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Rose S, Kusnoor A, Huynh P, Greely J, Rojas-Khalil Y, Kung D, Gill A, Ismail N, Appelbaum N. Addressing unprofessional behaviors in the clinical learning environment: lessons from a multi-year virtual, intergenerational, interdisciplinary workshop. Med Educ Online 2024; 29:2316491. [PMID: 38354128 PMCID: PMC10868425 DOI: 10.1080/10872981.2024.2316491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Optimizing the clinical learning environment (CLE) is a medical education priority nationwide. MATERIALS AND METHODS We developed a virtual, one-hour workshop engaging students, housestaff and faculty in small-group discussions of five case scenarios adapted from reported unprofessional behaviors in the CLE, plus didactics regarding mistreatment, microaggressions and bystander interventions. RESULTS Over two sessions (2021-2022), we engaged 340 students and 73 faculty/housestaff facilitators. Post-session surveys showed significant improvement in participants' ability to recognize and respond to challenges in the CLE. DISCUSSION Our innovative workshop, including scenarios derived from institutional reports of unprofessional behaviors, advanced participants' knowledge and commitment to improve the CLE.
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Affiliation(s)
- Stacey Rose
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Anita Kusnoor
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Phuong Huynh
- Student Assessment and Program Evaluation, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jocelyn Greely
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | | | - Doris Kung
- Department of Neurology, Assistant Dean of Clinical Curriculum, School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Anne Gill
- Department of Pediatrics, Assistant Dean of Interprofessional Education, School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Nadia Ismail
- Department of Medicine, School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Nital Appelbaum
- Department of Education, Innovation and Technology, Baylor College of Medicine, Houston, TX, USA
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Caba AE, Christophe NK, Renley BM, Simon KA, Feinstein BA, Eaton LA, Watson RJ. Measurement invariance of the LGBT People of Color Microaggressions Scale among LGBTQ+ youth. J Res Adolesc 2024. [PMID: 38616300 DOI: 10.1111/jora.12937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 10/16/2023] [Accepted: 03/15/2024] [Indexed: 04/16/2024]
Abstract
The LGBT People of Color Microaggressions Scale (LGBT-PCMS) is a widely used measure of intersectional microaggression experiences among sexual and gender minority people of color. Although it is widely used-and increasingly used in adolescent and young adult samples-it is unknown whether the LGBT-PCMS demonstrates similar measurement properties across subgroups of sexual and gender minority youth of color (SGMYOC). Among 4142 SGMYOC (ages 13-17) we found evidence for either partial or full scalar invariance (item loadings and intercepts were generally equal) across sexual orientation, race-ethnicity, and gender identity groups for all three subscales. Specific patterns of invariance and noninvariance across groups, as well as implications for the use of the LGBT-PCMS and its subscales among SGMYOC are discussed.
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Affiliation(s)
- Antonia E Caba
- Department of Human Development and Family Sciences, University of Connecticut, Storrs Mansfield, Connecticut, USA
| | | | - Benton M Renley
- Department of Human Development and Family Sciences, University of Connecticut, Storrs Mansfield, Connecticut, USA
| | - Kay A Simon
- Department of Family Social Science, University of Minnesota, Minneapolis, Minnesota, USA
| | - Brian A Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs Mansfield, Connecticut, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs Mansfield, Connecticut, USA
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Brown CE, Jackson SY, Marshall AR, Pytel CC, Cueva KL, Doll KM, Young BA. Discriminatory Healthcare Experiences and Medical Mistrust in Patients With Serious Illness. J Pain Symptom Manage 2024; 67:317-326.e3. [PMID: 38218413 PMCID: PMC11000579 DOI: 10.1016/j.jpainsymman.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/03/2024] [Accepted: 01/06/2024] [Indexed: 01/15/2024]
Abstract
CONTEXT Though discrimination in healthcare settings is increasingly recognized, the discriminatory experiences of patients with serious illness has not been well studied. OBJECTIVES Describe racial differences in patient-reported experiences with discrimination in the healthcare setting and examine its association with mistrust. METHODS We used surveys containing patient-reported frequency of discrimination using the Discrimination in Medical Setting (DMS) and Microaggressions in Health Care Settings (MHCS) scales, mistrust using the Group Based Medical Mistrust (GBMM) scale, and patient characteristics including patient-reported race, income, wealth, insurance status, and educational attainment. Univariable and multivariable linear regression models as well as risk ratios were used to examine associations between patient characteristics including self-reported race, and DMS, MHCS, and GBMM scores. RESULTS In 174 participants with serious illness, racially minoritized patients were more likely to report experiencing discrimination and microaggressions. In adjusted analyses, DMS scores were associated with elements of class and not with race. Black, Native American/Alaskan Native (NA/AN), and multiracial participants had higher MHCS scores compared to White participants with similar levels of income and education. Higher income was associated with lower GBMM scores in participants with similar DMS or MHCS scores, but Black and NA/AN participants still reported higher levels of mistrust. CONCLUSION In this cross-sectional study of patients with serious illness, discriminatory experiences were associated with worse mistrust in the medical system, particularly for Black and NA/AN participants. These findings suggest that race-conscious approaches are needed to address discrimination and mistrust in marginalized patients with serious illness and their families.
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Affiliation(s)
- Crystal E Brown
- Cambia Palliative Care Center of Excellence at UW Medicine (C.E.B., A.R.M.), Seattle, Washington, USA; Division of Pulmonary, Critical Care, and Sleep Medicine (C.E.B.), Department of Medicine, University of Washington, Seattle, Washington, USA; Department of Bioethics and Humanities (C.E.B.), School of Medicine, University of Washington, Seattle, Washington, USA.
| | - Sandra Y Jackson
- United States Army (S.Y.J.), Center for Army Analysis, Fort Belvoir, Virginia, USA
| | - Arisa R Marshall
- Cambia Palliative Care Center of Excellence at UW Medicine (C.E.B., A.R.M.), Seattle, Washington, USA
| | - Christina C Pytel
- Department of Anesthesiology and Pain Medicine (C.C.P.), University of Washington, Seattle, Washington, USA
| | - Kristine L Cueva
- Department of Medicine (K.L.C.), University of Washington, Seattle, Washington, USA
| | - Kemi M Doll
- Division of Gynecologic Oncology (K.M.D.), Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
| | - Bessie A Young
- Division of Nephrology (B.A.Y.), Department of Medicine, University of Washington, Seattle, Washington, USA; Justice, Equity, Diversity, and Inclusion Center for Transformational Research (B.A.Y.), Office of Healthcare Equity, University of Washington, Seattle, Washington, USA
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Nishi NW, Collier MJ, Morales GI, Watley E. Microaggressions in veterinary communication: what are they? How are they harmful? What can veterinary professionals and educators do? J Am Vet Med Assoc 2024; 262:1-6. [PMID: 38041951 DOI: 10.2460/javma.23.07.0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/04/2023] [Indexed: 12/04/2023]
Abstract
Trusting relationships between veterinary professionals and clients are important for the well-being of people and the ultimate health of their animals. Yet, microaggressions pose a threat to these relationships. Defined as slights or indignities wielded against people with marginalized identities, microaggressions inflict a unique form of harm that reaffirms negative stereotypes enmeshed in systems of racism, sexism, classism, and beyond. In this article, we explore how microaggressions work and how they are applicable in veterinary settings. We also offer initial suggestions for veterinary professionals and educators to better understand and counteract their damage in the profession.
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Affiliation(s)
- Naomi W Nishi
- 1College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - Mary Jane Collier
- 2Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - Gabriela I Morales
- 3Department of Communication Studies, New Mexico State University, Las Cruces, NM
| | - Erin Watley
- 4Department of Communication & Cinema, McDaniel College, Westminster, MD
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Samek DR, Crumly B, Akua BA, Dawson M, Duke-Marks A. Microaggressions, perceptions of campus climate, mental health, and alcohol use among first-year college students of color. J Res Adolesc 2024; 34:96-113. [PMID: 37984497 DOI: 10.1111/jora.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 08/11/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023]
Abstract
Depressive and anxiety symptoms are increasingly common, and problematic alcohol use remains prevalent in college. To expand on prior research on mostly white samples, we surveyed first-year students of color from our predominately white university (Southeastern US) to identify risk factors for mental health symptoms and potentially co-occurring problematic alcohol use. Results showed significant associations between microaggressions and poor campus climate (hypothetical predictors) with depressive, anxiety, somatic symptoms (hypothetical outcomes) that were indirectly linked through perceived stress, poor sleep, and academic burnout (hypothetical mediators). Poor campus climate, academic burnout, and using alcohol to cope were the most relevant to alcohol use disorder symptoms. Results support efforts to address and reduce racial microaggressions and promote a positive campus climate for all.
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Affiliation(s)
- Diana R Samek
- Auburn University, Human Development and Family Science, Auburn, Alabama, USA
| | - Brianna Crumly
- Auburn University, Human Development and Family Science, Auburn, Alabama, USA
| | - Bruno Ache Akua
- Auburn University, Human Development and Family Science, Auburn, Alabama, USA
| | - Mary Dawson
- Auburn University, Human Development and Family Science, Auburn, Alabama, USA
| | - Adrienne Duke-Marks
- Auburn University, Human Development and Family Science, Auburn, Alabama, USA
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Farr RH, Cashen KK, Siebenthaler KA, Simon KA. Microaggression and discrimination experiences among diverse youth with LGBTQ+ parents in the United States. J Res Adolesc 2024. [PMID: 38339824 DOI: 10.1111/jora.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 01/08/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
Family-based microaggressions and discrimination experienced by youth with LGBTQ+ parents are important to understand from their perspectives. Using mixed methods, we examined such experiences among 12- to 25-year-old youth (N = 51) with at least one LGBTQ+ parent in the United States. Youth were diverse in race/ethnicity, family structure, gender and sexual identities, socioeconomic status, and geographic region. Using interviews, we explored LGBTQ+ family-based microaggressions (reported through scale items with feedback) and discrimination (assessed via thematic analysis). Microaggressions and discrimination based on having LGBTQ+ parents were common, yet there were distinctions in direct and indirect stigma across the quantitative items and qualitative themes. These results underscore the value of mixed methods research with youth and implications for future research, practice, and policy.
