9-21-23 MEDG: Identifying Microaggressions and Discussing Responses

September 22, 2023

ID10731

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00:00Breakout room and we are not recording
00:02anything from the breakout rooms when you
00:05move into the breakout rooms at one point,
00:07but the session will be recorded.
00:09So if you wanted to access it after
00:11the session, I'm Janet Haffler,
00:13and we now have the new Center for
00:16Medical Education that I'm thrilled about.
00:19We have incorporated all the work that
00:21we did in the teaching and Learning
00:24Center and we also now have this CME
00:27continuing medical education in the
00:29new center and it really has been
00:31under the Dean and Deputy Dean Jessica
00:33Lucy to really centralize many of our
00:36resources to reach out to more faculty.
00:39So I welcome all of you to one of
00:41our sessions now in the new Center
00:43for Medical Education and I'm really
00:46thrilled we're going to go around
00:48and introduce each of ourselves.
00:50We have a presentation that we've
00:52put together and please,
00:54if you have any questions at any
00:56point in time,
00:57please feel free to add them to
00:59the chat and we will monitor them.
01:02This is a topic I think dear to all
01:05our hearts as we think about what we're
01:08understanding about microaggressions.
01:12So we're first going to introduce
01:14ourselves and then we'll move on
01:16to the presentation and we have
01:18Doctor Diaz after the disclosure
01:20slide will give us a little bit of
01:22history of this particular project.
01:24So Tishiana, do you want to start us off?
01:27Yes,
01:27hi, I'm Doctor Tishiana Armah.
01:29I am a psychiatrist.
01:30I'm an assistant clinical
01:33assistant clinical professor in the
01:36Department of Psychiatry and and senior
01:38faculty at our Weissman Institute at
01:40Community Health Center Incorporated.
01:43And you've been with this project
01:45since your residency to Shianna.
01:47I have her residency here
01:50under Doctor Diaz. Great,
01:53Elizabeth. Hi, everyone.
01:55It's great to be with you.
01:55My name is Elizabeth Conklin,
01:57and I am the Associate Vice
01:59President for Institutional Equity,
02:01Accessibility and Belonging and also
02:03the University Title 9 Coordinator.
02:06I work closely with the School of
02:08Medicine and all of the schools
02:10within the University on both
02:12the prevention and response to
02:14discrimination and harassment,
02:16and I'm thrilled to be here with you.
02:17Thanks for having me,
02:19Esperanza. Yes, hello. I'm Esperanza Diaz.
02:23I'm a psychiatrist.
02:24I'm an associate director of
02:27Psychiatry residency program.
02:28And I'm professor of psychiatry.
02:30And I'm the Director of medical
02:32director of Hispanic Clinic at the
02:34Connector Mental Health Center.
02:37Thanks, Esperanza. And Allison,
02:39Hello. Thanks, Janet.
02:41I'm Allison Brent Fro,
02:43and I'm the executive director for our
02:45Continuing Medical Education Department
02:47here at the Yale School of Medicine.
02:49Welcome. Thank you.
02:53So, Allison, yeah.
02:56So who better to give the disclosure
02:58page than this ME Director, right.
03:01So just doing our due diligence
03:02here to let you know that none
03:05of our presenters today have any
03:07conflict of interest to disclose.
03:09I saw that Reagan had placed
03:11the texting code in the chat.
03:14If you do not have yourself set
03:16up in order to be able to text,
03:18certainly you can reach out
03:20to me after the program.
03:21We do ask that even if you
03:23don't need category one credit,
03:25please go ahead and text your
03:27attendance today because that
03:28gives us a better perspective and
03:29a picture of who actually attended
03:31and joined our session today.
03:33Thank you.
03:34Terrific. Thanks a lot.
03:37I'm just going to stop sharing
03:39for a moment because Esperanza
03:41is going to give us a very brief
03:44history of this project. Esperanza,
03:47thank you very much, Janet,
03:48and thank you for everybody being here.
03:52Yes, we've been together,
03:53working on this project for many
03:56years and it's very fulfilling.
03:58In the late 90s,
04:00the Institute of Medicine commissioner
04:03study to explore how hell these
04:05parties have changed after many years
04:07of cultural competence trainings.
04:09You might recall that the investigators
04:11found nothing had changed.
04:13Disparities in cancer treatment,
04:15maternal health, cardiovascular health,
04:17etcetera, were the same as in the 1980s.
04:21So, in response to the
04:24Institute of Medicine report,
04:26the State of Connecticut required
04:28all physicians to obtain 1 Continuing
04:31Medical Education Credit in the
04:33area of cultural competency.
