Discrimination 911: A Novel Response Framework to Teach Bystanders to Become Upstanders When Facing Microaggressions

A Narrative Review of Key Studies in Medical Education in 2023: Applying the Current Literature to Educational Practice and Scholarship

Pediatric clinician educators face the challenge of juggling clinical practice with teaching responsibilities. The balancing act is even more challenging when one considers the need to stay current with evidence from clinical and medical education literature. In this narrative review of 2023 medical education literature, the Academic Pediatric Association Education Committee's Top Articles team summarizes high-yield articles that possess the potential to significantly influence pediatric clinician educator teaching and practice. A standardized blinded rubric was applied to identify the most impactful articles from 19 medical education and specialty journals. Final selections were categorized into six domains: artificial intelligence and technology, belonging in the learning environment, bias in the workplace, clinical learning, curriculum and assessment, and family and community partnerships. The reviewers summarize key findings from the top articles and describe implications for pediatric clinician educator practice.

The time has come: discussing the clinical neuropsychology provider's role in cultural respect and inclusion

There has been both a national and global emphasis within the past 3 years to promote diversity, equity, inclusion (DEI), and cultural respect in healthcare and academia. One discipline and healthcare arena where this has been evident is the psychology field. Indeed, there has been rampant and widespread adoption and advancement of DEI and cultural respect across most of psychology. Unfortunately, not all psychology specialties have fully embraced DEI or focused on provider factors, one of which is clinical neuropsychology. Regarding DEI efforts and emphasis in clinical neuropsychology, the majority of research and education has primarily focused on patient demographic and neuropsychological test factors. While such patient demographic and test factors are important and merit significant attention, so too does the focus on the clinical neuropsychological provider. Unfortunately, the clinical neuropsychology specialty has provided little to no focus on the provider's role in DEI and cultural respect. The purpose of this critical review is to focus on the role of the clinical neuropsychologist and how it impacts DEI and cultural respect. Specifically, the review will inform the factors that impact the practice of clinical neuropsychology on the part of the provider including unconscious/implicit bias, diagnostic threat, and microaggressions. Also, the review will inform strategies to create a DEI responsive and culturally respectful clinical neuropsychological practice with the overarching goal to uncover the clinical neuropsychological role to advance and evolve the specialty through a DEI and culturally respectful lens. With considerable work completed in other aspects of DEI and cultural respect, the clinical neuropsychology specialty is well poised to now focus on the role of the provider. This focus can provide a constructive path forward to create new knowledge to advance the role of the provider to optimize overall clinical, research, and training practices.

From Bystander-to-Upstander: A Novel Intervention Framework to Address Microaggressions in a Pediatric Academic Medical Center

Microaggressions undermine health professionals' performance in patient care, research, and education. This study aimed to develop and evaluate an intervention addressing microaggressions in healthcare settings by empowering bystanders to act as upstanders across an academic medical center (AMC). This was achieved through an educational intervention that included a novel framework, didactics, video demonstrations, and practice with realistic scenarios. Methods Participants were faculty, trainees, education experts, clinical and administrative staff from a large, urban pediatric AMC. Participants were recruited from 3 training sessions, and taught the "Be Aware" and "ACT" framework, a novel tool for bystanders to use when witnessing microaggressions. Pre-training, retrospective pre-post, and 10-week follow-up surveys evaluated changes in awareness, confidence, and intervention rates. Quantitative analyses were conducted using generalized linear mixed effects models across the 3 surveys to assess participants' changes in confidence. Qualitative analysis used inductive content analysis. Results Among the 205 attendees, 134 (65.4%) completed the pre-training survey. The study cohort (n=108) included those who completed the pre-training survey with either the retrospective pre-post (n=24), 10-week follow-up (n=26), or both (n=58). Participants reported increased confidence in intervening during microaggressions, with confidence rising from 7.5% pre-training to 24.2% at 10-week follow-up (p=0.004). Qualitative analysis revealed a shift from passive response to active intervention, with participants applying the "Be Aware" and "ACT" framework during actual incidents. Conclusions The "Be Aware" and "ACT" framework increased and sustained awareness and confidence in addressing microaggressions. This AMC-wide intervention successfully equipped participants to move from passive bystanders to active upstanders.

Upholding our PROMISE: Increased representation is not enough to foster belonging in graduate medical education

PURPOSE

Sense of belonging supports academic achievement and encourages career endurance. The purpose of this study was to characterize what individual and institutional factors influence one's sense of belonging by describing the experiences of underrepresented in medicine (UIM) paediatric and internal medicine-paediatric residents in the United States.

METHOD

The authors conducted a national survey of paediatric and internal medicine-paediatric residents. The 23-item anonymous web-based survey was distributed between October 2020 and January 2021 and included questions on socio-demographic characteristics and individual perceptions on sense of belonging, value, common mission or values at a program or institution and respect. The authors used linear mixed models and fitted regression models to examine individual factors and environmental factors that impact sense of belonging, value and respect.

RESULTS

Across 29 residency programs, 938 (53%) of 1748 residents completed the survey. One hundred sixty-seven (18%) self-identified as UIM. UIM residents had a lower sense of belonging than non-UIM residents [mean (SD) 3.6 (0.87) vs. 4.0 (0.57)]. Black/AA and Hispanic/Latinx residents had the lowest sense of belonging [3.5 (0.82) and 2.8 (0.93), respectively]. UIM residents demonstrated decreased sense of belonging in programs that lacked bias training and where peers discriminated against them. Sense of belonging was increased in programs where they perceived a sense of support, respect or values alignment. Surprisingly, individual UIM resident sense of belonging was not improved by having more UIM residents in a program.

CONCLUSION

UIM paediatric residents experience a decreased sense of belonging during training. Programs can support sense of belonging for UIM residents by demonstrating respect and support for them and by offering systems for bias training and reporting bias and discrimination. Recruiting a greater number of UIM trainees remains important; however, compositional diversity alone does not improve a sense of belonging for UIM residents. There is continued need for structural/institutional change, including addressing institutional culture and structural racism.

Anti-racism bystander training: A critical need in medical schools

Despite increasing acknowledgment of racism in both the curricular and clinical spaces, it continues to pervade the medical field, with clear detrimental impacts to the health of our patients. The introduction of anti-racism bystander training (ARBT) may provide a unique opportunity to reduce inequitable care and health disparities that occur secondary to racism in healthcare. ARBT, in its various forms, has been shown to be an effective method to increase participants' confidence and efficacy in intervening on observed racist encounters. This training can take numerous forms, and the authors provide one successful template used with medical students at their own institution. If medical centers, educators, and leaders in the field of medicine truly hope to mitigate the individual racist behaviors that remain in healthcare, ARBT must be employed to a much wider degree in medical education.

Diversity in the Cardiothoracic Surgery Workforce: What I Can Do

Within the cardiothoracic surgery workforce, there are significant gaps in the numbers of women and underrepresented in medicine minorities, but some progress has been made in gender diversity at the resident level. Individual surgeons play an important role in combatting discrimination and harassment, while also promoting women and minorities through mentorship and sponsorship. More importantly, a multifaceted and structured approach is needed to increase diversity at the institutional level with strategies to create a culture of inclusion, working to retain underrepresented minority and female surgeons, and eliminating bias in the recruitment process.