Title

The Value and Feasibility of Resident Facilitators in Formal Training on Microaggressions


Authors

Brandon Francis, MD1; Bridget Adcock, MD1; Simran Ganeriwal, MD1; Randy Ogbenna, DO1; Navin Pathak, MD1; Kaitlin Payne, MD1; Ana Yepes-Rios, MD1; David Harris, MD2; Richard Wardrop, MD, PhD, FAAP, FACP, SFHM1

1Department of Internal Medicine, Cleveland Clinic, Cleveland, OH

2Department of Palliative and Supportive Care, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH


Introduction

Microaggressions are interactions that communicate slights, insults, or invalidations to marginalized individuals. They are often subtle or automatic, leaving targets, bystanders, and perpetrators alike uncertain if a microaggression has even occurred.1 When unchallenged, microaggressions perpetuate a hostile climate, contributing to increased burnout and even suicidal ideation.2,3 Previous studies have suggested individuals address microaggressions through strategies termed “microinterventions”, which have proven to be successful.4,5,6 Unfortunately, the development of these skills is a resource-intensive exercise, requiring small group practice with trained facilitators and limiting deployment to large group settings.5 Train the Trainer (TTT) programs have been successful in delivering workshops to large groups in other settings, with residents responding positively to peer teaching of other subjects.7,8 Therefore, a TTT program was created for interested residents to learn and subsequently facilitate a resident workshop on responding to microaggressions.


Methods

The TTT program consisted of three 2-hour training sessions covering the course material and fundamental principles of small group facilitation. The workshop involved a 1-hour didactic introduction to microaggressions and microinterventions followed by a 45-minute small group session to practice effective strategies in example scenarios, with selected faculty and residents serving as facilitators of the small group sessions. Post-workshop feedback was anonymously solicited via a RedCap survey. Responses to questions were provided in either a 5-point Likert scale or confidence rating on a scale from 0 (not at all confident) to 100 (very confident). Categorical questions utilizing Likert scales were reported as percentages, while pre-session and post-session continuous variables were analyzed using Wilcoxon signed rank testing, with p < 0.05 demonstrating statistical significance.


Results

169 residents were trained over 5 sessions by 4 faculty and 12 resident facilitators, allowing for a learner-to-facilitator ratio of 11:1 and 18 completed post-workshop surveys. Residents rated their confidence in recognizing microaggressions prior to the session as 37.6, which increased to 78.4 following the session (p < 0.01). Importantly, residents' confidence in challenging microaggressions from patients (36.3 to 64.9, p < 0.01), co-residents (39 to 71.9, p < 0.01), and attendings (19.6 to 47.9, p < 0.01) increased significantly following the session. When asked whether co-residents' stories helped individuals understand the impact of microaggressions, 94.4% agreed or strongly agreed. Additionally, when asked whether individuals felt confident in their ability to be an ally for their peers experiencing microaggressions, 100% agreed or strongly agreed.


Conclusion

Implementation of a TTT model to train resident facilitators and subsequently deploy a program-wide microaggressions workshop led to significantly improved internal medicine resident confidence in recognizing and responding to microaggressions from varying sources of power. This serves as further evidence that TTT models can be successfully utilized in residency programs to empower peer teaching and meaningfully educate large groups on challenging topics. Unfortunately, the delivery of the post-workshop survey was delayed, likely contributing to the limited sample size. Future efforts should include subsequent iterations of this model with trainees from other specialties, the assessment of the longitudinal impact of the course on residents’ abilities to recognize and respond to microaggressions, and the impact on resident facilitators.


References

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