04:35Policies were created to ensure
04:37that health professionals have
04:39training about disparities,
04:41the influence of rational biases,
04:43and sensitive skills to
04:45illicit health information.
04:47So in 2010,
04:49Janet to Shanna and I work together
04:52to create the first education
04:55module entitled Teaching Cultural
04:57Sensitivity in the patient Clinician
04:59relationship to fulfill the Connecticut
05:02State mandates CME requirements and
05:04importantly to educate and inform
05:07our Yale School of Medicine faculty.
05:09The module is available to all
05:11physicians through Yale CME.
05:13What we're sharing today is the
05:15expansion that we have done by
05:18creating additional education modules
05:20in collaboration with Tishianna Arma,
05:22Matthew Elman, Andrea Mendiola,
05:24Amanda Calhoun, Gary Leidon,
05:27and Dorothy de Bernardo.
05:29These materials also address verbal
05:31statements or behaviors that are harmful,
05:33the stigmatizing or discriminating
05:35against an individual who identifies
05:38with the marginalized group.
05:40Our scenarios are written from actual
05:43life experiences reported in the
05:45classroom and clinical settings.
05:47They portray common occurrences in
05:50healthcare and medical education.
05:52We will bring to your attention
05:54what constitute various forms of
05:56microaggressions and talk about
05:57how to respond to them. Thank you.
06:00Thanks so much, Esperanza.
06:02I'm going to share my screen,
06:14Allison. Yeah. So we wanted to
06:16start by just expressing what the
06:18objectives are today and what we
06:20hope to accomplish with this session.
06:23The 1st is to provide that framework
06:26and defining the term microaggression,
06:29then thinking about identifying
06:31microaggressions and helping us
06:34develop those observing skills.
06:37Next is exploring how to
06:39create that brave space,
06:40which is a term some of you may
06:42or may not be familiar with,
06:43but we'll have more on that.
06:44Tishiana is going to share the
06:46creating a brave space for our
06:48learners and how to report and
06:50even to discuss microaggressions.
06:52And then lastly
06:53we want to can
06:56we go ahead? There we go.
06:58We went. It was a secret.
07:00We want to identify the
07:02resources on how you report.
07:04If if we didn't tell you how to
07:06leave here with the mechanism for
07:08reporting and discussing your
07:10experiences with microaggression,
07:11then we've done a disservice.
07:13So we want to make sure that you know
07:15when you leave here how you can go
07:18about reporting those those instances.
07:20So let's look about think about a
07:22framework from which we're all working.
07:24So let's provide that base,
07:25base definition of what we're
07:28talking about with microaggression.
07:30And it's really coming from the work
07:32that Chester Pierce had done in 1970,
07:34which you can see the reference
07:35here at the bottom on defining
07:38microaggressions as those everyday verbal,
07:41nonverbal, environmental slights,
07:44snubs or insults.
07:46But we also would be a remiss if we
07:49didn't give a perspective that Mary
07:51Rowe had shared in 1973 where she
07:54coined the term micro inequities,
07:56which is really coming from the an
07:57extension of that microaggression theory,
08:00if you will.
08:01So think about this sometimes quiet,
08:04potentially hostile unintentional
08:08slights or snubs.
08:10The term that you might hear
08:12most recently is being dissed,
08:14something of that nature.
08:16Thanks, Allison. So there are
08:19different types of microaggressions.
08:21One is verbal that can be
08:24harmful or stigmatizing.
08:25We also might have something
08:28that's behavioral,
08:29an action or behavior that results
08:31in harm or discrimination to certain
08:34marginalized group or groups.
08:36Environmental they're expressed
08:39in society through the lack of
08:43representation and diversity or negative
08:47imagery and virtual microaggressions
08:49that present in virtual interactions
08:53or virtual work environments.
08:55So we really wanted to sort of move through
08:59these to have a common understanding
09:01because there are also subtypes
09:03that I wanted to point out to you,
09:05and this was from the racial
09:09microaggressions in everyday life.
09:11The micro assaults are deliberate and
09:14intentional slights or insults that
09:16are meant to hurt the intended victim.
09:19Micro insults are rude,
09:21insensitive comments that suddenly
09:24disrespect A person's racial
09:26heritage or identity.
09:28And micro invalidations are when
09:30someone attempts to discredit or
09:33minimize the experiences of a person
09:36who's from an underrepresented group.
09:41So as we think privately think, have you
09:47observed or experienced A microaggression?
