“We want you all to do better,” said the presenter to the medical students, as if only the next generation can enact change … the next time around. This session is one of many aimed at making the culture of medicine more inclusive and collaborative—less hierarchical and less patriarchal.
Medicine has a longstanding history of hazing those lower on the totem pole with scut work and authority. Unfortunately, this breeds the perfect environment for microaggressions: everyday slights, insults, and putdowns that slip under the radar. While microaggressions can happen amongst peers, it is more common for them to occur between a person and their superior—as at their core, microaggressions are about establishing power.
As well-intentioned as the presenter’s comment was, why is medical education waiting for the next generation of physicians to enact a culture of inclusivity and collaboration? Why is the onus on the students, the recipients of these microaggressions, to hold those in power responsible for their behavior?
I propose a few different solutions to help us share this responsibility.
Third-party reporting. One of the most common ways microaggressions are dealt with is through reporting tools monitored by a faculty member. This can be done anonymously or with identification. However, there is often no way to track the steps taken to address the report if done anonymously, leading to potential delays. If the complainant’s identity is disclosed, there may be concern for blowback, especially if the faculty member monitoring the reporting tool does not share similar sentiments. Having a third party monitor this tool could help provide an extra layer of confidentiality, a tracking system, and expedite the response time.
While third-party reporting can encourage microaggression recipients to speak up, it does not help them address their concerns to the source of the microaggression directly, which can lead to quicker resolution. Unfortunately, going directly to the source of the microaggression can lead to blowback and defensiveness. However, sessions for those in positions of authority could help them be more attentive to these conversations.
Bipartisan workshops. The sources of the microaggressions (i.e., residents, attendings, faculty) should also receive sessions to help them recognize harmful language and microaggressions. These sessions should remind them of the hierarchy they have also experienced and acknowledge that there is still room to grow. Communication tactics on how to discuss a microaggression experience should be discussed. The language of these tactics should be the same as provided to students, so it is easily recognizable when a student tries to have this discussion with the source of the microaggression.
It is easier to get students in the same room and mandate sessions like this than it may be for full-time physicians.
Continuing education sessions. Continuing education credits are mandatory for physicians every year to renew their licenses. These presentations could provide a platform for physicians to receive communication training, built into their already-established responsibilities.
Continuing education sessions are often online, and engagement with these presentations is minimal.
Discussions at conferences. Conferences could provide an avenue to have discussions about microaggression experiences and successful tactics. Sharing first-hand experiences about successful tactics could help disseminate those practices elsewhere. Unfortunately, those least likely to attend these sessions may be the targeted audience who most need such interventions. Therefore, attendance should be incentivized with additional continuing education credits or certifications that can be listed on CVs.
Every suggestion so far requires money and extra time from an individual to implement the logistics.
Grants. We need grants to help compensate and motivate the individuals who take initiative for creating these programs. Otherwise, we perpetuate the burden on those who have experienced microaggressions to change this culture. Awareness of the issue is key to raising funds. With grant money backing their programs and compensating their time, these individuals could fortify their efforts for creating resources, workshops, and incentives for engagement.
The hierarchical nature of medicine is necessary to provide oversight for learning. However, there is room for improvement of interpersonal communications within this space. A team effort is the best shot at reducing power dynamic-based microaggressions.
Atithi Patel is a medical student.
