Becoming Active Bystanders and Advocates: Teaching Medical Students to Respond to Bias in the Clinical Setting

Abstract

Introduction Incidents of bias and microaggressions are prevalent in the clinical setting and are disproportionately experienced by racial minorities, women, and medical students. These incidents contribute to burnout. Published efforts to address these incidents are growing, but gaps remain regarding the long-term efficacy of these curricular models. We developed and longitudinally evaluated a workshop that taught medical students a framework to respond to incidents of bias or microaggressions. Methods In October 2019, 102 Vanderbilt core clerkship medical students participated in an hour-long, interactive, case-based workshop centered around the 3 D's response behavior framework: (1) direct, (2) distract, and (3) delegate. Participants were surveyed before and after the training, and both qualitative and quantitative data were collected. A refresher workshop was offered 8 months later, which added two additional D's: delay and display discomfort. Results After the workshop, respondents’ knowledge of the assessed topics improved significantly, as did their confidence in addressing both personally experienced and witnessed incidents. Respondents initially indicated a high likelihood of using response behaviors to address incidents. The workshop did not consistently modify behavioral responses to experienced or witnessed incidents. Ninety-one percent of respondents agreed the workshop was effective. Discussion This workshop provided an effective curriculum to sustainably improve participant knowledge and confidence in responding to incidents of bias and microaggressions. This resource can be adopted by educators at other institutions.

Active Bystander Training: Using Standardized Patient Methodology to Teach Residents to Navigate Microaggressions in Patient Encounters

“…This encourages colleagues to reflect on the ways they can uniquely intervene in the situation using their power and privilege. For educators interested in replicating this activity at their institution, the WAKE active bystander strategies can be utilized; however, the SP cases provided could also be used with other effective behavioral response frameworks in the medical education literature, such as the 5 D's (direct, distract, delegate, delay, and display discomfort) 24 and VITALS (validate, inquire, take time, assume, leave opportunities, speak up). 25 The SP cases and WAKE active bystander strategies could also be applied to other health care professional trainees.…”

“… 22 , 23 Due to its success on college campuses, active bystander intervention is also being modified to address other forms of oppression, including microaggressions related to racism, sexism, and other forms of prejudice in the clinical learning environment. 20 , 24 , 25 …”

Exploring the experiences and expectations of pharmacist interns in large general hospitals in China: from the perspective of interns

“…In terms of theoretical knowledge learning, PBL helps students enhance their interest in learning and improve their self-learning abilities [42]. CBL helps to improve students' analytical and decision-making skills [43]. The process of case discussion will also significantly improve students' cooperation, communication, and expression skills.…”

Bias at the Bedside: a Roleplay-Based Workshop for Responding to Biased Comments in the Teaching Hospital

“…Strategies for responding to biased comments from patients and families have been taught via webinars [ 9 ], scenario-based workshops [ 10 – 14 ], and reenactment [ 15 ]. None of these, however, asks participants to practice responding in real time, and only one [ 10 ] specifically confronts the challenge of addressing incidents of bias from patients with mental health conditions, whose mental status may be compromised due to mania, psychosis, delirium, or intoxication.…”