09:50I just want to give you 15 seconds to
09:55think about that with those definitions.
10:07So hold on to that if you have observed,
10:11because we're going to take you through
10:14bystander and upstander work, Tishiana.
10:18So to continue that breakdown of terminology,
10:21we want to talk about these
10:23two additional terms.
10:24They'll focus on a lot today referring
10:27to when microaggressions are occurring.
10:29So one, when we say bystander,
10:31what are we talking about?
10:32Someone who sees or knows a
10:35behavior or something that is said
10:37is wrong but takes no action to
10:40address it right or to report it.
10:42Then we have another term, upstander,
10:44someone who recognizes that something's
10:47wrong and acts to make it right.
10:50Now another similar term you will hear
10:52used here at Yale is active bystander,
10:55where someone who recognizes A potentially
10:58harmful situation or interaction
11:00chooses to respond in a way that could
11:03positively influence the outcome.
11:04So very similar terms,
11:07active bystander or upstander.
11:09We're going to mostly use
11:11the term upstander today.
11:15And so to move along, we are going
11:18to talk a little bit about space.
11:20So you know, we put all that
11:22lingo out there because we're also
11:24going to have some discussion.
11:27I want to ask for a show of
11:29virtual hands or actual hands.
11:32In fact, now if you put your actual hand up,
11:34it will put a virtual hand up for you.
11:37A show of hands if you've ever been in
11:40a group or a meeting where they asked
11:44you to agree to honor a safe space.
11:46So any any okay,
11:47I see some hands going up. Great.
11:49Well, to make sure,
11:52even though we have some hands up,
11:53make sure we're all on the same page,
11:55you know, I will tell you what I mean and
11:58what's intended when I say safe space here.
12:01So it's it typically meant to mean
12:04it's a space that's free of bias,
12:07free of conflict, free of criticism,
12:10and free of potentially
12:12threatening ideas or conversations.
12:14And I want to just say preface this was
12:17saying they are needed at times safe spaces.
12:20They provide a retreat from ideas and
12:23perspectives that are at odds from our own.
12:25Sometimes we need that because
12:28typically we feel understood in those
12:31kinds of spaces and feel renewal.
12:34It usually works really well with
12:36likeminded people that have similar
12:37ideas and experiences and beliefs.
12:39But there are dangers. Okay.
12:42What are some of the dangers?
12:43I'm going to tell you 33 dangers,
12:46one where all that is said applies.
12:50It can become an echo chamber.
12:52So that's one way in which it can be
12:54a little dangerous and you can lower
12:56your hands at any point because I
12:57might ask you to raise them again.
13:00And then the second is that, you know,
13:03there's a likely scenario where someone
13:06in the space is different in some way,
13:10in ways that others in the space don't know.
13:13So sort of different from
13:14others in the group.
13:15And there's something that's said
13:17in the the sort of sense of,
13:20oh, this is a safe space.
13:21So I can say this that might end up
13:24making that one individual or two
13:26or three feel actually very unsafe.
13:28And then where you have very mixed company,
13:31things can be said that are not really
13:34sensitive to the experience of the few,
13:36but for the comfort of the majority
13:39in the name of being a safe space,
13:42everyone just accepts what's set.
13:45But this safe space is actually harmful
13:47and dangerous for those who are having
13:50actually can even have an emotional,
13:52and you know,
13:53I'm a psychiatrist,
13:54an emotional and even a physical reaction to
13:57what was just accepted and left on the table.
14:01Now this is an effort to make
14:02the majority feel comfortable,
14:04but that minority may left be left
14:07really felt feeling voiceless,
14:09and they will speak with their feet
14:11and withdraw in the moment mentally
14:14or ultimately withdraw physically
14:16from the environment.
14:17Now again for another show of hands,
14:19I wonder if there's anyone here who's
14:23been in that situation like that where
14:25you know it's it's supposed to be a safe
14:28space but you actually feel unsafe.
14:30All right. So we all,
14:32all I needed was one hand so.
14:34So thank you. Thank you for also
14:37sort of being vulnerable and and
14:38and and and bringing that up so you
14:41can also lower your hands again.
14:43So why do I talk about all of that?
14:46Because there's an alternative.
14:48And that alternative,
14:49one alternative that's been
14:51brought is a brave space.
14:54A brave space, in contrast to the safe,
14:56is an environment that really allows
14:58learners to engage with one another
15:00and have conversations about topics
15:02like social issues with honesty,
15:03sensitivity, respect and generosity.
15:05These brave spaces ask us to engage
15:08in uncomfortable conversations
15:10in order to learn to do better.