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Affiliation(s)
| | | | | | - Kay A Simon
- University of Minnesota, Minneapolis, Minnesota, USA
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Ramsey K, Carmichael N, Gutierrez-Kapheim M, Dell-Suguitan MD, Lopez Santibanez Jacome L, Bao AK, Hoell C. Exploring the occurrence of microaggressions in the genetic counseling student-supervisor relationship: A mixed-methods study. J Genet Couns 2024; 33:28-40. [PMID: 38217277 DOI: 10.1002/jgc4.1854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/07/2023] [Accepted: 12/14/2023] [Indexed: 01/15/2024]
Abstract
While research has shown that genetic counseling students with minoritized racial or ethnic identities face microaggressions throughout graduate training, quantitative data regarding the frequency of these experiences have not been reported. The purpose of this mixed-methods study was to investigate the frequency and types of microaggressions experienced by graduates of accredited genetic counseling programs in the United States during fieldwork rotations. A quantitative survey was administered to assess how frequently 14 different types of microaggressions occurred in interactions with supervisors. Survey responses were analyzed using situation-based coding (the number of different types of microaggressions experienced) and frequency-based coding (the sum of participants' weighted Likert answers). Select survey respondents with minoritized identities were interviewed to better contextualize and categorize microaggression experiences. Analysis of 87 survey responses revealed that participants with minoritized racial and ethnic identities experience significantly more types of microaggressions (t(61) = 2.77; p = 0.007) at a significantly higher frequency (t(55) = 2.67; p = 0.010) than their white counterparts. Participants who identified as part of the disability community were also found to experience significantly more types of microaggressions (t(10) = 3.25; p = 0.009) at a significantly higher frequency (t(9) = 2.32; p = 0.045) than those who did not. Qualitative analysis of 11 interviews revealed that microaggressions from supervisors included offensive and inappropriate comments, unequal treatment, cultural intolerance, and disparaging feedback. Overall, our data present evidence that students with minoritized racial and ethnic identities and students with disabilities are subjected to a variety of inequitable, exclusionary, and harmful interactions. As a result, we recommend that all supervisors receive training about recognizing and preventing microaggressions to ensure that students are provided with an equitable and inclusive training experience, regardless of identity.
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Affiliation(s)
- Kyra Ramsey
- Loyola University Medical Center, Chicago, Illinois, USA
- Center for Genetic Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nikkola Carmichael
- Department of Graduate Medical Sciences, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | | | - Mike Darren Dell-Suguitan
- ACL Laboratories, Advocate Aurora Health, Rosemont, Illinois, USA
- Northwestern Medicine Central DuPage Hospital, Winfield, Illinois, USA
| | | | - Annie K Bao
- Center for Genetic Medicine, Northwestern University, Chicago, Illinois, USA
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Christin Hoell
- Center for Genetic Medicine, Northwestern University, Chicago, Illinois, USA
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Ramsey K, Carmichael N, Gutierrez-Kapheim M, Dell-Suguitan MD, Bao AK, Hoell C. Exploring the impact of microaggressions on the genetic counseling student-supervisor relationship: A qualitative study. J Genet Couns 2024; 33:41-53. [PMID: 38356454 DOI: 10.1002/jgc4.1876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 07/03/2023] [Accepted: 12/27/2023] [Indexed: 02/16/2024]
Abstract
Genetic counseling students with minoritized identities have reported experiencing microaggressions throughout graduate training, including from fieldwork supervisors. However, the impacts of these fieldwork experiences have not been thoroughly investigated. As supervision is known to be integral to genetic counseling students' skill development and success, the purpose of this qualitative study was to explore the impact of microaggressions on student training, with a specific focus on the supervisory working alliance. To achieve this goal, we conducted 11 interviews with recent genetic counseling graduates (2019-2021) who reported experiencing at least one microaggression from a fieldwork supervisor during graduate school training. Purposive sampling was used to prioritize interviewees who identified as underrepresented in the field due to race, ethnicity, gender identity, sexual orientation, and/or disability status. All interviewees were initially recruited as part of a larger mixed-methods study investigating the frequency and types of microaggressions genetic counseling students experience from fieldwork supervisors. Interview questions explored the time period before a microaggression event, during the event, and after. Qualitative thematic analysis resulted in four themes, three of which are presented in this paper: (1) Impact of microaggressions, (2) Barriers to reporting microaggressions, and (3) Experience reporting microaggressions. Microaggressions from supervisors were shown to impair the psychological well-being of participants and hinder learning opportunities. These experiences led participants to question their choice of profession and avoid time in clinic, ultimately constraining the development of strong supervisory working alliances. Some participants did not report microaggressions due to fear of negative repercussions, and those who did described defensive responses which harmed students' relationships with program leadership. This study reveals opportunities for supervisors to improve student training conditions by centering students' feelings and experiences, increasing open and honest communication, and extending psychosocial tools to supervision. Additionally, graduate programs are encouraged to establish structured reporting protocols for students and evaluate current shortcomings in equity and inclusion initiatives.
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Affiliation(s)
- Kyra Ramsey
- Loyola University Medical Center, Maywood, Illinois, USA
- Center for Genetic Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nikkola Carmichael
- Department of Graduate Medical Sciences, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | | | - Mike Darren Dell-Suguitan
- ACL Laboratories, Advocate Aurora Health, Rosemont, Illinois, USA
- Northwestern Medicine Central DuPage Hospital, Winfield, Illinois, USA
| | - Annie K Bao
- Center for Genetic Medicine, Northwestern University, Chicago, Illinois, USA
- Vagelos College of Physicians and Surgeons, Columbia University, New York City, New York, USA
| | - Christin Hoell
- Center for Genetic Medicine, Northwestern University, Chicago, Illinois, USA
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Marchi M, Travascio A, Uberti D, De Micheli E, Quartaroli F, Laquatra G, Grenzi P, Pingani L, Ferrari S, Fiorillo A, Converti M, Pinna F, Amaddeo F, Ventriglio A, Mirandola M, Galeazzi GM. Microaggression toward LGBTIQ people and implications for mental health: A systematic review. Int J Soc Psychiatry 2024; 70:23-35. [PMID: 37638668 DOI: 10.1177/00207640231194478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND Research suggests that microaggressions detrimentally impact the mental health of members of marginalized social groups. AIMS The aim of this systematic review was to assess the exposure to microaggressions and related implications on mental health of Lesbian, Gay, Bisexual, Transgender, Intersex, and Queer (LGBTIQ) people. METHOD Medline, Scopus, PsycINFO, CINAHL, and EMBASE were searched until January 2023. Studies reporting data on the exposure to microaggressions toward LGBTIQ people were identified. Meta-analyses of rates of exposure to microaggression and of the association between microaggressions and mental health outcomes were based on odds ratio (OR) and standardized mean difference (SMD) with 95% confidence intervals (95% CI), estimated through inverse variance models with random effects. RESULTS The review process led to the selection of 17 studies, involving a total of 9036 LGBTIQ people, of which 6827 identifying as cisgenders, and 492 as heterosexuals, were included in the quantitative synthesis. Overall, LGBTIQ people showed an increased risk of microaggression (SMD: 0.89; 95% CI [0.28, 1.50]), with Transgender people having the highest risk (OR: 10.0; 95% CI [3.08, 32.4]). Microaggression resulted associated with risk of depression (SMD: 0.21; 95% CI [0.05, 0.37]), anxiety (SMD: 0.29; 95% CI [0.17, 0.40]), suicide attempts (OR: 1.13; 95% CI [1.08, 1.18]), alcohol abuse (OR: 1.32; 95% CI [1.13, 1.54]), but not to suicidal ideation (OR: 1.56; 95% CI [0.64, 3.81]) and cannabis abuse (OR: 1.44; 95% CI [0.82, 2.55]). The quality of the evidence was limited by the small number of studies. CONCLUSIONS LGBTIQ people are at higher risk of microaggressions compared with their cisgender/heterosexual peers, which may lead to mental health consequences. This evidence may contribute to public awareness of LGBTIQ mental health needs and suggest supportive strategies as well as preventive interventions (e.g., supportive programs and destigmatizing efforts) as parts of tailored health-care planning aimed to reduce psychiatric morbidity in this population.
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Affiliation(s)
- Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Travascio
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Daniele Uberti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Edoardo De Micheli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Quartaroli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Laquatra
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Pietro Grenzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Pingani
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Ferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Federica Pinna
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi di Cagliari, Cagliari, Italy
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Massimo Mirandola
- WHO Collaborating Centre for Sexual Health and Vulnerable Populations, Epidemiology Unit - Infectious Diseases Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- School of Health Sciences, University of Brighton, Brighton, UK
| | - Gian M Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Alhammadi NA, Al Jabbar I, Alahmari SA, Alqahtani RM, Alhadi WA, Alnujaymi BM, Al-Jakhaideb MM, Almoghamer HD, Alqahtani MS, Mahmood SE. Gender-Related Microaggressions in Orthopedic Surgery: A Comprehensive Survey of Women Orthopedists and Implications for Progress, Saudi Arabia. J Healthc Leadersh 2024; 16:29-37. [PMID: 38223496 PMCID: PMC10785692 DOI: 10.2147/jhl.s437083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/22/2023] [Indexed: 01/16/2024] Open
Abstract
Background Microaggressions are subtle and often unintentional acts that can be verbal, nonverbal, or environmental, and they convey negative messages to individuals belonging to marginalized social groups. This study aims to determine the prevalence of microaggressions experienced by female Saudi orthopaedic surgeons. Methods This cross-sectional study was conducted online and targeted female in orthopedic surgery across different regions of the Kingdom of Saudi Arabia. The survey was uploaded to Google Forms and distributed through social media platforms like Twitter, Instagram, and WhatsApp by well-trained data collectors. Results In this survey we included 96 female Saudi orthopedics. Their mean age was 27.46 ± 12.20 years. Most respondents were either residents (52.63%), or specialists (23.16%). Most participants (92.63%) were still in training or early in their careers, with the vast majority (93.68%) had their residency in Saudi Arabia. Nearly three-fifths (61.05%) have reported experiencing microaggressions as victims, 76.84%, did not see themselves as perpetrators of microaggressions, 23.16% acknowledged having engaged in such behavior. Patients or their families were reported to be involved in microaggressions in 43.16% of cases, while male surgeons and male support staff were implicated at 51.58% and 23.16%, respectively. Additionally, other male medical doctors participate in microaggressions in 33.68% of instances. Female surgeons were identified as being involved in 22.11% of microaggressions, whereas 29.47% involve female support staff. Conclusion The study's outcomes can help inform strategies to promote a supportive and inclusive environment within the field of orthopaedic surgery, encouraging positive interactions and equitable opportunities for all practitioners.
