Background: An increasing amount of literature demonstrates the detrimental impact of discrimination and microaggressions at personal and institutional levels in the healthcare workplace (1-5). Confronting these displays of bias involves a multifaceted approach across professional disciplines and hierarchies. Residency is a time when physicians experience and learn to navigate bias (6). To address this, we designed and implemented an adaptable and reproducible virtual simulation session aimed to help residents develop skills for identifying and constructively responding to microaggressions.

Methods: This virtual simulation curriculum was implemented in the 2020/2021 and 2021/2022 academic years for senior internal medicine residents. The session was preceded by a needs assessment, which measured the prevalence of experienced microaggressions in our program and self-reported response rates to microaggressions. The curriculum began with a didactic overview to establish foundational knowledge of bias followed by a workshop focused on strategies to address microaggressions. The session culminated with skills application in a virtual simulation activity in which learners were tasked to address observed microaggressions as bystanders in realistic case-scenarios utilizing standardized actors. We administered pre- and post-evaluation surveys assessing learner confidence in responding to microaggressions, which were linked anonymously through a unique identifier. We employed sign testing for the data.

Results: A total of 68 residents participated in the curriculum over two academic years, 27 of whom provided complete data for analysis. Overall, there was a statistically significant increase in learner confidence identifying microaggressions. Both as a bystander and target/recipient of microaggressions, there were statistically significant increases in learner confidence addressing gender-based microaggressions, race-based microaggressions, and microaggressions reflecting other types of bias. In terms of the workplace setting, there were statistically significant increases in learner confidence addressing microaggressions in low acuity contexts, high acuity contexts, across interprofessional disciplines, with a supervisor, and with a supervisee. A marginally significant increase in learner belief that trainees should practice addressing microaggressions in the healthcare setting was also observed.

Conclusions: With this virtual session, we aimed to develop a replicable resource that will assist residents in recognizing and addressing microaggressions during a pivotal time in their training. Our curriculum can also be modified to match learner needs at their home institutions. The results convey that an experiential learning session on responding to microaggressions can be implemented on a virtual platform and can help increase trainee confidence in responding to microaggressions in a variety of professional contexts. Our trainees indicated that they believed the ability to practice responding to microaggressions was important. In addition, we gleaned that using standardized actors was tremendously important in simulating a more realistic experience. We hope that our tool serves as a resource for other institutions striving to improve their residents’ ability to recognize and respond thoughtfully to microaggressions in the workplace, thus contributing to a more welcoming and inclusive practice environment for all.