15:13Now accountability is essential
15:14to brace spaces and that includes
15:17accepting responsibility for one's
15:20actions and the repercussions in
15:22what we may say and a willingness
15:24to name and challenge especially
15:27oppressive ideas and recognize
15:29how one's identity and privilege,
15:30because we all carry privilege,
15:32right, impacts group dynamics.
15:34So we're going to move on to a scenario
15:37want to share with you and you're
15:39going to see it on this next slide.
15:40But I'm going to give a little different
15:42twist on it than what's exactly on that side.
15:44So, so, so listen to the scenario,
15:47the situation.
15:47So now I want you to imagine
15:50that this is a planning meeting
15:53that's held virtually in a room,
15:54a zoom room,
15:56just like we're all here
15:58today on and there is a a
16:04faculty member. We're going to
16:05say this is a faculty member,
16:07a black faculty member,
16:08and we're going to call her Joanne.
16:11And in response to a question,
16:13she proposes a new teaching strategy
16:16to incorporate into a course.
16:21Crickets.
16:24It's so quiet. No one in the meeting
16:28acknowledges this recommendation.
16:30Next a younger white male faculty member,
16:35we'll call him Tom, who has less experience,
16:39less time in the role,
16:40in fact comes from a different department,
16:42not really associated with the content
16:43of the course, but learned about
16:45it and tested to join the meeting.
16:47Really excited. Tom makes the
16:50same almost word for word comment.
16:53Now, after he repeats the same suggestion,
16:56everyone applauds the ideas.
16:57We've got messages in the chat.
16:59We've got, you know, clapping.
17:01We've got the little party.
17:03I don't even know what that's called,
17:04but you know the little
17:06party thing that comes out.
17:07And while this happens,
17:09one person sends a little side
17:11note to Joanne in the chat.
17:14That's just she's appalled.
17:16Oh my goodness.
17:17Did she just see what happened?
17:19This is a direct chat,
17:20just privately to Joanne.
17:22Now, later that day,
17:23Joanne reaches out to Tom in an e-mail.
17:26It's just a sort of feeling,
17:27not feeling good about this.
17:29And so she gently said,
17:32you know, sort of ask,
17:33was he aware what happens, you know,
17:36sort of feeling a bit frustrated by it,
17:39wondering if they could discuss.
17:42And he responds by really discounting
17:44the intent or the impact.
17:47So the question is,
17:48is this a microaggression,
17:51and if so,
17:52by whom?
17:59Think about it And then you know
18:03what type of microaggression.
18:04We just went over some terminology.
18:06What type of microaggression?
18:08Can we name it?
18:09And if you want to put put in
18:12the chat or jump in and just
18:18say if you do see this as a microaggression
18:22or and by whom you want to throw
18:24anything in the chat, we'll take it.
18:34I think it is a microaggression,
18:36I think primarily
18:37by Tom, but I wonder also about the
18:39the silence of the people in the room.
18:41And you know, who observed this One
18:43person sent a chat, but you know,
18:45but undoubtedly everybody else
18:46noticed or if they didn't that's
18:48that's problematic as well.
18:49I think it could be by both.
18:52Absolutely.
18:56And so the next thought is, you know,
18:58as an upstander and so first of all,
19:01absolutely yes, yes and yes.
19:04The, you know, Tom,
19:06all of the silence and even there's even
19:10something that feels frustrating about the
19:13person who sent a chat message to Joanne.
19:16Right. So they they saw it and they
19:18sort of discreetly just with her said,
19:20Oh my goodness, what just happened
19:22that that didn't feel good? Okay.
19:25And and again, real life scenario,
19:27real life scenario.
19:30So what would you have done
19:32in a scenario like this?
19:34How could you have been a upstander?
19:37Often times before we move on,
19:39I'll just say often times
19:40we sort of run away.
19:41And you can kind of imagine maybe
19:43that's where this person who sent
19:45the little message in the chat
19:47was we may run away from being
19:49upstander because we'll say,
19:50you know,
19:51we don't want to make anyone
19:52feel uncomfortable.
19:53The reality is that if you can
19:56feel some discomfort in that
19:57moment watching this thing happen,
19:59then the likelihood that others
20:02feel uncomfortable already is
20:04is pretty is pretty certain.
20:06And so the only person who doesn't
20:07feel uncomfortable is the one who's
20:09committing this microaggression
20:10in the in the moment.
20:11Now,
20:11sometimes they might feel a little
20:13bit uncomfortable afterward because
20:14they've sort of recognized it,
20:16but but often times that's that's
20:17pretty much the only one who's not
20:19feeling uncomfortable in the moment.