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Affiliation(s)
- Nouf A Alhammadi
- Rheumatologist and Lupus Specialist, Department of Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | | | | | - Wajd A Alhadi
- College of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | | | | | | | - Syed Esam Mahmood
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
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Punches BE, Osuji E, Bischof JJ, Li-Sauerwine S, Young H, Lyons MS, Southerland LT. Patient perceptions of microaggressions and discrimination toward patients during emergency department care. Acad Emerg Med 2023; 30:1192-1200. [PMID: 37335980 DOI: 10.1111/acem.14767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Disparities in emergency department (ED) care based on race and ethnicity have been demonstrated. Patient perceptions of emergency care can have broad impacts, including poor health outcomes. Our objective was to measure and explore patient experiences of microaggressions and discrimination during ED care. METHODS This mixed-methods study of adult patients from two urban academic EDs integrates quantitative discrimination measures and semistructured interviews of discrimination experiences during ED care. Participants completed demographic questionnaires and the Discrimination in Medical Settings (DMS) scale and were invited for a follow-up interview. Transcripts of recorded interviews were analyzed leveraging conventional content analysis with line-by-line coding for thematic descriptions. RESULTS The cohort included 52 participants, with 30 completing the interview. Nearly half the participants were Black (n = 24, 46.1%) and half were male (n = 26, 50%). "No" or "rare" experiences of discrimination during the ED visit were reported by 22/48 (46%), some/moderate discrimination by 19/48 (39%), and significant discrimination in 7/48 (15%). Five main themes were found: (1) clinician behaviors-communication and empathy, (2) emotional response to health care team actions, (3) perceived reasons for discrimination, (4) environmental pressures in the ED, and (5) patients are hesitant to complain. We found an emergent concept where persons with moderate/high DMS scores, in discussing instances of discrimination, frequently reflected on previous health care experiences rather than on their current ED visit. CONCLUSIONS Patients attributed microaggressions to many factors beyond race and gender, including age, socioeconomic status, and environmental pressures in the ED. Of those who endorsed moderate to significant discrimination via survey response during their recent ED visit, most described historical experiences of discrimination during their interview. Previous experiences of discrimination may have lasting effects on patient perceptions of current health care. System and clinician investment in patient rapport and satisfaction is important to prevent negative expectations for future encounters and counteract those already in place.
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Affiliation(s)
- Brittany E Punches
- The Ohio State University College of Nursing, Columbus, Ohio, USA
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Evans Osuji
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jason J Bischof
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Simiao Li-Sauerwine
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Henry Young
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael S Lyons
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lauren T Southerland
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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D'Amore S, Green RJ, Mouton B, Carone N. European gay fathers via surrogacy: Parenting, social support, anti-gay microaggressions, and child behavior problems. Fam Process 2023. [PMID: 37918437 DOI: 10.1111/famp.12950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023]
Abstract
The present study investigated child behavior problems, parenting styles, coparenting, and couple relationship satisfaction in 67 European gay father families via surrogacy and 67 European heterosexual parent families via unassisted conception, all with children aged 1.5-10 years (M = 3.57 years, SD = 2.09). The two family groups were matched for child age and gender. In the gay father group only, the associations between family anti-gay microaggressions, family/friend support, and other main variables also were explored. Children of gay fathers had fewer externalizing and internalizing problems compared to children of heterosexual parents. Also, gay fathers reported more effective parenting styles, greater coparenting quality, and higher couple relationship satisfaction compared to heterosexual parents. Overall, child externalizing problems (i.e., aggression, rule-breaking) and internalizing problems (i.e., anxiety, depression) were more strongly associated with being raised in a heterosexual parent family, more authoritarian parenting, and lower positive coparenting. Specific to the gay father sample, anti-gay microaggressions experienced by family members were associated with more child internalizing problems, lower positive coparenting, and lower social support from family and friends. These results refute concerns about possible detrimental effects on child development of surrogacy conception or of being raised by gay fathers. The results further suggest that family therapists treating child behavior problems should focus mainly on improving the coparenting relationship, reducing authoritarian/punitive parenting styles, and (for gay father families specifically) coping with anti-gay microaggressions and lack of social support outside the nuclear family.
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Affiliation(s)
- Salvatore D'Amore
- Faculty of Psychological Sciences and Education, DéFaSy (Centre de Recherche sur la Psychologie du Développement, de la Famille et des Systèmes Humains), Université Libre de Bruxelles, Brussel, Belgium
| | - Robert-Jay Green
- California School of Professional Psychology, Alliant International University, San Francisco, California, USA
| | - Benedicte Mouton
- Faculty of Psychological Sciences and Education, DéFaSy (Centre de Recherche sur la Psychologie du Développement, de la Famille et des Systèmes Humains), Université Libre de Bruxelles, Brussel, Belgium
| | - Nicola Carone
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Guerin A, Lee J, Floyd B, Yemane L, Fassiotto M, Griffith E, Blankenburg R, Hilgenberg SL, Dali S, De Araujo M, Jones K, Kuo K, Rassbach CE. Building an Antiracist Department Through an Experiential Department-Wide Antiracism Curriculum. Acad Pediatr 2023; 23:1505-1506. [PMID: 37422256 DOI: 10.1016/j.acap.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Allison Guerin
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - July Lee
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Baraka Floyd
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Lahia Yemane
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Magali Fassiotto
- Office of Faculty Development & Diversity (M Fassiotto), Stanford School of Medicine, Stanford, Calif.
| | - Emmett Griffith
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Rebecca Blankenburg
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Sarah L Hilgenberg
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Salma Dali
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Monique De Araujo
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Kamaal Jones
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Kevin Kuo
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Caroline E Rassbach
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
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DeSon JJ, Andover MS. Microaggressions Toward Sexual and Gender Minority Emerging Adults: An Updated Systematic Review of Psychological Correlates and Outcomes and the Role of Intersectionality. LGBT Health 2023. [PMID: 37906109 DOI: 10.1089/lgbt.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Purpose: Quantitative data on the psychological effects of microaggressions toward sexual and gender minority individuals have grown substantially. Sexual orientation-based and transgender and gender-diverse (trans+) identity-based microaggressions have been thematically identified in prior research. In addition, combined lesbian, gay, bisexual, transgender and gender-diverse, queer/questioning, and other non-heterosexual (LGBTQ) microaggressions can be examined intersectionally with other marginalized identities. This systematic review synthesizes research on the relationships among these microaggressions and psychological correlates and outcomes. Methods: Forty-five quantitative studies examining sexual orientation-, trans+ identity-, or intersectional identity-based microaggressions and various psychological outcomes were identified from systematic searches of PsycINFO, PsycARTICLES, MEDLINE, and PubMed databases. Data regarding microaggressions were extracted, synthesized, and grouped by mental health outcome or correlate. Results: Sexual orientation-based microaggressions were risk factors for depression, anxiety, and internalized stigma and were positively associated with psychological distress, traumatic stress symptoms, alcohol use and abuse, cannabis use and problems, suicidal ideation, and suicide attempt. Trans+ identity-based microaggressions were positively associated with depression, suicide attempt, and cannabis use. LGBTQ intersectional identity-based microaggressions concerning race/ethnicity were associated with depression, anxiety, and suicidal ideation. Research on other intersectional identity-based microaggressions is scarce. Conclusion: These findings emphasize the psychological harm inflicted by various microaggressions on LGBTQ late adolescents and early adults. Future work should focus on microaggressions toward individuals with trans+ and intersectional identities and protective factors for these experiences. This review also highlights the distinct need for community-based research on implementing microintervention strategies in family, school, and work environments to mitigate the harmful effects of these microaggressions.
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Affiliation(s)
- Joshua J DeSon
- Department of Psychology, Fordham University, Bronx, New York, USA
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15
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Smith KC. Ethnicity, Race, and Gender in Engineering Education: The Nuanced Experiences of Male and Female Latinx Engineering Undergraduates Targeted by Microaggressions. Psychol Rep 2023; 126:2345-2382. [PMID: 35084262 PMCID: PMC10517585 DOI: 10.1177/00332941221075766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Compared to other groups, relatively less research has specifically addressed the retention of Latinx students in STEM disciplines. These students face many negative stereotypes about their group, especially related to their academic success, yet there is limited research regarding how microaggressions, subtle or ambiguous discriminatory behaviors, targeting Latinx students in engineering education settings impact their experience in those programs. Guided by Sue's definitions and taxonomy of microaggressions, Critical Race Theory and Latino Critical Theory, the purpose of the current study was to answer the following research questions: 1) What microaggressions do Latinx engineering undergraduates experience in an engineering education environment? and 2) How do these microaggressions impact Latinx engineering undergraduates' academic well-being, as defined by their academic self-efficacy and academic performance?
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Affiliation(s)
- Kalynda C. Smith
- North Carolina Agricultural and Technical State University, Greensboro, NC, USA
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16
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Buckner JD, Morris PE, Threeton EM, Zvolensky MJ. Cannabis and Nicotine Dual Use among Sexual Minority Individuals: Relations to Cannabis Use and Negative Affect. Subst Use Misuse 2023; 58:1813-1817. [PMID: 37622481 PMCID: PMC10786340 DOI: 10.1080/10826084.2023.2250427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Background: Sexual minority individuals report significantly more cannabis use and use-related problems than their heterosexual peers, and emerging data indicate sexual minority individuals who use cannabis are at greater risk for dual use of nicotine products (combustible smoking, e-cigarette use) than heterosexual individuals. Although cannabis-nicotine dual use is related to worse cannabis outcomes and negative affect, little work has identified factors related to dual use among sexual minority individuals or tested if sexual orientation-based discrimination (microaggressions, overt discrimination) is related to dual use. Objectives: The current study tested if cannabis-nicotine dual use is related to more frequent cannabis use, more cannabis-related problems, negative affect, and discrimination among sexual minority undergraduate students who endorsed current (past three-month) cannabis use (N = 328), 43.6% of whom endorsed dual nicotine use. Cannabis-nicotine dual use was related to more frequent cannabis use, more cannabis-related problems, more anxiety (but not depression), and more sexual orientation-based microaggressions and microaggressions-related negative affect (but not overt discrimination or non-sexual orientation-based daily stressors). Conclusions/Importance: Overall, this is the first known study to identify that sexual orientation-based discrimination is related to cannabis-nicotine dual use and that dual use is related to more frequent cannabis use, use-related problems, and negative affect (especially anxiety) among this underrepresented group.
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Affiliation(s)
- Julia D. Buckner
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA 70803, USA
| | - Paige E. Morris
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA 70803, USA
| | - Evan M. Threeton
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA 70803, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
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Awad MN, Connors EH. Active bystandership by youth in the digital era: Microintervention strategies for responding to social media-based microaggressions and cyberbullying. Psychol Serv 2023; 20:423-434. [PMID: 36951730 PMCID: PMC10517072 DOI: 10.1037/ser0000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Microaggressions are intentional or unintentional slights, insults, invalidations, and offensive behaviors that communicate hostile or derogatory messages to minoritized populations. When microaggressions cross over to social media, they can be considered a form of cyberbullying, which occurs over digital devices and harms, threatens, undermines, or socially excludes others. Microaggressions and cyberbullying have adverse mental health outcomes for racial and cultural minority youth, and there is an urgent need for practical strategies youth can use online to interrupt and disarm negative and harmful social media content. We used a multimethod approach to critically appraise and adapt Sue et al.'s (2019) microinterventions framework for use on social media with youth bystanders. Our analysis found high compatibility between microinterventions and youth bystander research, supporting transferability to social media for use with youth. Relevant adaptations include incorporating strategies that promote cognitive appraisal, cognitive empathy, education via social media, and use of social media features for external support. Using a social media microaggression example for each of the four microinterventions, we provide concrete tactics and example social media posts that youth can use when they come across insulting or offensive commentary online. The resulting framework offers a promising set of theory and research-informed strategies ready for further testing and refinement. When validated and refined, these microinterventions could be used as stand-alone strategies and/or incorporated into existing cyberbullying prevention or media literacy programs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Michael N Awad
- Department of Psychiatry, Division of Prevention and Community Research, Yale University
| | - Elizabeth H Connors
- Department of Psychiatry, Division of Prevention and Community Research, Yale University
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18
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Bettache K. The WEIRD Microcosm of Microaggression Research: Toward a Cultural-Psychological Approach. Perspect Psychol Sci 2023; 18:743-748. [PMID: 36379043 DOI: 10.1177/17456916221133826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Microaggression research has made great strides over the past decade while steadily pushing itself into mainstream psychological science. Yet the field remains firmly situated within the Western, educated, industrialized, rich, and democratic (WEIRD) cultural context. Correspondingly, recurring criticisms against the validity of microaggressions are often rooted in individualist, decontextualized understandings of behavior, and critics' rebuttals are often grounded in a philosophical and reflective understanding of the cultural context. In this article, I put forward that (a) the enactments and appraisals of microaggressions are the behavioral results of the cognitive salience of cultural schemas; (b) cultural schemas are informed by cultural ideologies, underlining their methodological and empirical relevance for future research; and (c) cultures are dynamic by highlighting the effects of geopolitical events on the content of cultural schemas that may moderate the perception and enactment of microaggressions. For these reasons, I argue that a cultural psychology of microaggressions may help to depathologize the individual by situating behavior in its cultural context while at the same time necessitating the inclusion of communities residing in non-WEIRD societies.
