Nurturing Resilience: Addressing Microaggression in Medical Education

5-7 Minute Read

Author: Gretchen Keys, EdD, MSL, RT

Purpose

Provide clinical educators with a framework for handling microaggressions in the clinic.

Learning Objectives

(1) Define the term microaggressions.

(2) Describe two ways microaggressions hinder learning experiences.

(3) Illustrate ways to respond to microaggressions toward a medical student.

In the dynamic landscape of medical education, the pursuit of knowledge occurs in diverse educational environments. Amid the intellectual growth and clinical acumen cultivated in medical school, the insidious presence of microaggressions can cast shadows on this transformative journey. These subtle, often unintended, expressions can impact the well-being and professional development of aspiring healthcare practitioners. This article serves to guide medical educators to effectively address microaggressions.

Recognizing Microaggressions

There has been a gradual societal move beyond prevalent, nearly ubiquitous overt racism in all corners of society towards more covert manifestations of racism in society. Sue and colleagues describe microaggressions as, “the new face of racism.”(1)  This trend away from overt racism to the more subtle, ambiguous, and frankly sometimes unintentional racist comments “has led many Americans to wrongly believe that racism is no longer a problem for non-white Americans.”(2)

Microaggressions encompass verbal, behavioral, and environmental actions that convey intentional or unintentional indignities.(2) These acts communicate hostile, derogatory, or negative slights and insults, impacting the target person or group. People of African, Asian, Native American, and Latino descent, women, Jews and Muslims, people with disabilities, and LGBTQ individuals are the most frequent victims of microaggressions.(3)

Psychologist Derald Wing Sue identified four ways that microaggressions manifest:

1. Microinsults: verbal remarks or behaviors that convey rudeness and insensitivity that demean a person’s racial heritage or identity.

2. Microinvalidations: verbal remarks or behaviors that exclude, negate, or nullify the psychological thoughts, feelings, or experiential reality of a person or color.

3. Microassaults: explicit racial derogations characterized primarily by a violent verbal or nonverbal attack meant to hurt the intended victim.

4. Environmental microaggressions: racial assaults, insults, and invalidations that are manifested at systemic and environmental levels.(4)

How Microaggressions hinder learning experiences

Often called “death by a thousand cuts” microaggressions can produce fear, stress, and emotional harm, and may embarrass or intimidate the victim, undermine his or her credibility, and expose vulnerabilities particularly those from marginalized communities.(2) Microaggressions inflict significant harm on individuals of color, impairing their performance across diverse settings by draining their psychic and spiritual energy and contributing to the creation of inequities. (4,5)

The existing body of literature emphasizes the detrimental effects of subtle sexism on women. This form of discrimination invalidates women, undermines their contributions and accomplishments, and restricts their effectiveness in both social and professional spheres.(6-8)

Victims of microaggressions often find themselves grappling with two distinct inclinations: 1) to suppress their anger or 2) openly protest, irrespective of the aggressor's intent to cause harm. Openly protesting can be beneficial to all parties, especially if the microaggressor admits fault.(9-11) This approach, however, can fail miserably if the microaggressor fails to recognize the harm they caused and lashes out negatively to the victim for their reproach. This dynamic can worsen the situation, with the aggrieved person, seeking reconciliation, being unfairly labeled as 'defensive' or 'overly sensitive.'

Whether arising from an overtly racialized incident or a premeditated/unintentional act, the ramifications of these ordeals are deeply penetrating and pervasive. Existing research underscores that despite their seemingly small and innocent nature, microaggressions take a genuine psychological toll on recipients, leading to anger, depression, and a decline in work productivity and problem-solving capabilities. It is imperative not to overlook, dismiss, or underestimate the myriad consequences stemming from these encounters.(12)

How to Handle Microaggressions

Addressing these subtle yet harmful behaviors involves a delicate balance of assertiveness, empathy, and a commitment to promoting awareness. We will explore effective strategies and considerations for navigating the challenges posed by microaggressions from three different angles: 1) it happened to you, 2) you witnessed it, and 3) you committed the microaggression.

It happened to you:

When you are the target, microaggressions can inflame a variety of emotions from fear to anger to embarrassment.  Start by taking a moment to breathe and gather your thoughts and assess the situation with a clear mind, reflecting on what occurred. If you decide the incident is worth addressing, use the V.I.T.A.L.S. guide for responding to microaggressions.(13) However, you may find there was no real infraction and decide not to confront the situation.