20:21Now they've succeeded to make.
20:23Everyone feel uncomfortable on top of it.
20:24So the person who has been
20:27microaggressed upon, let's say you know,
20:29feels utterly alone and typically
20:30is questioning whether or not they
20:32made it all up in their head.
20:34And perhaps they're overreacting.
20:37So we said, yes, it's a A,
20:40a microaggression,
20:41but let's let's start to talk about strategy.
20:43So there's problem. How do we address it?
20:46So first we're going to just talk
20:48about these 3R's okay to sort of
20:50summarize how we might really approach it.
20:52So keep it kind of simple, Okay.
20:54So first thing is reflecting, right.
20:57So reflecting the conversation back
20:59by asking the person who committed
21:02the microaggression what they actually
21:04meant or why they did what they did,
21:06right.
21:06So Joanne actually sort of tried that,
21:08raising awareness by informing
21:10the individual who committed the
21:12microaggression on why their
21:14actions were actually harmful, Okay.
21:16And then the final being reaffirming,
21:19reaffirming boundaries by stating
21:21what you know that certain language
21:23or behaviors really aren't tolerated
21:26and everyone deserves to be treated
21:28with respect.
21:29So that's the broad overview with the 3R's.
21:33But in situations where microaggression
21:35has occurred and the reality is
21:38they will continue to happen,
21:40folks may feel a need to have
21:42some real specific okay.
21:43So we wanted to do that as well and
21:46to sort of arm you as we're going
21:48to break out into some breakout
21:50sessions and a moment.
21:52So now we're in this brave space,
21:56learning space,
21:57taking about accountability,
21:58accepting and we want to find
22:03some strategies. First one,
22:05naming what you saw or heard, right?
22:07And that's kind of reflected in
22:09the three R's asking openended
22:11questions about it, right?
22:13So not necessarily putting a sort of
22:16judgment on it first and sort of figuring
22:18out where people are coming from so
22:20that it can sort of open some doors.
22:22And then once those openended
22:24questions are asked,
22:25another strategy that can follow it
22:27really nicely is to probe for some more
22:30clarity and then clarifying your own stances,
22:33how you feel about the situation,
22:35making it a teachable moment and then
22:38reminding folks of institutional values.
22:40Now this is adapted from a
22:42reference on the slide Ouch.
22:44And to wrap up these strategies,
22:46there's a wonderful quote that
22:48sort of sums everything up.
22:49And it says in the book the simple act of
22:53naming A bias or objecting to it on the spot,
22:57establishes a social atmosphere
22:59that discourages it.
23:01Saying nothing serves to condone it.
23:06So one strategy if you don't
23:09know what to say,
23:10you've forgotten all the things
23:12are to say potentially it's been
23:15proposed to say out and it really
23:17can sort of pause the conversation,
23:19assume the thought is also to try
23:22and assume good intent and making
23:25it really sort of individual
23:26when you're approaching it.
23:28And finally,
23:28we can't do all of this and say all
23:31of this without really addressing the
23:33resources that are right here at Yale.
23:36And so there are a number of resources
23:38to help you be an upstander or active
23:40bystander as Yale typically uses.
23:42And for that,
23:43I will turn the conversation
23:44over to Elizabeth.
23:47Thank you so much. I really appreciate
23:50the way that you frame that.
23:52So as I mentioned when I introduced myself,
23:54I oversee offices that are often in the
23:57position of responding to concerns from
23:59members of our community and wanted to
24:03make you aware of various resources.
24:05So certainly some of these things
24:07can be handled at the local level.
24:09And there's actually research,
24:10including out of the National
24:12Academies of Science,
24:13Engineering and Medicine,
24:14that suggests interrupting this behavior
24:17that can be on a lower scale compared
24:19to other types of discrimination
24:21and harassment can be a really
24:23effective way to drive culture change.
24:26It's interesting.
24:27In studies of harassment and discrimination,
24:31lack of professionalism,
24:33incivility,
24:33and microaggressions are in fact
24:36among the top risk factors for
24:39discrimination and harassment to occur.
24:41And when you think about it,
24:42that sort of makes sense.
24:44But not all scenarios are those where
24:48folks necessarily feel comfortable
24:50speaking up in the moment because of
24:53disparate power or other types of dynamics.
24:56There also can be situations that
24:58feel trickier than those that can
25:00be handled at the local level.
25:01So in addition to arming you with enhanced
25:05skills around speaking up in the moment,
25:07I like and have used the Ouch.