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Affiliation(s)
- Karim Bettache
- Faculty of Social Science, The Chinese University of Hong Kong
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19
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Fattoracci ESM, King DD. The Need for Understanding and Addressing Microaggressions in the Workplace. Perspect Psychol Sci 2023; 18:738-742. [PMID: 36379041 DOI: 10.1177/17456916221133825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
The special issue on microaggressions highlighted how subtle interpersonal bias is complex, harms its targets, and reinforces established systems of inequity. The aim of this commentary is to contribute an organizational science perspective to this insightful and important dialogue. Given that the workplace is a microcosm of the broader society where adults spend most of their waking hours, studying microaggressions in this context can shed light on their unique manifestations and consequences, as well as methods to address this unique source of workplace adversity. Unlike other social contexts, many employees do not have complete autonomy over whom they interact with (e.g., choosing one's supervisor, officemates, or clients) and what they are able to convey authentically and safely in those interactions (i.e., choices about how one responds to microaggressions). As a result, people from minoritized backgrounds must often maintain professional relationships with colleagues or supervisors who harbor bias and (un)consciously convey it via microinvalidations, microassaults, and microinsults. Further, reward systems in the world of work (e.g., wages, promotions) may not only reflect but also reinforce systems of disadvantage (e.g., who experiences social mobility). In addition to understanding microaggressions in the workplace, there is a need to actively address them. We engage with Ong et al., Johnson et al., and Spanierman et al. to suggest that organizational understanding and remediation of microaggressions offers a viable avenue for challenging systems of oppression and fostering employee and organizational resilience to adversity.
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Bergkamp J, O’Leary Sloan M, Krizizke J, Lash M, Trantel N, Vaught J, Fulmer T, Waite I, Martin AM, Scheiderer C, Olson L. Pathways to the therapist paragon: a decolonial grounded theory. Front Psychol 2023; 14:1185762. [PMID: 37457084 PMCID: PMC10343956 DOI: 10.3389/fpsyg.2023.1185762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/09/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction While many professional associations within clinical and counseling psychology have made an aspirational call for clinician awareness of social position, there is a lack of research into how socially-conferred privilege impacts psychotherapy. Specifically of interest is the differences in race and gender within the therapeutic dyad, in which there is a BIPOC (Black, Indigenous, and Persons of Color)/white or male/female-identified dynamic. Method The authors utilized a Grounded Theory approach to analyze qualitative interviews with practicing psychologists to construct a process model regarding how socially-conferred privileged identity domains impact the therapeutic relationship and the participants' professionalization process. Results The analysis identified the core conceptual theme of the Therapist Paragon, representing an idealized version of what a perfect therapist should be. This replicated the foundational figures of our field - primarily older, white men. The process model consisted of two distinct pathways toward the Therapist Paragon, one for BIPOC psychologists and one for white psychologists. The female BIPOC pathway consisted of imposter syndrome, persistent feelings of inadequacy, and tendencies to over-credential their professional identity to seek credibility in the eyes of clients and colleagues. The white pathway consisted of down-playing whiteness and attempting to initially modify behavior toward client cultural norms. Discussion The results point to a distinct professionalization and practice process for BIPOC psychologists compared to white counterparts. This dynamic may have implications beyond increasing support for BIPOC clinicians specifically, but instead indicate a lack of acknowledgement of the psychological impact of socially-conferred privilege in the psychotherapy enterprise overall. Recommendations are offered for revisions to training models, continuing education, and supervision/consultation.
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Myers AK, Williams MS, Pekmezaris R. Intersectionality and Its Impact on Microaggression in Female Physicians in Academic Medicine: A Cross-Sectional Study. Womens Health Rep (New Rochelle) 2023; 4:298-304. [PMID: 37404574 PMCID: PMC10316039 DOI: 10.1089/whr.2022.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 07/06/2023]
Abstract
Introduction The burden of microaggressions in the workplace is an ongoing stressor for female physicians in academic medicine. For female physicians of Color or of the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual community, this burden is even heavier due to the concept of intersectionality. The goal of this study is to assess frequency of microaggressions experienced by participants. In addition, to explore the associations between microaggression and individual outcomes, patient care practices and attitudes, and perception of pay/promotion equity. Methods This was a cross-sectional analysis of female residents, fellows and attendings conducted from December 2020-January 2021 at Northwell Health across all specialties. One hundred seventeen participants replied to the study in REDCap. They completed questionnaires related to the topics of imposter phenomenon, microaggressions, gender identity salience, patient safety, patient care, counterproductive work behavior and pay and promotion equity. Results A majority of the respondents were white (49.6%) and 15+ years out of medical school (43.6%). Around 84.6% of female physicians endorsed experiencing microaggressions. There were positive associations between microaggressions and imposter phenomenon as well as microaggressions and counterproductive work behavior. There was a negative association between microaggressions and pay equity or promotion. The small sample size did not allow for us to examine differences by race. Discussion Although the number of female physicians continues to rise due to an uptick in female medical school enrollees, female physicians still must deal with the burden of microaggressions in the workplace. Conclusions As a result, academic medical institutions must seek to create more supportive workplace for female physicians.
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Affiliation(s)
- Alyson K. Myers
- Division of Endocrinology, Department of Medicine, North Shore University Hospital, Manhasset, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Institute of Health Systems Science, Northwell Health, Manhasset, New York, USA
| | - Myia S. Williams
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Institute of Health Systems Science, Northwell Health, Manhasset, New York, USA
| | - Renee Pekmezaris
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Institute of Health Systems Science, Northwell Health, Manhasset, New York, USA
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Sharda S, Butler K, Al Mandhari M, Mehta S. Microaggressions in anesthesiology and critical care: individual and institutional approaches to change. Can J Anaesth 2023; 70:1026-1034. [PMID: 37268799 DOI: 10.1007/s12630-023-02459-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 06/04/2023] Open
Abstract
Microaggressions are subtle verbal or nonverbal insults that convey derogatory and negative messages to and about people who belong to oppressed groups. Microaggressions reflect structurally and historically perpetuated societal values, which advantage some groups of people by considering them to be inherently more worthy than others, while simultaneously disadvantaging others. While microaggressions may seem innocuous and are often unintentional, they cause tangible harm. Microaggressions are commonly experienced by physicians and learners working in perioperative and critical care contexts and are often not adequately addressed, for a multitude of reasons, including witnesses not knowing how to respond. In this narrative review, we provide examples of microaggressions towards physicians and learners working in anesthesia and critical care, and offer individual and institutional approaches to managing such incidents. Concepts of privilege and power are introduced to ground interpersonal interventions within the larger context of systemic discrimination, and to encourage anesthesia and critical care physicians to contribute to systemic solutions.
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Affiliation(s)
- Saroo Sharda
- Department of Anesthesia, Faculty of Health Sciences, McMaster University, 1280 Main St. W., Hamilton, ON, L8S 4L8, Canada.
| | - Kat Butler
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Maha Al Mandhari
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Sangeeta Mehta
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sinai Health, Toronto, ON, Canada
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23
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Erving CL, Zajdel R, McKinnon II, Van Dyke ME, Murden RJ, Johnson DA, Moore RH, Lewis TT. Gendered Racial Microaggressions and Black Women's Sleep Health. Soc Psychol Q 2023; 86:107-129. [PMID: 38371316 PMCID: PMC10869115 DOI: 10.1177/01902725221136139] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Gendered racial microaggressions reflect historical and contemporary gendered racism that Black women encounter. Although gendered racial microaggressions are related to psychological outcomes, it is unclear if such experiences are related to sleep health. Moreover, the health effects of gendered racial microaggressions dimensions are rarely investigated. Using a cohort of Black women (N = 400), this study employs an intracategorical intersectional approach to (1) investigate the association between gendered racial microaggressions and sleep health, (2) assess whether gendered racial microaggressions dimensions are related to sleep health, and (3) examine whether the gendered racial microaggressions-sleep health association persists after accounting for depressive symptoms and worry. Gendered racial microaggressions were associated with poor sleep quality overall and four specific domains: subjective sleep quality, latency, disturbance, and daytime sleepiness. Two gendered racial microaggressions dimensions were especially detrimental for sleep: assumptions of beauty/sexual objectification and feeling silenced and marginalized. After accounting for mental health, the effect of gendered racial microaggressions on sleep was reduced by 47 percent. Future research implications are discussed.
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Affiliation(s)
| | - Rachel Zajdel
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
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Barnes MJD, Bradley C, Cade-White L, Williams JP. "I've never seen a Black woman chaplain before:" From personal narratives to hypotheses. J Health Care Chaplain 2023:1-13. [PMID: 37229592 DOI: 10.1080/08854726.2023.2209465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This article shifts the traditional approach to case studies in healthcare chaplaincy from questions about what chaplains do to questions of who chaplains are and how they experience the work. We draw insights from womanist theology to offer three narratives written by African American healthcare chaplains that illustrate themes of intersectionality, the effects interview contexts have on training and work, and key questions that emerge while doing the work. These narratives honor the largely invisible work of African-American chaplains while raising central hypotheses for research and intervention we outline in conclusion.
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Affiliation(s)
- Marilyn J D Barnes
- Department of Patient Counseling, Virginia Commonwealth University, Richmond, VA, USA
| | - Calvin Bradley
- Department of Patient Counseling, Virginia Commonwealth University, Richmond, VA, USA
| | - Lex Cade-White
- Department of Ethics and Department of Mission and Spiritual Care, Advocate Aurora Health Inc, Milwaukee, WI, USA
| | - Jaclyn P Williams
- Fuller Theological Seminary and Memorial Hermann Health System, Houston, TX, USA
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Davis J, Damo S, Spencer EC, Murray SA, Shuler HD, Vue Z, Heemstra JM, Diaz Vazquez A, Hinton A. Catalyst for Change: Future of DEI in Academia. Trends Chem 2023; 5:245-248. [PMID: 37743974 PMCID: PMC10512845 DOI: 10.1016/j.trechm.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
In this paper, we propose ways to address diversity, equity, and inclusion (DEI) challenges and outline steps and methodologies for creating allies and empowering leaders to support DEI efforts in science, technology, engineering, mathematics, and medicine (STEMM) for underrepresented minorities (URMs).
