9, 10 However, both models have been critiqued for their failure to address the structural inequalities that underlie disparities.
In response, experts have proposed that the concept of cultural humility replace cultural competency in order to shift the narrative to include providers’ self-awareness of their own unconscious and conscious biases. 8 Yet, without recognition of the role of systemic racism and providers’ own biases, this approach can lead to oversimplification of culture and perpetuation of stereotypes. 8 Cultural competency mainly focuses on knowledge acquisition about the differing values and belief systems underrepresented groups hold. Historically, individual provider bias has been managed by providing training around cultural competency. 2– 7 As a result, one possible strategy for eliminating health inequities has been to better characterize and mitigate implicit bias among health care providers. 1 Attention has turned toward mounting evidence suggesting that at the individual level, implicit bias is widespread in medicine and may negatively affect patient care. While structural issues-such as housing discrimination and criminal justice-indisputably contribute to these inequities, wide health disparities persist (e.g., hospital segregation) despite the dismantling of parts of these systems.
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Health inequities based on race, gender identity, sexual orientation, socioeconomic status, nationality, and other factors have persisted over decades, though exactly how to eliminate these inequities at their source is unknown. This innovative session improves readiness to address microaggressions by helping participants build and practice these skills in a supportive environment. Given the high self-reported prevalence of microaggressions in the clinical setting, students need the skills to respond. 001), and awareness of the clinical relevance of microaggressions ( p <. 001), improvements in familiarity with institutional support systems ( p <. 001), being unsure what to do or say ( p <. The curriculum appeared to significantly mitigate challenges associated with microaggressions, including reductions in perceived difficulty in identifying microaggressions ( p <. The majority (77%) had witnessed or experienced microaggressions in the clinical setting, and 69% reported very good or excellent familiarity with the concept of microaggressions. Preworkshop, 48% reported female gender, and 36% reported underrepresented in medicine status.
Of 163 students participating in the workshop, 121 (74%) completed the preworkshop survey, 105 (64%) completed the postworkshop survey, and 81 (50%) completed both. Participants completed electronic pre- and postworkshop surveys. The workshop consisted of a didactic portion describing microaggressions and strategies for responding to them and a case-based small-group portion to practice strategies. We created a 2-hour workshop to prepare preclinical medical and dental students to recognize and respond to microaggressions in clinical practice. Curricula tailored specifically towards medical students that raise awareness of microaggressions and aim to change behavior are absent. Microaggressions, subtle slights related to characteristics such as race, gender, or sexual orientation, in a clinical setting can sabotage the therapeutic alliance.
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