to:

• Identify uncomfortable situations requiring action to address microaggressions
• Practice how to respond to an insulting comment
• Name the players of a microaggression triangle model

AUTHORS:

Andrea Mendiola Iparraguirre MD
Tichianaa Armah MD
Matthew Ellman MD
Gary Leydon
Dorothy DeBernardo
Amanda Calhoun MD/MPH

SENIOR CO AUTHORS:
Janet P. Hafler, EdD
Esperanza Diaz MD

Contributors and their role in the Identifying Microaggressions Video Production:

Tichianaa Armah, MD – In the role of resident
Amanda Calhoun, MD/MPH – In the role of medical student
Matthew Ellman, MD – In the role of attending physician
Gary Leydon – In the role of patient

1. Recognize micro aggression by a patient towards a healthcare provider trainee in a clinical encounter
2. Identify the emotions and attitudes evoked by the video vignette
3. Identify types of micro aggression, and their potential impact on the clinical encounter
4. Explore healthcare provider and trainee reactions to micro aggression from a patient in the clinical encounter
5. Explore strategies on how to address patient care interactions involving learners, patients and teachers.

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 educational activity for a maximum of 1.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the Enduring Material activity.

Disclosure Policy
It is the policy of Yale School of Medicine, Continuing Medical Education (CME), to ensure balance, independence, objectivity, and scientific rigor in all its educational programs.  All individuals involved in the development and presentation of Accredited Continuing Education activities are required to disclose all financial relationship(s) with ineligible companies that has occurred within the past 24 months; and the opportunity to affect the content of CME about the products or services of the commercial interests. This information is disclosed to all activity participants prior to the commencement of the educational activity.

Banner and Thumbnail  photo was captured from the module video.
AMA PRA Category 1 Credits™ (1.00 hours), Non-Physician Attendance (1.00 hours)

Mitigation of Relevant Financial Relationships

Yale Continuing Medical Education adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CE activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

Additional Resources

Resources_Identifying Microaggressions Module.pdf