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Affiliation(s)
- Jamaine Davis
- Department of Biochemistry, Cancer Biology, Neuroscience, Pharmacology, Meharry Medical College, Nashville, TN 37232 USA
| | - Steve Damo
- Department of Life and Physical Sciences, Fisk University, Nashville, TN, 37208 USA
| | - Elsie C. Spencer
- Department of Molecular Physiology and Biophysics, Vanderbilt University; Nashville, TN, 37232 USA
- Teachers College, Columbia University; New York, NY, 10027 USA
| | - Sandra A. Murray
- Department of Cell Biology, University of Pittsburgh; Pittsburgh, PA, 15261 USA
| | - Haysetta D. Shuler
- Department of Biological Sciences, Winston-Salem State University, Winston-Salem, NC, 27110 USA
- Shuler Consulting, Winston-Salem, NC, 27110 USA
| | - Zer Vue
- Department of Molecular Physiology and Biophysics, Vanderbilt University; Nashville, TN, 37232 USA
| | - Jennifer M. Heemstra
- Department of Chemistry, Washington University in St. Louis, St. Louis, MO, 63130 USA
| | - Arnaldo Diaz Vazquez
- Graduate School of Biomedical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, 75390 USA
| | - Antentor Hinton
- Department of Molecular Physiology and Biophysics, Vanderbilt University; Nashville, TN, 37232 USA
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Cramer RJ, Cacace SC, Sorby M, Adrian ME, Kehn A, Wilsey CN. A Psychometric Investigation of the Hate-Motivated Behavior Checklist. J Interpers Violence 2023; 38:5638-5660. [PMID: 36205433 DOI: 10.1177/08862605221127196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Hate-motivated behavior (HMB) comprises a continuum ranging from microaggressions to criminal acts. The measurement of HMB is limited primarily to one or two minoritized groups in any given instrument. Current HMB research also lacks a way to assess the full range of acts and motivations for bias-based behavior. The present study fills gaps in HMB measurement by conducting a psychometric study of the Hate-Motivated Behavior Checklist (HMBC). The HMBC is a self-report instrument of HMB perpetration; the instrument also has sections capturing victim target group (e.g. race, sexual orientation, disability) and perpetrator motivation for HMB commission (e.g., perceived threat, impulsivity). We conducted an online cross-sectional survey of community-dwelling adults and college students (N = 463). Measures assessed demographic information, HMB, and social-political characteristics. Confirmatory factor analysis, item response theory analyses, between-groups analyses (e.g., Analysis of Variance), and descriptive statistics were used to examine HMBC properties. Primary findings included (1) poor model fit of the HMBC behaviors score; (2) good model fit with high reliability for an HMBC behaviors score adapted to binary (no/yes) scoring; (3) men reported meaningfully higher HMB scores compared to women; (4) the most common target classification for HMB was based on political affiliation; and (5) perceived intrusion was the most cited reason for committing HMB. Our findings are an important step in refining the HMBC. The instrument represents a potentially useful tool for HMB research, surveillance, and intervention evaluation. Future directions in HMBC research include application to extremist and criminal samples, replication and extension of the binary scoring to include cut-score derivation, and validation against behavioral outcomes.
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Affiliation(s)
| | | | - Mariah Sorby
- University of North Dakota, Grand Forks, ND, USA
| | | | - Andre Kehn
- University of North Dakota, Grand Forks, ND, USA
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Jamal N, Young VN, Shapiro J, Brenner MJ, Schmalbach CE. Patient Safety/Quality Improvement Primer, Part IV: Psychological Safety-Drivers to Outcomes and Well-being. Otolaryngol Head Neck Surg 2023; 168:881-888. [PMID: 36166311 DOI: 10.1177/01945998221126966] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022]
Abstract
Psychological safety is the concept that an individual feels comfortable asking questions, voicing ideas or concerns, and taking risks without undue fear of humiliation or criticism. In health care, psychological safety is associated with improved patient safety outcomes, increased clinician engagement, and greater creativity. A culture of psychological safety is imperative for physician well-being and satisfaction, which in turn directly affect delivery of care. For health care professionals, psychological safety creates an environment conducive to trust and openness, enabling the team to focus on high-quality care. In contrast, unprofessional behavior reduces psychological safety and threatens the culture of the organization. This patient safety/quality improvement primer considers the barriers and facilitators to psychological safety in health care; outlines principles for creating a psychologically safe environment; and presents strategies for managing conflict, microaggressions, and lapses in professionalism. Individuals and organizations share the responsibility of promoting psychological safety through proactive policies, conflict management, interventions for microaggressions, and cultivation of emotional intelligence.
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Affiliation(s)
- Nausheen Jamal
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, The University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - VyVy N Young
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Jo Shapiro
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Cecelia E Schmalbach
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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Arijs Q, Burgwal A, Van Wiele J, Motmans J. The Price to Pay for Being Yourself: Experiences of Microaggressions among Non-Binary and Genderqueer (NBGQ) Youth. Healthcare (Basel) 2023; 11. [PMID: 36900746 DOI: 10.3390/healthcare11050742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
This study explores the experiences of NBGQ youth with microaggressions. It investigates the types of microaggressions they face and their subsequent needs and coping mechanisms and the impacts on their lives. Semi-structured interviews with ten NBGQ youth in Belgium were conducted and analyzed using a thematic approach. The results showed that experiences of microaggressions were centered around denial. The most common ways to cope were finding acceptance from (queer) friends and therapists, engaging in a conversation with the aggressor, and rationalizing and empathizing with the aggressor, leading to self-blame and normalization of the experiences. Microaggressions were experienced as exhausting, which influenced the extent to which the NBGQ individuals wanted to explain themselves to others. Furthermore, the study shows an interaction between microaggressions and gender expression, in which gender expression is seen as a motive for microaggressions and microaggressions have an impact on the gender expression of NBGQ youth.
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Jean DA, Jacobson CE, Rodriguez I, Vitous A, Kwakye G. The Hidden Burden: Qualitative Differences in How URiM Students Experience the Clinical Microenvironment. J Surg Educ 2023; 80:372-384. [PMID: 36372726 DOI: 10.1016/j.jsurg.2022.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/22/2022] [Accepted: 10/23/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION It is well documented that medical students who identify as underrepresented in medicine are more likely to encounter social challenges in the clinical environment. Successful navigation of these challenges requires a social and emotional agility that is unmeasured in traditional metrics of success. The effects of this requirement has not yet been explored. The authors therefore set out to investigate the variations in experiences that exist between underrepresented minority students in medicine (URiM) and white students, and to determine if there was a difference in the quantitative performance evaluations applied to both groups of students. METHODS This was a mixed-methods study. In the quantitative portion, the authors retrospectively analyzed the standardized patient encounter scores of medical students from a single medical school in Michigan during the years of 2016 to 2018. The authors used multivariable ordinary least squares regression models to evaluate the differences in scores by race. In the qualitative portion, students volunteered to be interviewed and self-identified their race and gender. The authors employed semi-structured interview techniques to gather information about how the student felt their cultural or ethnic background affected their experience in the clinical environment. RESULTS For the quantitative portion of this study, the authors analyzed the scores of 534 students over 4 different standardized patient encounters. The average score across all 4 standardized patient encounters was 88.7 (SD=5.6). The average score across all 4 standardized patient encounters for white students was 89 (SD=5.3), Black 87.9 (SD=7.4) Twenty-four students participated in the semi-structured interviews. Participants described feeling that the way their assessors interacted with them was largely affected by their race or gender. They also described feeling tension between how they would usually express themselves and how they were expected to in the clinical environment. When probed further, participants described various methods of adaptation to this tension including changing their hair or natural style of speech and modifying their perception of their role in the clinical environment.
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Affiliation(s)
| | - Clare E Jacobson
- Department of Surgery, University of Michigan Health System (Michigan Medicine), Ann Arbor, Michigan
| | | | - Ann Vitous
- Department of Surgery, University of Michigan Health System (Michigan Medicine), Ann Arbor, Michigan
| | - Gifty Kwakye
- Department of Colorectal Surgery, University of Michigan Health System (Michigan Medicine), Ann Arbor, Michigan.
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Frey KT, Bisconti TL. "Older, Entitled, and Extremely Out-of-Touch": Does "OK, Boomer" Signify the Emergence of a New Older Adult Stereotype? J Appl Gerontol 2023; 42:1200-1211. [PMID: 36722325 DOI: 10.1177/07334648231154044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
"OK, Boomer" is a phrase used to dismiss an older person for their perceived out-of-touch or offensive beliefs. The popularity of this retort suggests the presence of intergenerational tension; this study explores how the use of "OK, Boomer" relates to the current age stereotype literature. Results indicated that this literature base does not adequately capture how younger adults perceived the titular "Boomer," and therefore, we used interpretive phenomenological analysis to identify seven unique characteristics ascribed to "Boomers": closed-minded, argumentative, out-of-touch, offensive, critical, nostalgic, and/or conservative. Future work should monitor how derogatory age-based internet jargon influences ageism and intergenerational relations.
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Sorrell SA, Lefevor GT, Bell JH, Berg CO, Skidmore SJ. "You're not gay; You're a child of god": Microaggressions experienced by LGBTQ+ teens and their parents in the Church of Jesus Christ of Latter-day saints. Fam Process 2023. [PMID: 36725693 DOI: 10.1111/famp.12863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 06/18/2023]
Abstract
Like other teens in conservative religious environments, LGBTQ+ teens raised in the Church of Jesus Christ of Latter-day Saints (CJCLDS) likely experience unique microaggressions. Furthermore, like other conservatively religious parents of LGBTQ+ teens, active Latter-day Saint (LDS) parents who openly support their LGBTQ+ teens likely both witness microaggressions toward their teens and may personally experience microaggressions. The present study sought to understand parents' and teens' experiences of microaggressions in conservative religious contexts by focusing specifically on the microaggressions experienced by (a) LGBTQ+ teens raised in the CJCLDS and (b) their active LDS parents. Thematic analysis of separate interviews with 19 dyads of LGBTQ+ teens and their active LDS parents (38 total interviews) revealed various ways in which they experienced verbal, nonverbal, and environmental microaggressions. We highlight parents' and teens' shared experiences of microaggressions that may be uniquely related to their religious contexts, such as assumptions that LGBTQ+ teens or their parents are not faithful and exclusionary Church policies. Additionally, we identified microaggressions that specifically targeted parents of LGBTQ+ teens, such as comments suggesting parents should limit their support for their teens. Finally, we found that parents had vicarious experiences with microaggressions through witnessing or learning about microaggressions that targeted their teens. Findings highlight the ways that the religious contexts in which microaggressions occur can influence the way that microaggressions are communicated to and experienced by LGBTQ+ teens - and their parents.