25:10Another strategy that I have
25:12used is simply the word wow.
25:15Things that interrupt conduct
25:17can be really helpful,
25:19but there are also people that that
25:21do this as part of their professional
25:23work and I think what makes Yale
25:25unique is that we have both local
25:27and university wide resources.
25:29So at the School of Medicine you have
25:32discrimination and harassment resource
25:33coordinators and I'm going to send the
25:36links to these after I'm done speaking.
25:38But they include Darren Lattimore,
25:40Karina Gonzalez,
25:41John Francis and Marietta Vasquez.
25:44You also have Deputy Title 9 coordinators
25:47who typically respond to concerns
25:48of sex or gender based issues.
25:50Again, Darren Lattimore,
25:52then Cindy Crusto, Megan King,
25:54and Rosemary Fisher.
25:56These folks can help think about
25:58how to navigate these situations.
26:00Perhaps engage in informal resolution,
26:02help you with a conversation
26:04or for serious conduct that's
26:07ongoing and persistent.
26:08Help to channel folks to investigative
26:11options which are offered by the
26:14University wide resources including
26:15the Office of Institutional Equity and
26:18Accessibility also known as O i.e.
26:20A.
26:20That is the office that we conduct
26:23investigations of concerns of
26:24discrimination and harassment that
26:26are more significant or persistent.
26:28The Title 9 office can provide
26:30support to anyone with concerns
26:32of sex or gender based issues.
26:34And then I want to note that the SHARE
26:36Center provides confidential support
26:38for members of the Yale community.
26:41This is for sex and gender based misconduct.
26:43It can be a good place to start when
26:46people are trying to decide how to proceed.
26:48I also want to note another local
26:51resources resource that you have,
26:53which is the Office of Academic and
26:55Professional Development, Bob Rohrbaugh.
26:57You may be here today.
26:59Really fantastic resource.
27:01We're concerns about faculty conduct.
27:04So if the concern is in particular
27:06about another faculty member that
27:08can be a great place to turn.
27:10I think the sort of main point
27:11here is that we all talk to
27:13each other where appropriate,
27:15certainly not breaking confidentiality,
27:16and we can provide resources and
27:19support at whatever level feels right
27:21to you and reach out and we will figure
27:24out with you how to provide support.
27:28And then I would just like to ensure
27:31that folks are aware that we do have
27:35official university policy speaking to our
27:38university expectations around conduct with
27:40respect to discrimination and harassment,
27:43which is prohibited. This policy
27:46includes prohibitions on retaliation.
27:48I know from overseeing thousands
27:50of discrimination and harassment
27:51cases in my career,
27:53as well as from the research,
27:54that fear of retaliation is the single
27:57biggest reason that individuals
27:59do not speak up, do not report,
28:01and as was stated earlier,
28:03let you know with their feet by
28:06leaving that something is wrong.
28:07And so we really need to create a
28:10culture within the School of Medicine
28:12and within the university where
28:14individuals are encouraged to utilize
28:16resources rather than told not to
28:19or experiencing retribution for so.
28:21Doing so.
28:21Heading off retaliation concerns that
28:23the past can be a really important
28:25part of changing culture and making it
28:28comfortable for people to speak up.
28:29You can support someone's right to
28:31report a concern without necessarily
28:33making judgment on the merits of it.
28:36Regardless of how any investigation
28:37comes out,
28:38individuals are entitled to speak up
28:40about concerns and let the folks who do
28:43inquiries and investigations do their job.
28:45So that is what I have to say.
28:47I will put a few things in the chat
28:49just so that you have the lengths to
28:51some of the resources I mentioned.
28:53Thank you so much.
28:54That's
28:54great. And thanks, Elizabeth,
28:56for mentioning our Title 9 resources here.
28:59It's very helpful.
29:00So we wanted to actually have
29:02you watch a short video.
29:04It's a small clip from the
29:06module that we created.
29:08It's a minute and a half,
29:10and this actual clip is the one
29:13that Esperanza referred to at the
29:15beginning that we have created.
29:17We want you to actually watch the video
29:20and identify any microaggressions.
29:22Some might be verbal,
29:24some might be nonverbal,
29:25but just list them in your
29:27small breakout groups.
29:28We will not be recording any
29:30of your breakout rooms.
29:32And then we're going to bring you
29:34back and discuss the microaggressions
29:36you observed in the breakout room,
29:38then return to the main room to discuss
29:41the microaggressions that you observed.
29:44And when we started this,
29:46we had the script written
29:48and it was really fun.
