Background: Biases and microaggressions are common in the clinical setting and can impact the wellbeing of medical trainees and faculty. From our knowledge, this is the first study to assess workplace experiences based on group identity of medicine faculty and trainees across sites and subspecialities using qualitative and quantitative data to help design re-enactment upstander training sessions on how to address identity-based offenses effectively.
Methods: A survey validated and modified based on a preceding pilot survey, was administered to faculty and post-graduate trainees at three sites within Yale New Haven Hospital health care system and the West Haven Veteran’s Affairs in the departments of Internal Medicine, Surgery, Psychiatry, Obstetrics/Gynecology, Pediatrics, Emergency Medicine, Radiology and Primary Care and all their subsections during 2/1/2022-6/1/2022. The survey asked if participants witnessed or experienced identity-based offense; who the offender was (faculty/patient/etc); >10 identity variables perceived to be the reason for insult (e.g. race/sex/age/gender identity/sexual orientation/accent/skin color/clothing/country of origin). Data was analyzed using descriptive statistics to characterize respondents using chi-square test. Upstander training and new policies were created and adapted at all sites. Qualitative data was used to write scripts for scenarios and faculty/chief residents went through re-enactment upstander trainings followed by evaluation surveys.
Results: The survey was completed by a total of 626 participants (322 post-graduate trainees, 304 faculty members), 54% identified as non-white and 51% as cis-gender woman (Table 1). Identity-based offenses experienced were microaggressions (36%), emotional/psychological distress/fear (31%) hurtful/offensive words (29%), unheard suggestions (27%), loss of opportunity (20%), verbal threats (9%), dismissal from patient care (8%), unwelcome touch (7%), physical assault (3%), other (10%). Similar % of each offense category were reported as being witnessed (Figure 1). Most subjected to these offenses were women (77%, p< 0.0001) and non-white participants (75%, p=0.016). Pre-post level of improvement after re-enactment scenario training was reported in ability to recognize type of bias (86%), knowledge of strategies to address bias (70%), upstander effectiveness (70%), and confidence (80%), 93% strongly recommended this training for others.
Conclusions: Identity-based biases and offenses occur routinely in healthcare settings. Thorough and periodic assessment, followed by policy and training implementation can help enhance awareness and recognition of offensive behavior and reporting pathways, ability and confidence to address these offenses, and hopefully improve learning and work environments for healthcare providers in clinical and academic settings.
