Acknowledging and Addressing Microaggressions: A Virtual Experiential Learning Approach for Faculty.

Introduction: Although the ACGME and other accrediting organizations are increasingly emphasizing the importance of clinical learning environments that value diversity, equity, and inclusion, faculty development surrounding behavioral skills that promote inclusivity in the learning environment still needs cultivation. We designed a virtual longitudinal faculty development curriculum focused on direct observation, feedback, and practice of behavioral skills to acknowledge and address microaggressions in the learning environment. Methods: We used Kern's six steps of curriculum development to create four voluntary virtual workshops offered twice throughout the academic year, with topics including: (1) recognizing and naming microaggressions, (2) apologizing when harm has been experienced, (3) setting expectations surrounding microaggressions, and (4) debriefing microaggressions. Participant learners included residency program directors, associate program directors, and other leaders across all medical and surgical departments from one institution. Results: Thirty-one faculty from 10 departments participated in this yearlong curriculum. Pre- and postworkshop surveys analyzed participants' self-assessments of confidence and comfort in applying learned skills. Participants were more confident in openly naming bias, delivering expectations surrounding microaggressions, and debriefing microaggressions with learners. Participants also reported greater comfort in apologizing to learners when harm has occurred in public, in person, and electronically. Discussion: To create an inclusive learning environment, faculty can increase their comfort and confidence with addressing bias and microaggressions through practice and feedback. Our curriculum demonstrates how experiential learning allows for continual practice to solidify a new skill.

Responding to Bias: Equipping Residents With Tools to Address Microaggressions.

Introduction: Resident physicians frequently experience bias at work, with patients and families often being the source. Women and other trainees underrepresented in medicine are disproportionately impacted by these negative experiences, and experiencing bias contributes to resident physician burnout. Unfortunately, many resident physicians feel inadequately prepared to respond to bias. Methods: We developed a 45-minute, peer-led, case-based workshop that equipped trainees with tools to respond to patient-expressed bias. Our toolkit centered on resident physicians by including an assessment of the trainee's emotional well-being, a team-based response, and an embedded debrief. The toolkit provided resident physicians with possible responses to bias directed towards themselves (bias-towards-self) or bias directed towards others (bias-towards-others). Surveys were administered pre- and postworkshop to assess change in participants' comfort in responding to patient-expressed bias. Results: Thirty-seven residents completed both surveys. The workshop significantly increased comfort in responding to bias-towards-self (p < .001; 95% CI, 1.00-1.50) and bias-towards-others (p < .001; 95% CI, 1.00-1.50). Discussion: We improved resident physicians' comfort responding to patient bias-towards-self and bias-towards-others through a toolkit and workshop designed specifically for trainees. The toolkit centers the resident physician perspective, incorporates clinical context, and embeds a debrief. Our novel approach situates the toolkit's teaching in a highly scalable, case-based workshop.

Racial microaggressions within the UK Healthcare System: a narrative review.

Racial microaggressions are subtle and everyday actions that communicate derogatory messages or assumptions based on an individual's race. These seemingly minor acts, often unintended, can accumulate to undermine patient well-being and contribute to healthcare disparities. They are the unnoticed comments, gestures, or attitudes that carry significant impact. Through a systematic analysis of the literature, we highlight the insidious nature of racial microaggressions and their impact on healthcare outcomes. The objectives of this paper are to: • Present real-life instances from research to showcase the tangible effects of racial microaggressions. • Identify the everyday scenarios within healthcare interactions where racial microaggressions often occur. • Emphasise the need for recognition and understanding of these biases for fostering better patient-provider relationships. Also, by analysing the fundamental elements underpinning racial microaggressions such as systems, interactions, vulnerabilities and consequences, we explore the implications it has on healthcare policy and management. Most importantly, we address the importance of identifying and tackling racial microaggressions in order to create a more inclusive healthcare environment.

Testing for Measurement Invariance (MI): Do the Structures of Microaggression, Discrimination, and Resilience Among Black Women Living with HIV Remain the Same Across Time?