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Cedeño B, Shimkin G, Lawson A, Cheng B, Patterson DG, Keys T. Positive yet problematic: Lived experiences of racial and ethnic minority medical students during rural and urban underserved clinical rotations. J Rural Health 2023. [PMID: 36702631 DOI: 10.1111/jrh.12745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF STUDY Medical students who identify as Black, Indigenous, and People of Color (BIPOC) regularly experience mistreatment and discrimination. This study sought to understand these student experiences during rotations in rural and urban underserved community teaching sites. METHODS Self-identified BIPOC medical students who completed the University of Washington School of Medicine's Rural Underserved Opportunities Program from 2019 through 2021 were invited to participate in a 60- to 90-minute focus group discussion via Zoom. From August to September 2021, 4 focus groups and 1 individual interview were conducted with a total of 12 participants. A current BIPOC medical student facilitated the sessions utilizing questions developed by the research team. Four study team members coded transcripts for key themes related to experiences of microaggressions. FINDINGS All participants reported having an overall positive experience, but everyone also witnessed and/or experienced at least 1 microaggression. Unlike those in urban placements, participants placed in rural sites expressed anxiety about being in predominantly White communities and experienced feelings of racial and/or ethnic isolation during the rotation. Participants recommended that rural preceptors identify themselves as trusted advocates and the program should prioritize placing BIPOC students at diverse clinical sites. CONCLUSIONS Medical schools must take action to address the mistreatment of BIPOC medical students in the clinical environment. Schools and rural training sites need to consider how to best support students to create an equitable learning environment and recruit more BIPOC physicians to rural practice.
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Affiliation(s)
- Brian Cedeño
- Medical Student, University of Washington School of Medicine, Seattle, Washington, USA
| | - Genya Shimkin
- Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Alexa Lawson
- Office of Rural Programs, University of Washington School of Medicine, Seattle, Washington, USA
| | - Bopha Cheng
- Office of Rural Programs, University of Washington School of Medicine, Seattle, Washington, USA
| | - Davis G Patterson
- WWAMI Rural Health Research Center, University of Washington School of Medicine, Seattle, Washington, USA
| | - Toby Keys
- Office of Rural Programs, University of Washington School of Medicine, Seattle, Washington, USA
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Baker L, Logan LD, Brooks K, Sikora A. Responding to racism, discrimination, and microaggressions: A student-designed case-based learning program. Am J Health Syst Pharm 2023; 80:98-101. [PMID: 36269036 DOI: 10.1093/ajhp/zxac304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Indexed: 01/26/2023] Open
Affiliation(s)
- Leanna Baker
- Division of Experience Programs University of Georgia College of Pharmacy Athens, GA, USA
| | - Linda D Logan
- Division of Experience Programs University of Georgia College of Pharmacy Athens, GA, USA
| | - Kay Brooks
- Division of Experience Programs University of Georgia College of Pharmacy Athens, GA, USA
| | - Andrea Sikora
- Department of Clinical and Administrative Pharmacy University of Georgia College of Pharmacy Augusta, GA.,Department of Pharmacy Augusta University Medical Center Augusta, GA, USA
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Abstract
Racial microaggressions, racially based remarks, or actions that negatively impact marginalized physicians of color (Black, Latino/a/x, and American Indian/Alaskan Natives) often go unaddressed. This article provides four strategies for how individuals and institutions can engage in anti-racism allyship: (1) be an upstander during microaggressions, (2) be a sponsor and advocate for physicians of color, (3) acknowledge academic titles and accomplishments, and (4) challenge the idea of a "standard fit" for academic faculty and research. Skills in academic allyship should be taught to all physicians throughout the educational continuum to mitigate feelings of isolation that racialized minority physicians frequently experience.
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Affiliation(s)
- Cassandra D.L. Fritz
- Division of Gastroenterology, Diversity, Equity, and Inclusion for Internal Medicine Residency Program, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
- Address correspondence to: Cassandra D.L. Fritz, MD, MPHS, Division of Gastroenterology, Diversity, Equity, and Inclusion for Internal Medicine Residency Program, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8124, St. Louis, MO 63110, USA.
| | - Shirlene Obuobi
- Division of Cardiology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Monica E. Peek
- Section of General Internal Medicine, Chicago Center for Diabetes Translation Research, MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois, USA
| | - Monica B. Vela
- Department of Medicine, The Hispanic Center of Excellence, University of Illinois College of Medicine, Chicago, Illinois, USA
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Butler PD, Wexner SD, Alimi YR, Dent DL, Fayanju OM, Gantt NL, Johnston FM, Pugh CM. Society of Black Academic Surgeons (SBAS) diversity, equity, and inclusion series: Microaggressions - Lessons Learned from Black Academic Surgeons. Am J Surg 2023; 225:136-148. [PMID: 36155676 PMCID: PMC9772234 DOI: 10.1016/j.amjsurg.2022.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 01/03/2023]
Abstract
Background: Microaggressions can target individuals based on a variety of differences and these can include sexual orientation, nationality, gender, or personal traits and are often disruptors in the healthcare setting. Methods: To address this issue, The Society of Black Academic Surgeons (SBAS) convened a series of presentations and a panel discussion by leaders from SBAS regarding the issue of microaggressions in the surgical workplace. This program was part of a monthly diversity, equity, and inclusion series produced by the Advances in Surgery Channel in alliance with the American College of Surgeons. Dr. Yewande Alimi addresses microaggressions in surgical training, Dr. Fabian Johnston talks about microaggressions in the black male physician, Dr. Lola Fayanju speaks to microaggressions and the black female surgeon, Dr. Carla Pugh discusses microaggressions in the surgical workplace, and Dr. Paris Butler presents on allyship, policies, and real solutions. Results: Specifically, through the lens of the Black surgeon experience, SBAS leaders candidly articulate and elaborate on microaggressions’ pervasiveness and the deleterious impact on the profession. Authentic opinions are rendered and constructive techniques to mitigate this challenge are provided. The concept of majority allyship is also introduced, and recommendations on how this can be operationalized is also examined. Conclusions: There are a lot of experiences that contribute to our understanding of microaggressions. We look forward to finding new ways to partner with our allies and continuing the conversation.
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Affiliation(s)
- Paris D. Butler
- Corresponding author. MPH 330 Cedar Street, BB330, New Haven, CT, 06519, USA. (P.D. Butler)
| | - Steven D. Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Yewande R. Alimi
- Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Daniel L. Dent
- Department of Surgery, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Oluwadamilola M. Fayanju
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy L. Gantt
- Department of Surgery, Northeast Ohio Medical University, Mercy St. Elizabeth Youngstown Hospital, Youngstown, OH, USA
| | | | - Carla M. Pugh
- Department of Surgery, Stanford University, Stanford, CA, USA
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Depauw H, Van Hiel A, De Clercq B, Bracke P, Van De Putte B. Addressing cultural topics during psychotherapy: Evidence-based do's and don'ts from an ethnic minority perspective. Psychother Res 2022:1-15. [PMID: 36585951 DOI: 10.1080/10503307.2022.2156307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE : Broaching-i.e., a counsellor's effort to install meaningful conversations in psychotherapy concerning one's cultural identity-is a strong predictor of positive treatment outcomes and client satisfaction, especially for minority-identified clients. Despite this understanding, the broaching literature has struggled to translate broaching principles into practical recommendations for specific behaviours and skills. The current study therefore explores the effects of broaching approaches by the therapist (i.e., direct, indirect and avoidant approach) about cultural topics including ethnicity, religion, gender expression and socioeconomic status on clients' perception of (1) the multicultural orientation of the therapist and (2) the frequency of microaggressions during therapy. METHOD : These research questions were investigated in a sample of ethnic minority clients (N = 231) who followed at least one session of mental healthcare counselling during the last 12 months. RESULTS : Findings show that indirect broaching is the overall most favourable approach, whilst avoidant broaching is consistently negatively associated with all therapy-related outcome measures. CONCLUSION : The results lay the basis for practical guidelines for broaching in psychotherapy, and provide counsellors with a foundation for having cultural conversations in an effective and respectful manner.
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Affiliation(s)
- Hilde Depauw
- Department of Developmental, Personality and Social Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Alain Van Hiel
- Department of Developmental, Personality and Social Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Barbara De Clercq
- Department of Developmental, Personality and Social Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Piet Bracke
- Department of Sociology, Faculty of Political and Social Sciences, Ghent University, Ghent, Belgium
| | - Bart Van De Putte
- Department of Sociology, Faculty of Political and Social Sciences, Ghent University, Ghent, Belgium
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Schouler-Ocak M, Moran JK. Racial discrimination and its impact on mental health. Int Rev Psychiatry 2022:1-9. [PMID: 36519290 DOI: 10.1080/09540261.2022.2155033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
There is evidence that racial discrimination at different levels has a major impact on mental health over the whole life span. It is related generally to poor health, with the relationship being particularly strong for mental health. All forms of structural, institutionalised, interpersonal and internalised racism as well as the cumulative impact of intersectional discrimination appear to be linked to mental health and well-being. Studies also show links between effects of racial discrimination and neurophysiology especially on the brain volume. All forms of racism need to be addressed in inter- and transdisciplinary ways in order to dismantle racial discrimination. This review provides an overview of these interconnections.
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Affiliation(s)
- Meryam Schouler-Ocak
- Psychiatric University Clinic of Charité at St. Hedwig Hospital Berlin, Berlin, Germany
| | - James Kenneth Moran
- Department of Psychiatry and Psychotherapy, Multisensory Integration Lab, Charité Universitätsmedizin Berlin, Berlin, Germany
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Ennis K. Addressing Implicit Bias to Acknowledge the Experience of Under-represented in Medicine Colleagues and Improve Patient Care. Int J Psychiatry Med 2022; 57:541-546. [PMID: 36056525 DOI: 10.1177/00912174221125026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article recounts episodes of implicit bias I have experienced as an emergency physician and explores how we can move in a better direction to benefit everyone. I was a toddler when my family moved to the US from Jamaica. A few years after that, I announced that I was going to be a doctor. I made this decision based on zero data. At the time, I had no idea that only 1/3 of 1% of the US population are physicians. And of that number only 2% are Black women. I walk into every patient room the same way, wearing blue scrubs & a long white coat with my name embroidered on it - visibly rubbing some hand sanitizer in so they know I care about spreading germs, a stethoscope hangs on a holster from my scrub pants and a name tag is clipped to my chest with my photo with a second bright orange tag with the word DOCTOR in all caps. "Hello, I'm Dr. Ennis, I'm the emergency physician. What brings you here today?" I greet everyone in the room & shake hands if offered and then I pause. Deliberately. I pause because the first and only thing they saw when I walked in the room was a black woman with dreads. Despite the costume, the optics I present do not say doctor. Addressing racism as it impacts the health of our patients and the sense of belonging for all our colleagues demands true effort & focus.