29:50Dorothy, you were the producer of this.
29:52And we have a wonderful array.
29:55And again,
29:56it's only going to be a minute and a half,
29:58and we're in a patient's room.
30:00But look for the microaggressions.
30:02And then we'll put you in breakout
30:05rooms of about four people.
30:12Hey, the rooms are open. And
30:14this morning I'm gonna just want I'll
30:15be the new resident taking care of you.
30:17So I'm your new Doctor going forward. Now,
30:22I hear that you had some pain last night.
30:23Can you tell me about how it is currently?
30:26What happened to Dr. Miller?
30:28He was here all last week.
30:30Doctor Miller moved on to a new service, Mr.
30:32Morton. So Doctor Cheedy's going to
30:34be taking over your care this week.
30:37Do you know when I'm going
30:38to be able to go home?
30:39Well, we'd like to get your
30:40home as soon as possible.
30:41I know you're anxious to get home,
30:43but we need to run a few more tests to
30:45be sure everything is is ready to go.
30:48I'm going to be home this weekend.
30:50It's my aunt's birthday.
30:52Unfortunately,
30:52we may not be able to get you
30:55home this weekend because you
30:57may have to run some more tests.
30:59OK. Excuse me.
31:00Who are you?
31:01I'm trying to talk to the doctor here.
31:06As I said before, I'm Dr.
31:09Cheney and I'm your new Doctor.
31:12I will be taking care of you,
31:14and so can you please
31:16tell me about your pain?
31:18You're the doctor. I'm sorry.
31:22There was a girl in here this
31:23morning that looked just like you,
31:25very articulate, just like you.
31:27She arranged the room and
31:29cleaned things up really nice.
31:36OK, so now we're going to ask
31:38you to join a breakout room.
31:41We're not recording in the
31:43breakout rooms and when you
31:44return to this main room,
31:46we're going to discuss the microaggressions.
31:48We're going to have you in
31:51the room for 8 minutes.
31:57What you observed around
32:01microaggressions maybe Kirsten,
32:03do you want to start us off.
32:06So our group pretty much said right off
32:08the bat there wasn't a lot that was micro
32:11about this scenario that there were a lot
32:13of pre overt and you know, macro level,
32:15you know assaults and and aggressions.
32:18You know ranging from initially the
32:20patient really not even not even making
32:22eye contact with or acknowledging resident
32:24physician really focusing his entire
32:26energy on the the white man in the room
32:29and using terms like honey girl you
32:32know to refer to a female professional.
32:35Miss ascribing of roles.
32:37You know and seeing that the
32:39saying oh there was a girl in here
32:40that looked looked just like you.
32:41So you know it's not my fault for
32:43getting things confused and then
32:45of course commenting that she
32:47was articulate just like you.
32:48So just just a little barrage
32:49of of microaggressions there.
32:52We
32:52felt disappointed I think too that the that
32:55the person with the most
32:56power privilege in the room,
32:58the attending also wasn't a very
33:00active upstander in this in this case.
33:02And we thought could have could have
33:04done maybe a more sort of job of
33:07you know backing up the resident and
33:09empowering her in this situation and
33:11and redirecting the patient you know to
33:13to the role that that that she played.
33:16It was it was definitely a
33:17tough tough video to watch.
33:18And then we we also discussed the
33:20response of the medical student a
33:22little color in the back of the room.
33:23He was clearly based on her body
33:24language and eye contact, you know,
33:26very disturbed by what was going on,
33:28I think, and seeing how the
33:29resident was treated and again,
33:30how the person with the most our
33:34privilege in the room didn't really act
33:36as a bit up standard in that situation.
33:38Thanks, Kirsten.
33:39Yeah, the medical student,
33:40I don't know, Jen,
33:41do you have anything to add?
33:42That was pretty comprehensive,
33:43but anything from your
33:45group and we'll just open
33:46it up to other reflections.
33:48I think we
33:49agree with what Kirsten was saying.
33:50We really felt that the
33:52microaggression was coming
33:54from the senior faculty
33:55member because his blatant
33:57disregard for what's going on and not being
34:00an upstander was really a microaggression.
34:03And we were discussing who was
34:06there that could have responded to
34:07it and would have felt comfortable
34:09given the hierarchy that was present
34:11and is always present on medical
34:13rounds and how they could have done
34:15it in a way that felt comfortable.
34:17You know, both the the patient and
34:19the senior faculty member needed to
34:21be addressed in the situation and and
34:24neither got addressed for their behavior.