Assessing measurement invariance and the interplay of discrimination, microaggressions, and resilience among Black women living with HIV (BWLWH) across time utilizing latent class and repeated measure analysis may provide novel insights. A total of 151 BWLWH in a southeastern U.S. city completed surveys focused on multiple forms of microaggressions and discrimination (race, gender, sexual orientation, or HIV-related) and resilience factors (social support, self-efficacy, post-traumatic growth) at baseline, 3 months, and 6 months. To capture the psychosocial domains of discrimination, microaggressions, and resilience, three latent factors were developed and measured across three time points. Latent class analysis was also conducted to identify and compare meaningful subgroups based on varying levels of discrimination, microaggressions, and resilience reported. Three latent classes were created. MI testing suggested that measurement invariance was partially met (established metric invariance and scalar invariance), and it is possible to compare factor means of discrimination, microaggressions, and resilience across time. Latent factor mean scores of microaggressions and discrimination decreased after 3 and 6 months and increased for resilience after 6 months and varied over time across the three latent classes identified. The subgroup with the lowest level of discrimination and microaggressions and the highest level of resilience reported at baseline, experienced increases in resilience after months 3 and 6. Clinical interventions, research, and policies aimed at promoting resilience and reducing structural and social barriers linked to racism, sexism, HIV stigma, and classism are needed to improve the health and well-being of BWLWH.

Status of LGBTQ+ inclusion: Multi-institution Assessment of US Radiology Residencies.

INTRODUCTION: An inclusive residency program is crucial to the recruitment and retention of competitive and diverse applicants. The radiology LGBTQ+ inclusion audit was published in 2022, which provided a roadmap for assessing the inclusivity of a program's policies, facilities, culture, and engagement. In this multi-institutional trial, we detail the results of the LGBTQ+ inclusion audit for nine US radiology residency programs. METHODS: A volunteer cohort of academic radiology programs was recruited through the Radiology Residency Education Research Alliance. The LGBTQ+ inclusion audit was modified to apply to a multi-institutional study. Participating programs performed the audit from December 2023-February 2024. A pre- and post-audit survey were distributed to capture participants subjective assessment of inclusivity at their programs. RESULTS: Nine US radiology residency programs completed the audit. Audit scores ranged from 6/10 to 9/10; no program received a perfect 10/10 score. Inclusive facilities and institutional culture scored highly, with 8/9 programs reporting all milestones met in these areas. The lowest performing areas were department culture and community engagement with only 3/9 and 4/9 programs reporting "all milestones met". After the audit, programs overall reported improved self-perceived inclusivity, with post-audit survey scores increasing in areas related to department policy, inclusive facilities, and LGBTQ community outreach. DISCUSSION: Participating radiology residency programs demonstrated an overall high level of LGBTQ+ inclusivity, however all programs identified inclusion shortcomings in department policy and practice. Intentional review of a department can be a helpful tool to promote a welcoming and healthy environment for a diverse radiology practice.

A biobehavioral observational study to understand the multilevel determinants of cardiovascular health in Black women: the BLOOM Study protocol.