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Affiliation(s)
- Khama Ennis
- 6090Cooley Dickinson Health Care, Northampton, MA, USA
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Burton WM, Paschal AM, Jaiswal J, Leeper JD, Birch DA. Gendered racial microaggressions and black college women: A cross-sectional study of depression and psychological distress. J Am Coll Health 2022:1-8. [PMID: 36227726 DOI: 10.1080/07448481.2022.2133567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/24/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
Objective: We assessed the association between gendered racism, the simultaneous experience of sexism and racism, depression, and psychological distress in Black college women using an intersectional instrument, the gendered racial microaggression scale. Participants: Black college women enrolled at a predominantly white institution (PWI) in the southeastern U.S. (N = 164, response rate = 77%, mean age 21.67). Methods: We used a cross-sectional survey to explore the impact of stress appraisal and frequency of gendered racial microaggressions on depression and psychological distress using validated scales. Results: 30% reported depression and 54% reported severe psychological distress. Correlations indicate significant relationships between gendered racism, depression and psychological distress, with the strongest relation reported between the frequency of gendered racism to depression. Regression analyses suggest significant relationships between gendered racism, depression and psychological distress. Conclusion: Gendered racism has significant bearing on the mental health of Black college women attending a PWI. Implications for interventions are discussed.
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Affiliation(s)
- Wanda Martin Burton
- Capstone College of Nursing, University of Alabama, Tuscaloosa, Alabama, USA
| | - Angelia M Paschal
- Department of Health Science, University of Alabama, Tuscaloosa, Alabama, USA
| | - Jessica Jaiswal
- Department of Health Science, University of Alabama, Tuscaloosa, Alabama, USA
| | - James D Leeper
- Department of Community Medicine and Population Health, University of Alabama, Tuscaloosa, Alabama, USA
| | - David A Birch
- Department of Health Science, University of Alabama, Tuscaloosa, Alabama, USA
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Matijczak A, Tomlinson C, Pham A, Corona R, McDonald S. Relations Between Interpersonal Microaggressions, Depressive Symptoms, and Pet Attachment in an LGBTQ+ Emerging Adult Sample. J LGBT Youth 2022; 20:658-679. [PMID: 37554400 PMCID: PMC10406454 DOI: 10.1080/19361653.2022.2091078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 08/10/2023]
Abstract
Exposure to microaggressions can have detrimental impacts on the mental health of LGBTQ+ emerging adults. Positive social relationships are a well-documented protective factor that help to buffer the impact of adversity on mental health in this population. However, the role of social relationships with pets has received minimal attention in research on LGBTQ+ mental health, despite the high prevalence of pets in U.S. households. This cross-sectional study examined whether the association between interpersonal microaggressions and depressive symptoms among LGBTQ+ emerging adults varied as a function of attachment to pets across three domains: love, emotion regulation, and personal growth. We recruited 163 LGBTQ+ emerging adults (18-21 years) who lived with a cat and/or dog within the past year (98.8% sexual minority, 47.2% gender minority, 37.4% racial/ethnic minority). We found that love and emotion regulation significantly moderated the positive association between interpersonal microaggressions and depressive symptoms. Specifically, this association was only significant when love and emotion regulation were at moderate or high levels. These findings have important implications for practice with LGBTQ+ pet owners, as it suggests that high levels of pet attachment may amplify the relation between interpersonal microaggressions and depressive symptoms.
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Affiliation(s)
- Angela Matijczak
- School of Social Work, Virginia Commonwealth University, Richmond VA, USA
| | - Camie Tomlinson
- School of Social Work, Virginia Commonwealth University, Richmond VA, USA
| | - An Pham
- Children’s Hospital of Richmond, Virginia Commonwealth University, Richmond VA, USA
| | - Rosalie Corona
- Department of Psychology, Virginia Commonwealth University, Richmond VA, USA
| | - Shelby McDonald
- Department of Psychology, Virginia Commonwealth University, Richmond VA, USA
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Abstract
There is a critical disconnect between scientific knowledge about the
nature of bias and how this knowledge gets translated into
organizational debiasing efforts. Conceptual confusion around what
implicit bias is contributes to misunderstanding. Bridging these gaps
is the key to understanding when and why antibias interventions will
succeed or fail. Notably, there are multiple distinct pathways to
biased behavior, each of which requires different types of
interventions. To bridge the gap between public understanding and
psychological research, we introduce a visual typology of bias that
summarizes the process by which group-relevant cognitions are
expressed as biased behavior. Our typology spotlights cognitive,
motivational, and situational variables that affect the expression and
inhibition of biases while aiming to reduce the ambiguity of what
constitutes implicit bias. We also address how norms modulate how
biases unfold and are perceived by targets. Using this typology as a
framework, we identify theoretically distinct entry points for
antibias interventions. A key insight is that changing associations,
increasing motivation, raising awareness, and changing norms are
distinct goals that require different types of interventions targeting
individual, interpersonal, and institutional structures. We close with
recommendations for antibias training grounded in the science of
prejudice and stereotyping.
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Crane PR, Swaringen KS, Rivas-Koehl MM, Foster AM, Le TH, Weiser DA, Talley AE. Come Out, Get Out: Relations Among Sexual Minority Identification, Microaggressions, and Retention in Higher Education . J Interpers Violence 2022; 37:NP8237-NP8248. [PMID: 33092456 DOI: 10.1177/0886260520967126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Heterosexism, in the form of microaggressions, contributes to hostile, anti-lesbian, gay, bisexual, transgender, and queer (LGBTQ) college campus climates, thereby limiting sexual and gender minority students' social engagement and academic persistence. Using Tinto's model of institutional departure, we examined the degree to which experiencing microaggressions affects sexual minority college students' retention as a function of their feelings of discomfort in the classroom. Mediation analyses were performed on a subsample of data from 152 self-identified LGBTQ college students at a southern university in the United States to examine relations among experiences of self-reported microaggressions, self-rated classroom discomfort, and expressed intentions to transfer from the university. Self-reported discomfort in the classroom accounts for the relation between experiences of microaggressions and LGBTQ students' intentions to transfer from the university. Specifically, LGBTQ students who experienced microaggressions more often reported greater discomfort in their classrooms and reported fewer intentions to continue studying at their university. Universities should strive to implement campus-wide programs that help minimize microaggressions, encourage cultural competency and comfort in the classroom, and combat anti-LGBTQ prejudice to better support students in their day-to-day academic endeavors. LGBTQ students who feel safe and supported in the classroom may be protected from heterosexism and social isolation and, thereby, may be more likely to persevere in their academic pursuits.
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Affiliation(s)
| | | | | | | | - Tran H Le
- Texas Tech University, Lubbock, TX, USA
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Browne NT, Hodges EA, Small L, Snethen JA, Frenn M, Irving SY, Gance-Cleveland B, Greenberg CS. Childhood obesity within the lens of racism. Pediatr Obes 2022; 17:e12878. [PMID: 34927392 DOI: 10.1111/ijpo.12878] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/28/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022]
Abstract
Despite decades of research and a multitude of prevention and treatment efforts, childhood obesity in the United States continues to affect nearly 1 in 5 (19.3%) children, with significantly higher rates among Black, Indigenous, and People of Colour communities. This narrative review presents social foundations of structural racism that exacerbate inequity and disparity in the context of childhood obesity. The National Institute of Minority Health and Health Disparities' Research Framework guides the explication of structurally racist mechanisms that influence health disparities and contribute to childhood obesity: biologic and genetic, health behaviours, chronic toxic stress, the built environment, race and cultural identity, and the health care system. Strategies and interventions to combat structural racism and its effects on children and their families are reviewed along with strategies for research and implications for policy change. From our critical review and reflection, the subtle and overt effects of societal structures sustained from years of racism and the impact on the development and resistant nature of childhood obesity compel concerted action.
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Affiliation(s)
| | - Eric A Hodges
- UNC-Chapel Hill School of Nursing, Chapel Hill, North Carolina, USA
| | - Leigh Small
- Michigan State University College of Nursing, East Lansing, Michigan, USA
| | - Julia A Snethen
- University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, Wisconsin, USA
| | - Marilyn Frenn
- Marquette University College of Nursing, Milwaukee, Wisconsin, USA
| | - Sharon Y Irving
- Pediatric Nursing, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.,Pediatric Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Cindy Smith Greenberg
- College of Health and Human Development, California State University, Fullerton, California, USA
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Hong LJ, Rubinsak L, Benoit MF, Teoh D, Chandavarkar U, Brockmeyer A, Stevens E, Ioffe Y, Temkin SM. Gynecologic Oncology and Inclusion of Women Into the Surgical Workforce: The Canary in This Coal Mine. Front Oncol 2022; 12:789910. [PMID: 35463315 PMCID: PMC9020218 DOI: 10.3389/fonc.2022.789910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Women make up a majority of the gynecologic oncology workforce. Increasing the numbers of women in leadership has been proposed as a path towards professional gender equity. This study examined whether leadership gender and departmental infrastructure impact the work environment for women gynecologic oncologists. Methods Members of a 472-member private Facebook group “Women of Gynecologic Oncology” (WGO) who self-identified as women gynecologic oncologists provided demographics, practice infrastructure, personal experience with workplace bullying, gender discrimination, microaggressions using a REDcap survey platform. Results Of 250 (53%) respondents to this survey, most were younger than age 50 years (93.6%); White (82.2%) and non-Hispanic (94.3%); married (84.7%); and parenting (75.2%). Practice environments included academic (n=152, 61.0%), hospital employed (n=57, 22.9%), and private practice (n=31, 12.4%), and 89.9% supervised trainees. A significant percent of respondents had experienced bullying (52.8%), gender discrimination (57%) and microaggressions (83%). Age, race, ethnicity, practice setting, or mentorship were not statistically significantly associated with these experiences. Reported perpetrators were varied and included colleagues (84%), patients (44%), staff (41%), administrators (18%), and trainees (16%). Prevalence of bullying (55.0 vs 47.7%, p=0.33), gender discrimination (59.1 vs 52.3%, p=0.33) and microaggressions (83.3 vs 83.0%, p=1.00) were similar irrespective of departmental leadership gender. Conclusions Women gynecologic oncologists report a high prevalence of workplace bullying, gender discrimination and microaggressions regardless of the gender of their immediate leadership. Proactive and deliberate structural interventions to improve the work environment for surgeons who are women are urgently needed.