You witnessed it:

If you choose to bring the incident to someone's attention, clearly state what happened, express your opinion, share your feelings about the instance, and suggest the appropriate course of action.

You committed the act:

If you were the one who committed the microaggression, allow the affected person to express themselves openly and respectfully. Listen with the sincere intention of understanding their perspective and validating their feelings. Also, avoid defensiveness and, if necessary, explain your intentions. Offer a sincere apology that acknowledges both the person and the impact of the microaggression.(14)

Summary

In navigating the nuanced landscape of responding to microaggressions, it becomes evident that a thoughtful and multifaceted approach is essential. From the perspective of those who have experienced these subtle slights, the importance of maintaining a clear mind, assessing situations with honesty, and addressing issues with constructive assertiveness emerges as a guiding principle.

For bystanders, the key lies in articulating incidents clearly, expressing personal perspectives, and advocating for appropriate actions to rectify the situation. Finally, for those who may have unintentionally committed microaggressions, embracing open communication, sincere apologies, and a genuine commitment to understanding and rectifying the impact is paramount.

By embracing these varied perspectives, we pave the way for meaningful dialogue and proactive measures that contribute to fostering inclusive environments. In responding to microaggressions, we not only address individual instances but also collectively work towards dismantling the broader structures that perpetuate such subtle forms of discrimination. Through shared understanding, empathy, and a commitment to change, we embark on a journey towards a more equitable and inclusive future.■

References

(1) Sue DW, Capodilupo CM, Torino GC, et al. Racial microaggressions in everyday life: implications for clinical practice. Am Psychol. 2007;62(4):271-286. doi:10.1037/0003-066X.62.4.271

(2)   Johnson NN, Johnson, TL. Microaggressions: an introduction. In: Thomas U, ed. Navigating Micro-aggressions Toward Women in Higher Education. IGI Global; 2019: 1-22.

(3)   Berk RA. Microaggressions in the academic workplace. J Fac Dev. 2017;31(2), 69–83.

(4)   Sue DW. Whiteness and ethnocentric monoculturalism: Making the “invisible” visible. Am Psycholo. 2004;59, 759 –769

(5)   Franklin AJ. From Brotherhood to Manhood: How Black Men Rescue Their Relationships and Dreams from the Invisibility Syndrome. Wiley; 2004.

(6)   Benokraitis NVE. Subtle Sexism: Current Practice and Prospects for Change. Sage Publications; 1997.

(7)   Nielsen LB. Subtle, pervasive, harmful: Racist and sexist remarks in public as hate speech. J Soc Issue. 2002; 58(2), 265–280. doi:10.1111/1540- 4560.00260

(8)   Watkins MB, Kaplan S, Brief AP, Shull A, Dietz J, Mansfield MT, & Cohen R. Does it pay to be a sexist? The relationship between modern sexism and career outcomes. J Voc Behav. 2006; 69(3), 524–537. doi:10.1016/j.jvb.2006.07.004

(9) Rowe MP. The Saturn’s rings phenomenon: Micro-inequities and unequal opportunity in the American economy. In: Proceedings of the National Science Foundation’s conference on women’s leadership and authority. Santa Cruz, CA: University of California; 1977.

(10) Rowe M. Micro-affirmations and micro-inequities. J Intl Ombuds Assoc. 2008; 1(1), 1–9.

(11) Rowe MP. Barriers to equality: The power of subtle discrimination to maintain unequal opportunity. Emp Respons and Rights J. 1990;3(2), 153–163. doi:10.1007/BF01388340

(12) Pierce C. Stress analogs of racism and sexism: Terrorism, torture, and disaster. In: Mental Health, Racism, and Sexism. Taylor & Francis; 1995: 277-293.

(13) Walker VP, Hodges L, Perkins M, Sim M, Harris C. Taking the VITALS to interrupt microaggressions. MedEdPORTAL: J Teach and Learn Resourc. 2022; 18, 11202. https://doi.org/10.15766/mep_2374-8265.11202

(14) Jones D. Microaggressions and how to manage them when they occur. 2022. https://blog.deettajones.com/blog/so-that-just-happened-i-experienced-witnessed-committed-a-microaggression-now-what