BACKGROUND: The racial/ethnic and gender disparities in cardiovascular disease (CVD) morbidity and mortality in the United States are evident. Across nearly every metric, non-Hispanic Black women have poorer overall cardiovascular health. Emerging evidence shows a disproportionately high burden of increased CVD risk factors in Black women of childbearing age, which has a far-reaching impact on both maternal and child outcomes, resulting in premature onset of CVD and further widens the racial disparities in CVD. There is growing recognition that the fundamental driver of persistent racial/ethnic disparities in CVD, as well as disparities in behavioral risk factors such as physical activity and sleep, is structural racism. Further, the lived personal experience of racial discrimination not only has a negative impact on health behaviors, but also links to various physiological pathways to CVD risks, such as internalized stress resulting in a pro-inflammatory state. Limited research, however, has examined the interaction between daily experience and health behaviors, which are influenced by upstream social determinants of health, and the downstream effect on biological/physiological indicators of cardiovascular health in non-pregnant Black women of childbearing age. METHODS/DESIGN: The BLOOM Study is an observational study that combines real-time ambulatory assessments over a 10-day monitoring period with in-depth cross-sectional lab-based physiological and biological assessments. We will use a wrist-worn actigraphy device to capture 24-h movement behaviors and electronic ecological momentary assessment to capture perceived discrimination, microaggression, and stress. Blood pressure will be captured continuously through a wristband. Saliva samples will be self-collected to assess cortisol level as a biomarker of psychological stress. Lab assessments include a fasting venous blood sample, and assessment of various indices of peripheral and cerebral vascular function/health. Participants' address or primary residence will be used to obtain neighborhood-level built environmental and social environmental characteristics. We plan to enroll 80 healthy Black women who are between 18 and 49 years old for this study. DISCUSSION: Results from this study will inform the development of multilevel (i.e., individual, interpersonal, and social-environmental levels) lifestyle interventions tailored to Black women based on their lived experiences with the goal of reducing CVD risk. GOV IDENTIFIER: NCT06150989.

Measuring Propensity to Perpetrate Microaggressions Toward LGBTQ Individuals: Sexual Orientation Microaggression Scale (SOMS-P) and Gender Identity Microaggression Scale (GIMS-P) Perpetration Version.

This study is an initial psychometric evaluation of the Sexual Orientation Microaggression Perpetration Scale (SOMS-P) and Gender Identity Microaggression Perpetration Scale (GIMS-P). Using data from 2,059 undergraduate students (Mage = 21.37, SD = 4.98; Range 18-68; 78.6% assigned female at birth, 13.3% self-identified as sexual minority person), item factor analysis for binary indicators and model comparisons indicated that a correlated four- and five-factor solution for the SOMS-P and GIMS-P, respectively, outperformed a one-factor and higher-order solutions. SOMS-P and GIMS-P scores were positively associated with self-reports of bullying, violence perpetration, and hostile attitudes toward individuals who self-identify as sexual or gender minorities. They were negatively associated with attitudes supportive of sexual or gender minority persons. Reliability of .80 and higher was observed only for theta values between + 0.40 to + 2.60 SD. The psychometric evaluation showed that, while there remain to be opportunities to examine their validity across diverse contexts, SOMS-P and GIMS-P are sound measures of the propensity for SOGI microaggression.

Exploring racial microaggression experiences among ethnic minority nursing students: A descriptive phenomenological study.

BACKGROUND: The increasing pursuit of enhanced educational opportunities has led to a significant rise in international student enrollment in various fields, including nursing. Nursing is currently in its early stages and faces challenges related to racial microaggression. Understanding the dynamics of racial microaggression is crucial in countries like Turkey, where students from diverse ethnic backgrounds are accommodated. OBJECTIVE: To explore and achieve a more profound insight into the lived encounters of ethnic minority nursing students confronting racial microaggression. METHOD: The study employed a descriptive phenomenological approach. Data collection involved conducting in-depth interviews from February 1, 2023, to June 1, 2023. Analysis was performed utilizing Colaizzi's analysis method. RESULTS: Each participant in the study encountered at least one type of microaggression. The analysis identified three clear themes: "challenges in social interactions," "unfavorable learning atmosphere," and "aspirations for the future." CONCLUSION: This study highlights the crucial need to establish secure and inclusive environments that foster authentic discussions within academic settings. Faculty and educators should strengthen their ability to consider diverse perspectives in various scenarios. Moreover, integrating an up-to-date and comprehensive curriculum, along with the adoption of inclusive language, into the nursing program is essential for effectively addressing these concerns.

Perceived discrimination and quality of life for African American and Caucasian American cancer patients: a coping mediation analysis of subtle and overt microaggressions.