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Affiliation(s)
- Linda J Hong
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Lisa Rubinsak
- Division of Gynecologic Oncology, Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, United States
| | - Michelle F Benoit
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Kaiser Permanente Washington, Seattle, WA, United States
| | - Deanna Teoh
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, United States
| | - Uma Chandavarkar
- Department of Oncology, Sutter Medical Group, Sacramento, CA, United States
| | - Amy Brockmeyer
- Division of Gynecologic Oncology and Gynecology, Department of Surgery, Virginia Mason Medical Center, Seattle, WA, United States
| | - Erin Stevens
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Prevea Health, Green Bay, WI, United States
| | - Yevgeniya Ioffe
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Loma Linda University School of Medicine, Loma Linda, CA, United States
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Lui F, Anglin DM. Institutional Ethnoracial Discrimination and Microaggressions among a Diverse Sample of Undergraduates at a Minority-Serving University: A Gendered Racism Approach. Equal Divers Incl 2022; 41:648-672. [PMID: 35898568 PMCID: PMC9310196 DOI: 10.1108/edi-06-2021-0149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Ethnoracial minorities report a variety of discriminatory experiences due to systemic racism. Yet, few studies have examined whether gender and race/ethnicity interact to predict institutional discrimination and racial microaggressions through an intersectional approach. Design/methodology/approach A predominantly female (60%), ethnoracial minority (20.8% Black, 31.6% Asian, 30.8% Latina/o, 8.2% White, 6.6% Middle Eastern) sample of 895 undergraduates attending a minority-serving public university in an urban setting completed self-report measures of sociodemographic characteristics, experiences of racial microaggressions, and institutional discrimination. Findings Significant (p<.05) gender × race/ethnicity interaction effects were found in several institutional discrimination domains: Males reported more police/court discrimination overall, but gender differences in police/court discrimination were less pronounced for non-Black vs. Black students. While males tended to report more institutional discrimination than females, the reverse was true for the Middle Eastern group: Middle Eastern females reported institutional discrimination in more domains and more discrimination getting hired than their male counterparts. There was a significant race/ethnicity × gender interaction effect for environmental microaggressions: White males reported more environmental microaggressions than White females, but gender differences were not found in the overall sample. Originality This study is the first to our knowledge to assess the interactive effects of gender and ethnicity on the type of microaggressions experienced in a diverse sample that includes individuals of Middle Eastern descent. The authors highlight the range of discriminatory events that ethnoracially minoritized undergraduates experience, even at a minority-serving institution.
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Affiliation(s)
- Florence Lui
- Department of Psychiatry and Behavioral Sciences, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Deidre M. Anglin
- Department of Psychology, City College of New York and The Graduate Center, City University of New York, New York, NY, USA
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Faucett EA, Brenner MJ, Thompson DM, Flanary VA. Tackling the Minority Tax: A Roadmap to Redistributing Engagement in Diversity, Equity, and Inclusion Initiatives. Otolaryngol Head Neck Surg 2022; 166:1174-1181. [PMID: 35380882 DOI: 10.1177/01945998221091696] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Academic medical centers striving to implement diversity, equity, and inclusion (DEI) and antiracism initiatives often ask faculty to volunteer substantial time to committee work, recruitment, mentoring, community, and administrative responsibilities. These requests are not in lieu of current workload and seldom count toward scholarship; the service may go unrecognized, unrewarded, and uncompensated. URiM faculty (underrepresented in medicine) providing such service thus pay a minority tax when precious time is syphoned away from career-advancing activities and personal growth. The resulting strain on available resources has social, psychological, and monetary ramifications that can undermine the long-term objectives of DEI initiatives. We examine the facets of the minority tax, consider the current state of diversity, and present a roadmap to redistribute, reform, and reduce URiM taxation through shared engagement in DEI initiatives. Key interventions include ascribing value to DEI efforts, implementing evidence-based policies to reduce bias, and promoting mentorship, sponsorship, and allyship.
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Affiliation(s)
- Erynne A Faucett
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Department of Child Health, University of Arizona, Phoenix, Arizona, USA.,Department of Otolaryngology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Dana M Thompson
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Valerie A Flanary
- Division of Pediatric Otolaryngology, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Office of Diversity and Inclusion, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Bond MA, Haynes-Baratz MC. Mobilizing bystanders to address microaggressions in the workplace: The case for a systems-change approach to Getting A (Collective) GRIP. Am J Community Psychol 2022; 69:221-238. [PMID: 34585752 DOI: 10.1002/ajcp.12557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 07/14/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
Microaggressions present significant barriers to the entry and advancement of individuals from marginalized groups within the workplace. Their ubiquity, coupled with their harmful impact, creates an urgent need for organizations to mitigate them to foster truly equitable and inclusive work environments. In this paper, we present a bystander-focused approach to address this particular form of workplace bias. Informed by the empirical literature and grounded in socioecological principles, we underscore the importance of a systems-change approach to the development and implementation of any bystander program. We describe ways to incorporate social-ecological sensibilities into the substance of the training itself by outlining our "Get A (Collective) GRIP" framework. This framework emphasizes the need for active bystanders to employ an ecological scan that includes Assessing what happened, determining one's Goals for intervening, considering the Relationships among those involved in the incident (target/s, transgressor/s, and witness/es), taking into account the Institutional context in which the incident occurs, and being attuned to structural issues and Power dynamics within the context. Finding ways to address microaggressions that embody systemic analyses has transformative potential for the workplace and doing so through activating bystanders to alter local social norms is an area that has tremendous promise in this regard.
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Affiliation(s)
- Meg A Bond
- Department of Psychology and Center for Women and Work, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Michelle C Haynes-Baratz
- Department of Psychology and Center for Women and Work, University of Massachusetts Lowell, Lowell, Massachusetts, USA
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Gillson SL, Hautala D, Sittner KJ, Walls M. Historical trauma and oppression: Associations with internalizing outcomes among American Indian adults with type 2 diabetes. Transcult Psychiatry 2022:13634615221079146. [PMID: 35225076 DOI: 10.1177/13634615221079146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
American Indian (AI) people experience disproportionate exposure to stressors and health inequities, including type 2 diabetes (T2D) and mental health problems. There is increasing interest in how historical trauma and ongoing experiences of discrimination and marginalization (i.e., historical oppression) interact to influence AI health. The purpose of this study is to examine the relationships between historically traumatic experiences (i.e., boarding schools, relocation programs, and foster care), current reports of historical cultural loss, microaggressions, and their relationship to internalizing symptoms among AI adults living with T2D. This community-based participatory research study with five AI tribal communities includes data from 192 AI adults with T2D recruited from tribal clinics. Results from structural equation modeling revealed that personal experiences in foster care and ancestral experiences in boarding schools and/or relocation were associated with increased reports of historical loss, and indirectly associated with internalizing symptoms through racial microaggressions and historical losses. The findings highlight the importance of considering multiple dimensions of historical trauma and oppression in empirical and practice-based assessments of mental health problems.
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Affiliation(s)
| | - Dane Hautala
- Department of International Health; Center for American Indian Health, 1466Johns Hopkins University
| | - Kelley J Sittner
- Department of Sociology, 33086Oklahoma State University, United States
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Croteau TA, Morrison TG. Development of the nonbinary gender microaggressions (NBGM) scale. Int J Transgend Health 2022; 24:417-435. [PMID: 37901057 PMCID: PMC10601503 DOI: 10.1080/26895269.2022.2039339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Background: While research pertaining to nonbinary microaggressions has become increasingly comprehensive in recent years, a measure specifically assessing this construct does not yet exist.Aims: The purpose of the present research was to develop and validate the Nonbinary Gender Microaggressions (NBGM) scale, which will allow future researchers to quantitatively examine nonbinary individuals' experiences of microaggressions. Methods and Results: In Study 1 (n = 5), interviews with nonbinary individuals were conducted to explore their microaggressive experiences. The results of this study, as well as findings from previous qualitative research, were used to generate an initial pool of 92 items. In Study 2 (n = 158), a principal component analysis, which was used for item reduction, resulted in the retention of 41 items. In Studies 3 (n = 151) and 4 (n = 266), an exploratory factor analysis yielded a 23-item 5-factor solution (i.e., Negation of Identity [6 items], Inauthenticity [6 items], Deadnaming [4 items], Trans Exclusion [3 items], and Misuse of Gendered Terminology [4 items]), and a confirmatory factor analysis found that this solution demonstrates adequate model fit. Evidence of the measure's scale score reliability, convergent validity, and incremental validity also were provided. Discussion: These findings indicate that, overall, the NBGM scale is a psychometrically sound measure of nonbinary individuals' experiences of microaggressions. As such, this measure can be utilized by future researchers and clinicians to better understand nonbinary individuals' microaggressive experiences.
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Affiliation(s)
- Terri A. Croteau
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Todd G. Morrison
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada
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Anderson N, Lett E, Asabor EN, Hernandez AL, Nguemeni Tiako MJ, Johnson C, Montenegro RE, Rizzo TM, Latimore D, Nunez-Smith M, Boatright D. The Association of Microaggressions with Depressive Symptoms and Institutional Satisfaction Among a National Cohort of Medical Students. J Gen Intern Med 2022; 37:298-307. [PMID: 33939079 PMCID: PMC8811096 DOI: 10.1007/s11606-021-06786-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/31/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite substantial research on medical student mistreatment, there is scant quantitative data on microaggressions in US medical education. OBJECTIVE To assess US medical students' experiences of microaggressions and how these experiences influenced students' mental health and medical school satisfaction. DESIGN AND PARTICIPANTS We conducted a cross-sectional, online survey of US medical students' experiences of microaggressions. MAIN MEASURES The primary outcome was a positive depression screen on the 2-item Patient Health Questionnaire (PHQ-2). Medical school satisfaction was a secondary outcome. We used logistic regression to model the association between respondents' reported microaggression frequency and the likelihood of a positive PHQ-2 screen. For secondary outcomes, we used the chi-squared statistic to test associations between microaggression exposure and medical school satisfaction. KEY RESULTS Out of 759 respondents, 61% experienced at least one microaggression weekly. Gender (64.4%), race/ethnicity (60.5%), and age (40.9%) were the most commonly cited reasons for experiencing microaggressions. Increased microaggression frequency was associated with a positive depression screen in a dose-response relationship, with second, third, and fourth (highest) quartiles of microaggression frequency having odds ratios of 2.71 (95% CI: 1-7.9), 3.87 (95% CI: 1.48-11.05), and 9.38 (95% CI: 3.71-26.69), relative to the first quartile. Medical students who experienced at least one microaggression weekly were more likely to consider medical school transfer (14.5% vs 4.7%, p<0.001) and withdrawal (18.2% vs 5.7%, p<0.001) and more likely to believe microaggressions were a normal part of medical school culture (62.3% vs 32.1%) compared to students who experienced microaggressions less frequently. CONCLUSIONS To our knowledge, this is the largest study on the experiences and influences of microaggressions among a national sample of US medical students. Our major findings were that microaggressions are frequent occurrences and that the experience of microaggressions was associated with a positive depression screening and decreased medical school satisfaction.
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Affiliation(s)
- Nientara Anderson
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Elle Lett
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | - Tara M Rizzo
- Equity Research and Innovation Center (ERIC), Yale School of Medicine, New Haven, CT, USA
| | - Darin Latimore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Marcella Nunez-Smith
- Department of Internal Medicine and the Equity Research and Innovation Center (ERIC), Yale School of Medicine, New Haven, CT, USA
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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