RECOGNIZING AND ADDRESSING MICROAGGRESSIONS IN THE LEARNING ENVIRONMENT

RECOGNIZING AND ADDRESSING MICROAGGRESSIONS IN THE LEARNING ENVIRONMENT

+ AGENDA Ø Welcome - Kim O’Connor, MD Ø Community Agreements - Kim O’Connor, MD Ø Framing of Learners’ Experiences and Definition of Microaggressions – Raye Maestas, MD Ø Audio Clip & Large Group Discussion - Norma. Alicia Pino, MA Ø Case Scenario Role Play & Discussion – Lynne Robins Ph. D Ø Report Back and Closing Remarks - Raye Maestas, MD

+ FACULTY Raye Maestas, MD, Interim Associate Dean Student Affairs & Professor, Department of Family Medicine Kim O’Connor, MD, College Faculty & Associate Professor, Division of General Internal Medicine Norma. Alicia Pino, MA, Director of Multicultural Education, Center for Health Equity, Diversity, and Inclusion (CEDI) Lynne Robins, Ph. D, Professor, Departments of Biomedical Informatics & Medical Education, Anesthesiology & Pain Medicine, Director, Center for Leadership & Innovation in Medical Education (CLIME) & Director, Teaching Scholars Program

+ WORKSHOP OBJECTIVES By the end of this session participants will be able to: • Define microaggressions and the harm they cause in any learning environment • Reflect upon the impact racial/gender microaggressions may have on learners • Apply the 4 R conceptual framework to racial/gender microaggressions

+ COMMUNITY AGREEMENT • Agree that we all have biases, whether we are conscious of them or not • Respect for each other • Gift of Listening and Gift of Speaking • Honesty and transparency are vital • Tell your own story, not someone else’s • If you make an error, heartfelt apologies are usually appreciated • This session is not about judging or blaming • Confidentiality

SETTING THE STAGE: STUDENT EXPERIENCES, RACIAL/GENDER BIAS, AND MICROAGGRESSIONS

Medical Student Graduation Questionnaire +Association of American Medical Colleges % Who Exhibited Behaviors of Mistreatment? 40 30 2018 National Average 20 2014 2015 2016 2017 2018 10 0 Clinical Faculty Residents Nurses Students

Medical Student Graduation Questionnaire Association of American Medical Colleges 16 Percentage of students who personally experienced negative behavior related to race one or more times in medical school… 2018 National Average Total percentage 14 12 10 2014 8 2015 6 2016 4 2017 2018 2 0 Denied opportunities Subjected to racially Received lower for training or rewards and ethnically offensive evaluations on basis of race remarks race

AAM AAMC GQ and Y 2 Q Comparison who personally experienced ed to gender or race one or medical school… Subjected to Denied racially and opportunities ethnically for training or offensive rewards on marks/names basis of race/ethnicity GQ 2018 Y 2 Q 2016 Y 2 Q 2017

MICROAGGRESSIONS The everyday verbal, nonverbal, and environmental slights, snubs, or insults, whether intentional or unintentional, that communicate hostile, derogatory, or negative messages to target persons based solely upon their marginalized group membership. * *Diversity in the Classroom, UCLA Diversity and Faculty Development 2014 10

Terms defined: Microaggression Like a dripping faucet, accumulate over time MACROAGGRESSION o Subtle, stunning, often automatic, and non-verbal exchanges which are “put-downs” o “…directed toward people of color (POC), often automatically or unconsciously” o Brief, everyday exchanges that send denigrating messages to POC o May be MORE impactful to racial anger, frustration and self-esteem than more overt acts Racial Microaggressions in Everyday Life: Implications for Clinical Practice; Sue, DW et al. American Psychologist 2007; 62: 271 -286

Kinds of microaggressions (Sue et al, American Psychologist 2007) Themes Examples Alien in own land “Where are you from? ” “You speak good English. ” Ascription of intelligence “You are a credit to your race. ” Color blindness “When I look at you, I don’t see color. ” “America is a melting pot. ” Criminality Person of color (POC) being followed in a store White person clutching bag near POC Denial of individual racism “I have black/Asian/Hispanic friends. ” Myth of meritocracy “Everyone can succeed if they work hard” “Most qualified person should get in, get position” Pathologizing culture “You shouldn’t be so loud/quiet, etc. ” Women being emotional or aggressive vs assertive 2 nd class citizen Assumption one is janitor, taxi driver, secretary etc. Environment No statues/pictures of POC in halls

+ 4 -R’S FRAMEWORK Recognize: Identify the microaggression(s) Reason: What might have been the messages heard and what is the potential impact of the aggression? Responsibility: Who is responsible and what are they responsible for? Respond: What should you do and why? What is the impact of acting or not acting?