OBJECTIVE: Perceived discrimination (PD; e.g. racism, agism, sexism, etc.) negatively impacts quality of life (QOL) among cancer patients. Prior research has established that for African American Cancer Patients (AACPs) only disengagement/denial coping mediated the PD-QOL relationship. In contrast, for Caucasian American Cancer Patients (CACPs), both agentic and disengagement/denial coping were mediators of the PD-QOL relationship. However, according to social constraint theory there may be a difference between subtle and overt PD in terms of the utility of certain coping mechanisms in relation to QOL, especially for AACPs. METHOD: 217 AACPs and 121 CACPs completed measures of PD, coping (agentic, disengagement/denial, adaptive disengagement) and QOL. PD items were classified as subtle or overt microaggressions. PD was mainly attributed to race/ethnicity by AACPs and to income, age, and physical appearance for CACPs. RESULTS: : In both subtle and overt microaggression models with CACPs, agentic coping and disengagement/denial coping were significant mediators of PD-QOL. Like CACPs, for AACPs, agentic and disengagement/denial coping were significant in the context of subtle microaggressions. In contrast, for overt microaggression only disengagement/denial coping was a significant mediator of the PD-QOL relationship for AACPs. Adaptive disengagement was related to QOL only for AACPs. CONCLUSIONS: : Whereas more research is needed, it appears that overt microaggressions for AACPs, that consist mainly of racial and ethnic maltreatment, constitute a class of social contexts that may raise above the threshold for serious threat and harm, and, as a result, disengagement/constraint may reduce negative consequences. This additional burden for AACPs contributes to disparities in QOL. Future research is needed on the utility of adaptive disengagement for AACPs in relation to PD.

Workplace microaggressions: results of a survey of the American College of Surgeons members.

BACKGROUND: Workplace microaggressions are a longstanding but understudied problem in the surgical specialties. Microaggressions in health care are linked to negative emotional and physical health outcomes and can contribute to burnout and suboptimal delivery of patient care. They also negatively impact recruitment, retention, and promotion, which often results in attrition. Further attrition at the time of an impending surgical workforce shortage risks compromising the delivery of health care to the diverse US population, and may jeopardize the financial stability of health care organizations. To date, studies on microaggressions have consisted of small focus groups comprising women faculty or trainees at a single institution. To our knowledge, there are no large, multiorganizational, gender-inclusive studies on microaggressions experienced by practicing surgeons. OBJECTIVE: This study aimed to examine the demographic and occupational characteristics of surgeons who do and do not report experiencing workplace microaggressions and whether these experiences would influence a decision to pursue a career in surgery again. STUDY DESIGN: We developed and internally validated a web-based survey to assess surgeon experiences with microaggressions and the associated sequelae. The survey was distributed through a convenience sample of 9 American College of Surgeons online Communities from November 2022 to January 2023. All American College of Surgeons Communities comprised members who had completed residency or fellowship training and had experience in the surgical workforce. The survey contained demographic, occupational, and validated microaggression items. Analyses include descriptive and chi-square statistics, t tests, and bivariable and multivariable logistic regression. RESULTS: The survey was completed by 377 American College of Surgeons members with the following characteristics: working as a surgeon (80.9%), non-Hispanic White (71.8%), general surgeons (71.0%), aged ≥50 years (67.4%), fellowship-trained (61.0%), and women (58.4%). A total of 254 (67.4%) respondents reported experiencing microaggressions. Younger surgeons (P=.002), women (P<.001), and fellowship-trained surgeons (P=.001) were more likely to report experiencing microaggressions than their counterparts. Surgeons working in academic medical centers or health care systems with teaching responsibilities were more likely to experience microaggressions than those in private practice (P<.01). Surgeons currently working as a surgeon or those who are unable to work reported more experience with microaggressions (P=.003). There was no difference in microaggressions experienced among respondents based on surgical specialty, race/ethnicity, or whether the surgeons reported having a disability. In multivariable logistic regression, women had higher odds of experiencing microaggressions compared with men (adjusted odds ratio, 15.9; 95% confidence interval, 7.7-32.8), and surgeons in private practice had significantly lower odds of experiencing microaggressions compared with surgeons in academic medicine (adjusted odds ratio, 0.3; 95% confidence interval, 0.1-0.8) or in health care systems with teaching responsibilities (adjusted odds ratio, 0.2; 95% confidence interval, 0.1-0.6). Among surgeons responding to an online survey, respondents reporting microaggressions were less likely to say that they would choose a career in surgery again (P<.001). CONCLUSION: Surgeons reporting experience with microaggressions represent a diverse range of surgical specialties and subspecialties. With the continued expansion of surgeon gender and race/ethnicity representation, deliberate efforts to address and eliminate workplace microaggressions could have broad implications for improving recruitment and retention of surgeons.

