Addressing microaggressions in racially charged patient-provider interactions: a pilot randomized trial

Abstract

Background: Racial bias in medical care is a significant public health issue, with increased focus on microaggressions and the quality of patient-provider interactions. Innovations in training interventions are needed to decrease microaggressions and improve provider communication and rapport with patients of color during medical encounters. Methods: This paper presents a pilot randomized trial of an innovative clinical workshop that employed a theoretical model from social and contextual behavioral sciences. The intervention specifically aimed to decrease providers' likelihood of expressing biases and negative stereotypes when interacting with patients of color in racially charged moments, such as when patients discuss past incidents of discrimination. Workshop exercises were informed by research on the importance of mindfulness and interracial contact involving reciprocal exchanges of vulnerability and responsiveness. Twenty-five medical student and recent graduate participants were randomized to a workshop intervention or no intervention. Outcomes were measured via provider self-report and observed changes in targeted provider behaviors. Specifically, two independent, blind teams of coders assessed provider emotional rapport and responsiveness during simulated interracial patient encounters with standardized Black patients who presented specific racial challenges to participants. Results: Greater improvements in observed emotional rapport and responsiveness (indexing fewer microaggressions), improved self-reported explicit attitudes toward minoritized groups, and improved self-reported working alliance and closeness with the Black standardized patients were observed and reported by intervention participants. Conclusions: Medical providers may be more likely to exhibit bias with patients of color in specific racially charged moments during medical encounters. This small-sample pilot study suggests that interventions that directly intervene to help providers improve responding in these moments by incorporating mindfulness and interracial contact may be beneficial in reducing racial health disparities.

Culture and psychedelic psychotherapy: Ethnic and racial themes from three Black women therapists

“…Barriers to safe and effective psychedelic care include a lack of clinicians who are able to navigate challenging racial material in a non-violent matter, and a lack of awareness surrounding how to optimally utilize cultural, spiritual, and historical material as it arises. These problems point to a need for more therapists of color who understand nuanced cultural issues as they pertain to specific ethnic groups, as well as better multicultural training for all therapists, which should include education about microaggressions and the therapeutic use of FAP (e.g., Kanter et al, 2020;Williams, Reed, & Aggarwal, 2020). Some important efforts in this area have begun, but much more is needed and on a larger scale.…”

“…However, many substances currently used for psychedelic medicine are derived from plants that are considered to have sacred healing properties by indigenous groups, and are still being used by those communities today. Even manufactured psychedelic substances are derived from plants, some of which have been prized for their health benefits by indigenous peoples, such as sassafras and similar spice trees, which produce safrole oil, the source of MDMA (Kemprai et al, 2020).…”

“…One important avenue for understanding some of the other themes may lie in cultural differences in approaches to understanding the self. The North American concept of the person centers on individualism, where each person is considered autonomous and uniquely deserving the free pursuit of their own private goals; this "egocentric" notion of the person leads individuals to think about their identity primarily in terms of personal history and achievements (Kirmayer, 2007). However African cultures typically have more of a "cosmocentric" sense of self, and may therefore narrate their identity in relation to ancestors, spirits, or larger cosmic forces.…”

“…However African cultures typically have more of a "cosmocentric" sense of self, and may therefore narrate their identity in relation to ancestors, spirits, or larger cosmic forces. Of course, the different ways of construing the self are not mutually exclusive, as egocentric and cosmocentric views may exist simultaneously (Kirmayer, 2007).…”

“…When therapists are unable to make use of cultural material it can represent a lost opportunity for healing, but it is much worse when therapists actively cause harm. It has been recognized for some time that racially charged materials can provoke violence from clinicians in the form of microaggressions or other harmful actions or inactions, as therapists struggle to manage their own psychic woundedness around issues of race (Comaz-Diaz & Jacobsen, 1991;Kanter et al, 2020). Race relations in the US, Canada, and many other Western nations operate within a system whereby people of color are expected to maintain White comfort by remaining silent about past and present experiences of racial oppression (DiAngelo, 2011;Kanter et al, 2019).…”