Introduction: Microaggressions, subtle slights related to characteristics such as race, gender, or sexual orientation, in a clinical setting can sabotage the therapeutic alliance. Curricula tailored specifically towards medical students that raise awareness of microaggressions and aim to change behavior are absent. Methods: We created a 2-hour workshop to prepare preclinical medical and dental students to recognize and respond to microaggressions in clinical practice. 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. Participants completed electronic pre-and postworkshop surveys. Results: Of 163 students participating in the workshop, 121 (74%) completed the preworkshop survey, 105 (64%) completed the postworkshop survey, and 81 (50%) completed both. Preworkshop, 48% reported female gender, and 36% reported underrepresented in medicine status. 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. The curriculum appeared to significantly mitigate challenges associated with microaggressions, including reductions in perceived difficulty in identifying microaggressions (p < .001), being unsure what to do or say (p < .001), improvements in familiarity with institutional support systems (p < .001), and awareness of the clinical relevance of microaggressions (p < .001). Discussion: Given the high self-reported prevalence of microaggressions in the clinical setting, students need the skills to respond. This innovative session improves readiness to address microaggressions by helping participants build and practice these skills in a supportive environment.
Over the past decade, medical schools across the United States have increasingly dedicated resources to advancing racial and social justice, such as by supporting diversity and inclusion efforts and by incorporating social medicine into the traditional medical curricula. While these changes are promising, the academic medicine community must apply an anti-racist lens to every aspect of medical education to equip trainees to recognize and address structural inequities. Notably, organizing and scholarly work led by medical students has been critical in advancing anti-racist curricula. In this article, the authors illustrate how student activism has reshaped medical education by highlighting examples of student-led efforts to advance anti-racist curricula at Harvard Medical School (HMS) and at the University of California, San Francisco (UCSF) School of Medicine. HMS students collaborated with faculty to address aspects of existing clinical practice that perpetuate racism, such as the racial correction factor in determining kidney function. They also responded to the existing curricula by noting missed opportunities to discuss structural racism, and they planned supplemental sessions to address these gaps. At UCSF, students identified specific avenues to improve the rigor of social medicine courses and developed new curricula to equip students with skills to confront and work to dismantle racism. The authors describe how HMS students, in an effort to improve the learning environment, developed a workshop to assist students in navigating microaggressions and discrimination in the clinical setting. At UCSF, students partnered with faculty and administration to advocate pass/fail grading for clerkships after university data revealed racial disparities in students' clerkship assessments. In reviewing these examples of students' advocacy to improve their own curricula and learning environments, the authors aim to provide support for students and faculty pursuing anti-racist curricular changes at their own institutions.
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