A Conditional Process Analysis of Microaffirmations, Microaggressions, and Mental Health Among Thai Sexual Minorities.

Sexual orientation (SO) microaggressions contribute to mental health issues among sexual minorities. Microaffirmations may mitigate these effects, with internalized heterosexism and SO concealment proposed as mediators. A community sample of 307 Thai sexual minorities completed measures assessing SO microaggressions, microaffirmations, internalized heterosexism, SO concealment, and mental health concerns. Serial mediation analysis using Hayes' PROCESS macro model 6 tested indirect effects through proposed mediators. Conditional process analysis using PROCESS model 85 examined the moderating role of microaffirmations. These models tested hypothesized moderated serial mediation relationships among study variables. SO microaggressions had a total effect on mental health concerns, directly and indirectly through increased SO concealment. The internalized heterosexism → SO concealment sequence mediated this relationship. Microaffirmations moderated the direct microaggressions-mental health link, reducing this association at higher levels of microaffirmations. The full model accounted for 31.6% of the variance (R2 = 0.316) in mental health concerns. The Johnson-Neyman technique identified 0.613 as the microaffirmations value above which the effect of SO microaggressions on mental health was no longer significant. Findings elucidate mechanisms linking SO microaggressions to mental health issues and microaffirmations' protective role among Thai sexual minorities. These results could inform efforts to mitigate minority stress impacts.

An obscured obstacle-Prevalence and nature of micro aggressions amongst healthcare professionals.

INTRODUCTION: Microaggressions create negative consequences on the mental health of individuals who experience them, such as feelings of alienation, frustration and low self-esteem. Physicians worldwide are negatively impacted by the detrimental effects of microaggressions and implicit bias. It is imperative to establish the prevalence specificity of the problem hence the aim of this study is to determine the prevalence, nature and determinants of microaggressions amongst healthcare professionals. METHOD: The study used an online anonymous survey to collect data including demographics, awareness of the term, experience of microaggression, acts and response. The research findings were analyzed using univariate and multivariate analyses using Chi-square test and binary logistic regression respectively. RESULT: A total of 443 participants (40.9% males, 59.1% females) included 403 physicians (91%), 21 dentists (4.7%), 15 nurses (3.4%) and 4 pharmacists (0.9%). More than half of the participants (59.8%) were aware of the term micro-aggression. The percentage was significantly higher among respondents from the western region of Saudi Arabia than the Gulf/Middle Eastern countries. Approximately 38.1% of the participants experienced microaggression and more than half (55.62%) did not report experiencing microaggression. The most common form of microaggression was passive-aggressive behavior (80.5%) followed by invalidation of an opinion (73.4%). Among those who experienced microaggression, (12.9%) reported anger as the most predominant emotional response. CONCLUSION: Microaggression is a universal phenomenon. Further research is necessary to determine its prevalence in other countries to establish a comprehensive understanding of its cultural context.

Harmonizing Assessments of Everyday Racial Discrimination Experiences: The Multigroup Everyday Racial Discrimination Scale (MERDS).