34:27Thanks Jen. Other comments or reflections,
34:31I think there's an institutional
34:33microaggression that's not
34:34been addressed here as well.
34:36I don't think that there's been
34:38any standardization of how we
34:40should walk into a patient's room,
34:42how we should all be dressed.
34:45Are there differences in
34:47hierarchical changes that take
34:49place by the positioning, the order?
34:51I think we can do a better job
34:54in designing a process that will
34:57enable the opportunity for people
34:59to be more potent upstanders.
35:02By standardizing how it is we position
35:06ourselves and introduce ourselves and
35:08set expectations for a conversation.
35:12Thanks Michael. I'm going to push
35:13a little bit on that because
35:15it's a really important comment.
35:17How could we do that?
35:22Well, I I I think that there are
35:24are lots of different ways in which
35:26we need to think about doing it.
35:28We should have a better concept of what
35:31is an appropriate team teaching size,
35:33how it is that attendings are taught
35:37to introduce members of the team or
35:40who's the person who's going to be
35:42doing the introductions to the team.
35:44I don't think we've standardized
35:47any of those processes and and we
35:49certainly don't witness it in a
35:52way that real time feedback could
35:54be afforded to the members of that
35:57team to help address those issues.
36:01Thanks, Michael, John wrote.
36:02Wow, a great point.
36:04And Jen has written radical transparency.
36:07Provide feedback to all
36:09team members every time.
36:11Thanks. Other comments,
36:12These are really important comments.
36:18One of the big things that I think
36:20needs to be addressed is also how is the
36:24doctor patient relationship going to be
36:26salvaged after this this point, right?
36:29How is or who is going to
36:31take the lead in you know,
36:33establishing then a relationship
36:36because because it has now you know been
36:41macro aggressively, you know disrupted.
36:44And so how do we make sure that this
36:47patient albeit you know aggressive gets
36:50the best treatment because we have to
36:53do no harm and yet give the the respect
36:57and the position that each one of the
37:00people in the room necessitates to be
37:03able to do their their work right.
37:05And and the other point is just and
37:09maybe this is more from a child psych
37:12perspective just in going back to the
37:15previous point is leading by example,
37:17you know kind of like modeling
37:19the behavior that is expected.
37:21We are in a teaching environment,
37:22so always modeling the behavior and
37:24knowing that people are always going to
37:26be looking to us to model the behavior
37:29especially if we are the adult in the
37:31room or the senior person in the room.
37:33We are modeling that behavior to everyone.
37:37And I think role modeling
37:38is probably one of the most
37:40powerful forms of teaching.
37:41So thanks for pointing that out.
37:43Other comments,
37:46I
37:54just wanted to make the one point
37:56which is that in this these
37:59modules we go over different ways
38:02that the attending addresses it,
38:06the how the resident reacts.
38:08So there are different scenarios and
38:10some of the things that you're talking
38:12about also end up getting pointed out.
38:15But these are such great,
38:17great points that folks have made. Thanks
38:19Tishiana. On that, you can actually
38:22use this QR code to access the online
38:26modules to complete the three sessions.
38:29You only saw a clip and a half out of
38:33the second one about microaggressions,
38:35but we also talk about discussing responses,
38:37which is really important,
38:39what Anjali and others have mentioned,
38:41what we really didn't address,
38:43Michael and your points really
38:45important are the systems issues.
38:46So we have to think more about that together.
38:49And as you do this and take the QR code,
38:52if you just go into the chat,
38:54we would really appreciate you filling out a
38:57very short evaluation of the session today.
39:00We cherish the feedback and it's such
39:02an important topic and there's so many
39:05experts that we have in the room today
39:07and we just want to continue to work
39:10together and think about how we can
39:13constantly improve the learning environment.
39:15And I love when Tishiana really helped
39:18us think more about Brave Space.
39:21And I want to thank, thank the team,
39:22what an amazing group to help put
39:25this together.
39:26But please,
39:27these are online modules in and they're
39:30all CME related and they're all free.
39:32And so you can browse through these.
39:35So I thank you all for attending
39:37the session today.
39:38And please,
39:39please fill out the eval.
39:40We do want your feedback and I hope
39:43that you found this helpful.
39:45And Jana, I just wanted to add
39:47that you can also access the
39:49modules without getting credit.
39:50You can always just get the material,
39:52which I think is important.
39:53And you know, we just want to make
39:54sure that you get the information.
39:57Terrific. Thanks, Allison.
40:04I'll leave this up for a moment
40:10and we're happy to answer any other
40:12questions if before you leave.