Addressing microaggressions with medical learners

Bruce Peyser, MD, FACP

Director of Education and Teaching, Duke Primary and Urgent Care

Physician, Duke Primary Care Pickett Road

Professor of Medicine, Duke University School of Medicine

At Duke Primary and Urgent Care’s faculty development session on Oct. 29, speakers reviewed microaggressions. Below, I share a few of the most important take-home points from the discussion.

Here is a good definition of the problem: “Microaggressions are brief and commonplace, verbal, behavioral, and environmental indignities…that communicate hostile, derogatory, or negative slights and insults that potentially have harmful or unpleasant psychological impact on the target person or group” (Derald Sue, et al., 2007).

Sadly, microaggressions are common. They come in many different shapes and forms, and most often are disrespectful and negative. They can be conveyed not only by the words people choose, but also by body language and tone of voice. They are personal, and they are subjective—so what one person perceives as a microaggression might not be interpreted the same way by a different person.

It turns out that medical trainees oftentimes have to deal with microaggressions that come from patients or patients’ loved ones. We also know microaggressions disproportionately affect learners from underrepresented minority groups based on race, ethnicity, or sexual orientation. A group at particularly high risk includes African American women.

It’s important to talk about microaggressions with our new students. When I have a new learner, I will ask them to tell me if they are ever made to feel uncomfortable when seeing a particular patient. While it might be easier to ignore such interactions, it’s better to lean into the situation if it’s happening so that our learners can feel supported. It’s also key to have some awareness of this problem at all times. That awareness can help you react quickly if an intervention is needed.

Several individuals created a pneumonic to help them remember a good pathway for how to respond to microaggressions. They called it GRIT. The first part involves “Gathering one’s thoughts,” to pause and not immediately respond with anger. The R stands for “Restate the comment,” so the speaker might be asked to clarify why they were saying the comments that are hurtful. The I part of the pneumonic stands for “Inquire,” meaning to push deeper and try to obtain clarification, while not being judgmental. The last letter T stands for “Talk it out,” meaning to separate the person from the comment and avoid personal attacks.

In summary, microaggressions are quite common and affect underrepresented minority students more frequently than others. It’s important for preceptors to have their sensors out in order to pick up on subtle comments or movements or gestures. It’s also good to plan ahead and create respectful work and learning environments. Lastly, don’t forget to debrief your learner or colleague if they experience a microaggression, as this will help them a lot.