Reliable and valid assessment of direct racial discrimination experiences in everyday life is critical to understanding one key determinant of ethnoracial minority health and health disparities. To address psychometric limitations of existing instruments and to harmonize the assessment of everyday racial discrimination, the new Multigroup Everyday Racial Discrimination Scale (MERDS) was developed and validated. This investigation included 1,355 college and graduate students of color (Mage = 21.54, 56.0% women). Factor analyses were performed to provide evidence for structural validity of everyday racial discrimination scores. Item response theory modeling was used to investigate item difficulty relative to the level of everyday racial discrimination, and measurement error conditioned on the construct. MERDS scores were reliable, supported construct unidimensionality, and distinguished individuals who reported low to very high frequency of everyday racial discrimination. Results on the associations with racial identity and psychopathology symptoms, and utility of the scale are discussed.

Characterizing Asian American medical students' experiences with microaggression and the impact on their well-being.

PURPOSE: This mixed-methods study quantified and characterized incidents of microaggressions experienced by Asian American medical students. The authors report on their impact and suggest improvements to create a more equitable and supportive learning environment. METHOD: Quantitative and qualitative data were collected from 305 participants who self-identified as Asian American or Pacific Islander. An online, anonymous survey was sent to US medical students through the Asian Pacific American Medical Student Association (APAMSA). Questions explored incidence, characteristics of, and response to microaggressions. We conducted four focus groups to further characterize students' experiences. Data were organized and coded, and thematic analysis was used to identify core themes. RESULTS: Racial microaggressions were prevalent among Asian American medical students. Nearly 70% (n = 213) of survey respondents reported experiencing at least one incident during their medical training to date. The most common perpetrators were patients (n = 151, 70.9%) and fellow medical students (n = 126, 59.2%), followed by professors (n = 90, 42.3%). The most prevalent themes included being perceived as a perpetual foreigner, the assumption of timidness, and ascription of the model minority myth. Students rarely reported the incident and usually did not respond immediately due to fear of retaliation, uncertainties about the experience or how to respond appropriately, and perception that they would bear the burden of advocacy alone. Experiences with microaggressions led to feelings of frustration and burnout and had a negative impact on mental health. Recommendations were made to improve the anonymous reporting systems in medical schools, and to increase diversity and inclusion in medical education and leadership. CONCLUSIONS: Asian American medical students face high exposure to racial microaggressions during their medical education that adversely impact their mental health. Changes are needed in medical training to create a more equitable and inclusive learning environment.

Microaggressions in European versus American Workplace Environments of Otolaryngology-Head and Neck Surgery.

Objective: To compare the workplace experience of European and U.S. members of the otolaryngology community. Methods: European and U.S. otolaryngologists-head and neck surgeons (OTO-HNS) were surveyed through three otorhinolaryngological societies. We inquired about personal and observed experiences of differential treatment in the workplace related to age, biological sex, ethnicity, disability, gender identity, political belief, and sexual orientation. Results were compared according to the world region. Differential treatment was used as a proxy for microaggressions. Results: A total of 348 practitioners participated in the survey: 148 American and 230 European OTO-HNS. European OTO-HNS reported significantly higher proportions of observed or personal experiences of differential treatment based on age (p = .049), language proficiency (p = .027), citizenship (p = .001), hair texture (p = .017), height/weight (p = .002), clothing (p = .011), and professionalism (p = .002) compared with U.S. OTO-HNS. Differential treatment related to political belief (p = .043), socioeconomic status (p = .018), and ethnicity (p = .001) were higher in the United States compared with Europe. Feelings of exclusion (p = .027) and consideration of leaving their position (p = .001) were significantly higher in the United States compared with Europe. In both the United States and Europe, female OTO-HNS reported more frequent differential treatment related to biological sex than males. Conclusion: Differential treatment, or microaggressions, related to personal characteristics or behavior varied in the United States and Europe with more ethnicity-based microaggressions in the United States and physical characteristic-based microaggressions in Europe. In both regions, females were more subject to microaggressions than males. More efforts are needed to tackle microaggressions and discrimination in the clinical and academic workplace of the Western otolaryngology community. Level of Evidence: 4.

Tools for Addressing Microaggressions: An Interactive Workshop for Perioperative Trainees.