+Audio clip from UWSOM student (3 min)

+ ACTIVITY • Use the partially completed worksheet to reflect on the microaggressions the student experienced. Example Theme Is your husband ethnic or 2 nd class citizen smart? What might be student’s experience? She was offended. When comments are personal they are more impactful.

+ Example ACTIVITY Theme What might be student’s experience? Is your husband ethnic or smart? 2 nd class citizen Ø Doctor believes that she was accepted into medical school because she was 'ethnic' not because she was smart Ø Was offended Ø Felt unwelcomed Ø Personal comments were more impactful Ø Impact on student made learning challenging for the rest of the day "Are you some kind of Mexican or Spanish? " Alien in One's Own Land Ø Student's ability to articulate lessened by offensive question and the attitude of the doctor Ø Student was shocked Ø Student didn't feel as if they belonged Ø Student disengaged ". . . too bad they let all these immigrants in, they can't get jobs or pay taxes and that's why our schools and healthcare systems don't have any money. . . " Second Class Citizen Myth of Meritocracy Ø Student may have thought that doctor was talking about her and her family - labeling her family and immigrants as inept, lazy or taking advantage Ø Doctor is blaming certain immigrants for existing social problems Ø Student felt unsafe

+ ACTIVITY Example Theme What might be student’s experience? ". . . except for the Indians Ascription of and the Asians, they can Intelligence get jobs when they get here. " • Student may worry that doctor will evaluate her as less than capable because she does not belong to one of the 'smart' groups ". . . being Mexican helped you get into medical school. " Myth of Meritocracy • Women of Color can't get into medical school on their own merits - they must be awarded unearned benefits, based on their race, to get in "I'm frequently asked if I'm the secretary at a place where I have been doing rotations for a while. " Second Class Citizen • Women of Color aren't smart enough to be doctors – they can only hold certain stereotypical roles • Women of Color are noticed – they are invisible

+ BREAK 19

+ ‘THE ATTENDING WHO TRIES TOO HARD’ CASE SCENARIO Characters: Ø Tomacita, 3 rd year medical student of color (identifies as Latina) Ø Dr. Garcia, Attending & Tomacita’s mentor (Identifies as Mexican and Indigenous) Ø Dr. Ross, Attending who sometimes supervises Tomacita (Identifies as white)

+ CASE SCENARIO DISCUSSION Facilitators: 1. Raye Maestas 2. Kim O’Connor 3. Lynne Robins 4. Norma. Alicia Pino INSTRUCTIONS FOR DISCUSSION: • Discuss the questions under the 4 -Rs. Focus on Responsibility and Respond. • Anticipate what you might say if you were to respond, from your current role and positionality.

+ REWIND ROLE PLAY

+ REASON: IMAGINE POSSIBLE IMPACT ON THE STUDENT Attempt to make meaning of event: Am I being too sensitive? Am I attacking someone as racist? If I don’t say something, will they do it again? Activation of stereotype threat: Is what they said true? Maybe I am _______. . . Adapted from slide set from Stanford Children’s Health

+ IMPACT https: //mashable. com/2015/04/16/microaggression/#yvkoq 8 Yx 2 iqs 24

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+ Poor physical/mental health 26

+ Disengagement Poor physical/mental health 27

+ Disengagement Poor physical/mental health Lack of confidence 28

+ Disengagement Poor physical/mental health Decreased performance Lack of confidence 29

+ Disengagement Lower evaluation Poor physical/mental health Decreased performance Lack of confidence 30

+ Disengagement Lower evaluation Poor physical/mental health Decreased performance Lack of confidence Can’t learn 31

+ TAKE AWAY Please share a phrase, sentence, idea about what you will take with you from today…

+ “Until we all commit to taking action every day to foster a true spirit of inclusion, we’ll risk perpetuating racial harms and undermining the true spirit of medical professionalism. I know race relations in medicine will not change overnight, but learning to see what is hidden in plain sight will be a crucial first step. ” Jennifer Adaeze Anyaegbunam, Medical Student, University of Virginia School of Medicine https: //www. statnews. com/2016/04/11/racismmedical-education/

+ ACKNOWLEGMENTS Anne Eacker, MD, Senior Associate Dean Student Affairs & Associate Professor at Kaiser Permanente, Pasadena, CA Danielle Ishem, MPH, MPA, Director of Workforce Development, Center for Health Equity, Diversity, and Inclusion (CEDI) & Director, Summer Health Professions Education Program Shobha Stack, MD, Ph. D, Acting Instructor, Division of General Internal Medicine & Associate Director, Medicine Student Programs 34