Background: Microaggressions (adapted from Sue et al. 2007) are “brief and commonplace verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative slights and insults with regards to race, gender, religion, or sexual orientation that target a person or group”. In healthcare, studies have examined microaggressions’ effect on trainee experience, patient-physician relationships, as well as frameworks for responding to them. However, to our knowledge no studies have examined how to address microaggressions between members of the hospital interdisciplinary team (IDT).The purpose of this study was to identify whether IDT microaggressions lead to workplace challenges and then implement a framework to identify and address microaggressions on the IDT.
Methods: We surveyed members of the IDT (resident physician (RP), nurse (N), nurse practitioner (NP), social worker (SW), case manager (CM)) asking them to rate how much their gender, race, sexual orientation, and team role made it challenging to succeed at the workplace using a five point scale ranging from not a challenge to it interferes with my ability to be effective in my role. Members of the IDT from six general Internal Medicine ward units were invited to a one hour skills building workshop that taught recognition of micro and macroaggressions and how to constructively address these using the “OUCH” framework developed at Yale University:When a microaggression is heard say, “Ouch!”:Open ended question: “What did you mean when you said that “isn’t typical of a __?Use the chance to teach (assume good intent then explain the impact): “You might have meant that to be funny but stereotypes are no joke.”Clarify your stance: “You might have meant well but that statement made me feel uncomfortable.”Here at NYU: “Here at NYU we have a commitment to respect.”Participants role-played OUCH with several adapted, workplace scenarios and were then given a retrospective pre-post survey measuring self-reported confidence/ability (Likert 1-4 scale) to identify and respond to micro and macroaggressions. Wilcoxin ranked test of after-before was used to evaluate for significant differences.
Results: A total of 134 IDT members (42 RP, 25 CM, 16 SW, and 51 N; 72% females) completed the needs assessment. 54.1% stated they were misidentified in their roles in the workplace and 63.8% felt their role on the team was slightly challenging or worse with regards to effectivity in the workplace. Ninety-five members of the IDT (29 RP, 20 SW, 15 N, 15 CM, 6 attendings, 1NP) participated in the workshop; 90/95 (94%) completed the survey. Significant improvement was found in each domain on the survey: identifying microaggressions (3.16 before, 3.69 after, p <.001), identifying macroaggressions (3.48 before, 3.76 after, p< 0.001), responding to microaggressions (2.78 before, 3.47 after, p < 0.001), responding to macroaggressions (2.9 before, 3.49 after, p < 0.001).
Conclusions: This study is one of the first to our knowledge to not only identify microaggressions relating to one’s role on the IDT but then showed that a one hour workshop and role play with members of the IDT can improve participants’ ability to identify and respond to micro and macroaggressions. Anecdotally, the OUCH framework has become a regular part of IDT dialogue. Next steps will include determining whether this empowerment technique leads to improved perceptions of IDT communication and morale on the team.