Introduction: Graduate trainees from diverse backgrounds may experience discrimination, mistreatment, and microaggressions. While the ability to identify and respond to microaggressions is a much-needed skill for all emerging trainees, limited training workshops exist for residents, especially within perioperative medicine. To embody the principles of diversity, equity, inclusion, and anti-racism (DEIA), we aimed to empower trainees in the perioperative environment with several strategies for addressing microaggressions to bridge this training gap. Methods: Based on critical race theory, transformative learning, minority stress theory, and the structural theory of gender and power, this workshop was developed with the primary aim of educating trainees on microaggressions, amplifying the role of allyship, and providing tools to respond to microaggressions as an ally. We used a mixed methods approach to examine participants' pre/post self-evaluations of microaggression intervention tools and the overall effectiveness of the workshop. Results: The postsurvey captured the experiences of 54 trainees, including 37 of 44 (84%) first-year clinical anesthesia residents and 14 of 24 (58%) surgery residents. The facilitator and course feedback was remarkably positive. Paired t test analyses on participants' pre- and postsurvey responses demonstrated a statistically significant increase in knowledge of microaggressions. This workshop also significantly increased learners' self-reported tools for responding to microaggressions. Discussion: Overall, these promising findings suggest that the strategies presented in this workshop could be applied across other graduate medical education programs. Institutions may wish to customize workshop elements, such as the case scenarios, and the workshop can also be incorporated within a DEIA curriculum.

Transition to Practice Among Diverse Early Professional Athletic Trainers.

CONTEXT: Early professional (EP) Athletic Trainers (ATs) may encounter adjustments and develop individual identities to master a new role, which can be difficult while transitioning from student to autonomous professional. Previous literature lacks content about the transition to practice of credentialed ATs who identify as Black, Indigenous, or People of Color (BIPOC). OBJECTIVE: Identify challenges during professional education and transition to practice of EP ATs identifying as BIPOC. DESIGN: Qualitative study. SETTING: Virtual interview. PATIENTS OR OTHER PARTICIPANTS: 15 recently credentialed athletic trainers (13 female, 2 male, age=26.73±1.41 years, experience=13.80±4.03 months) who self-identified as BIPOC. DATA COLLECTION AND ANALYSIS: We used an interview guide, validated by peer (n=1) and expert (n=3) review, to structure data collection sessions. Data saturation guided recruitment and we obtained theoretical redundancy after the final interview. We analyzed data with a phenomenological approach and used multianalyst triangulation (n=2) and peer review (n=2) as credibility strategies. RESULTS: Every participant mentioned they were victims of microaggressions during either their professional preparation and/or work environment because of their race. Those who chose to report the incidents felt a lack of support from work supervisors, faculty, peers, and preceptors. Participants noted a preference for racially concordant mentoring to facilitate talking to someone who could better understand BIPOC EPs' experiences. Participants also relied on outside support from friends and family as coping mechanisms. Finally, participants experienced perceived incompetency from supervisors due to their limited work experience as early professionals and felt their professional preparation was stunted by the COVID-19 pandemic. CONCLUSIONS: Participants perceived that their transition to practice was stressful due to microaggressions encountered, a lack of support, and a lack of racially concordant mentoring. Diversity, equity, and inclusion training should be included in athletic training education and workspaces to assist in providing more welcoming environments for BIPOC EP ATs and students.

Psychometric Exploration of the Swedish Translation of the Sexual Orientation Microaggressions Scale (SOMS), and a Commentary on the Validity of the Construct of Microaggressions.

The aim of the present study was to assess the psychometric properties of a Swedish translation of the Sexual Orientation Microaggressions Scale (SOMS) in a convenience sample of 267 Swedish LGB+ people (Mean age = 36.41). Testing suggested some strengths in terms of factor structure and 2-week test-retest reliability (ICC > .79). Also, internal consistency (α = .80-.91) and convergent validity were supported for most subscales. However, the Assumption of Deviance subscale was associated with low response variability and internal consistency (α = .35), and the correlational pattern between the Environmental Microaggressions subscale and mental health variables diverged from the overall trend. Furthermore, measurement invariance between homo- and bisexual participants was not supported for most subscales, and although microaggressions would be theoretically irrelevant to a small comparison sample of heterosexual people (N = 76, Mean age = 40.43), metric invariance of the Environmental Microaggressions subscale was supported in comparison to LGB+ people. We argue that these limitations suggest a restricted applicability of the SOMS in a Swedish context, and this has consequences for the definition and operationalization of the construct of microaggressions as a whole. Therefore, more research on the latent properties of microaggressions in Swedish as well as in other contexts is required.

Developing and Validating Thai Sexual Orientation Microaggression and Microaffirmation Scales.

Mental health disparities exist for sexual minority populations globally. Microaggressions and microaffirmations related to sexual orientation may negatively or positively impact well-being. Culturally validated tools are needed to assess these constructs among LGBQ+ (lesbian, gay, bisexual, queer/questioning) individuals in Thailand's high-context culture. This study aimed to develop and validate the Thai Sexual Orientation Microaggressions Scale (T-SOMG) and the Thai Sexual Orientation Microaffirmations Scale (T-SOMF) to quantify experiences among LGBQ+ Thais. A mixed-methods approach was utilized. Initial scale items were derived from a literature review, expert consultation, and interviews with LGBQ+ Thais. Exploratory factor analysis (n = 164) refined the item pools. Confirmatory factor analysis (n = 200) confirmed the factor structures. Reliability and validity were examined. The final 18-item T-SOMG contained two subscales-Interpersonal and Environmental Microaggressions. The 13-item T-SOMF contained Interpersonal and Environmental Microaffirmations subscales. All scales demonstrated good model fit, reliability, convergent validity, and discriminant validity. The T-SOMG and T-SOMF are culturally valid tools for assessing microaggressions and microaffirmations among LGBQ+ Thais. These localized scales can enable research on factors impacting LGBQ+ well-being. Further validation in diverse samples is warranted.

Perceptions of healthcare professionals and students about interventions addressing implicit bias and microaggression: A mixed-studies systematic review.

AIM: To consolidate and appraise available evidence on the experiences and perceptions of healthcare professionals and students about the interventions addressing implicit bias and microaggression in the clinical setting. BACKGROUND: Patient-perpetrated acts of implicit bias and microaggression have profound effects on healthcare professionals' and students' mental health. However, the efficacy of interventions targeted at addressing implicit bias and microaggression requires further scrutiny. DESIGN: Mixed-studies systematic review. METHODS: A comprehensive search was conducted on PubMed, EMBASE, CINAHL, Scopus, Web of Science, PsycINFO, Cochrane Library, ProQuest (Social Science Premium Collection Database), ProQuest (Dissertations and Theses Global), and ClinicalTrials.gov. Study selection, quality appraisal using the mixed methods appraisal tool, and data extraction were performed. Narrative and thematic synthesis were used to analyze quantitative and qualitative findings respectively. A results-based convergent approach was employed to integrate findings from both research designs. RESULTS: A total of 23 studies were included, involving 4667 healthcare professionals and students. There were 17 quantitative studies and six mixed-method studies of varying methodological quality. This review presented findings on healthcare professionals' and students' experiences and perceptions of the efficacy of the interventions targeted at addressing implicit bias and microaggression. Two themes were identified: 1) A safe space leading to enhanced confidence, and 2) what and why the interventions worked. CONCLUSION: Our review findings found that healthcare professionals and students generally had a positive view of implicit bias and microaggression interventions in the realm of helping them gain knowledge and confidence to identify and respond to biased clinical encounters. This review could provide insights for administrators and institutions to provide such interventions in mitigating the impact of implicit bias and microaggression on healthcare staff and students. Future research should focus on comparing the views of participants from varied geographical and cultural backgrounds, and those with different healthcare disciplines.