Mitigating Microaggressions in Medical Education Through the TRAUMA Framework.

ABSTRACT: Microaggressions are defined as brief communications directed at members of a stigmatized group that are received as derogatory but are unrecognized by the offender. Studies show microaggressions are detrimental to those of all identities who endure them. Given that microaggressions can result in specific emotional, psychological, and physical challenges for underrepresented medical students from minoritized backgrounds, it is imperative that the medical education community focus efforts on reducing them and their impact through appropriate responses. The TRAUMA framework was developed by the authors and can be used to organize a thorough response to the threat that microaggressions create for all students. The framework includes improved student support, guidelines for faculty and institutional responses to microaggressions, improved faculty development for addressing microaggressions, recommendations to improve classroom environments, and interventions both to create and measure culture change in medical education.

Heart on hypertension: Improving hypertension control in the FQHC setting through a group visit program.

INTRODUCTION: Many solutions for increasing hypertension control rates have been proposed yet the social determinants of health create health disparities within the populations served by Federally Qualified Health Centers (FQHC) that can complicate reaching these goals. This study observes impact of a group visit program on hypertension control within the patient population served by an FQHC. METHODS: Retrospective review and analysis of blood pressure data was performed for patients enrolled in the first 4 cohorts of the Heart on Hypertension Group Visit Program at the end of the program as well as 3 months, 6 months, and 12 months after the program ended. RESULTS AND DISCUSSION: Twenty-two patients participated in the program. Seventeen patients achieved the goal with a statistically significant mean change in blood pressure at p > 0.001. Patients who completed the program had a statistically significant mean change in blood pressure at p > 0.001 and those who discontinued prior to completing the program had a statistically significant mean change in blood pressure at p = 0.001 systolic and p = 0.002 diastolic. Changes in patient blood pressure were sustained for 3-months (78%), 6-months (83%), and 12-months (83%). IMPLICATIONS: Patients in the Heart on Hypertension program were successful in making significant changes in hypertension control in the FQHC setting. This method was useful in improving hypertension control metrics for patients facing increased influences by the Social Determinants of Health.

Pathways to equity: A pilot study implementing a health equity leadership curriculum in residency education as an antidote to systemic racism.

BACKGROUND: Health disparities negatively impact the lives of patients and are a product of the social categorization of medicine. In dismantling the systemic racism and biases that create health disparities, health equity curricula can be implemented that improve resident physician awareness and competency in caring for patients from vulnerable populations. OBJECTIVE: The objective of this study is to assess the impact of a resident-led health equity curriculum on the self-efficacy of family medicine residents in caring for vulnerable populations and managing challenging patient scenarios. METHODS: The Health Equity Leadership Concentration (HELC) curriculum was implemented in the fall of 2019. Residents self-selected their participation in the concentration and completed pre- and 6-month post- implementation surveys on self-efficacy. Deidentified survey data were analyzed with α = 0.05 significance level. RESULTS: Eight residents of 26 residents self-selected to participate (30%) with pre- and post- implementation survey response rates of 100% and 87.5% (HELC) and 66.7% and 88% (general residents). A significant increase in self-efficacy was observed in caring for the uninsured (p=0.007), LGBTQ (P=0.047), and Immigrant (p=0.04) populations and managing food insecurity (p=0.01) after 6 months in the HELC curriculum. No significant increases were seen in the general resident curriculum. HELC residents had a significant increase in self-efficacy in caring for the Medicaid population (p=0.048) in comparison with the general residents. CONCLUSIONS: The HELC was successful in increasing self-efficacy in caring for vulnerable populations and managing challenging patient scenarios at 6-months. Further evaluation is needed for generalizability and determination of true statistical significance.

The Association of Microaggressions with Depressive Symptoms and Institutional Satisfaction Among a National Cohort of Medical Students.

BACKGROUND: Despite substantial research on medical student mistreatment, there is scant quantitative data on microaggressions in US medical education. OBJECTIVE: To assess US medical students' experiences of microaggressions and how these experiences influenced students' mental health and medical school satisfaction. DESIGN AND PARTICIPANTS: We conducted a cross-sectional, online survey of US medical students' experiences of microaggressions. MAIN MEASURES: The primary outcome was a positive depression screen on the 2-item Patient Health Questionnaire (PHQ-2). Medical school satisfaction was a secondary outcome. We used logistic regression to model the association between respondents' reported microaggression frequency and the likelihood of a positive PHQ-2 screen. For secondary outcomes, we used the chi-squared statistic to test associations between microaggression exposure and medical school satisfaction. KEY RESULTS: Out of 759 respondents, 61% experienced at least one microaggression weekly. Gender (64.4%), race/ethnicity (60.5%), and age (40.9%) were the most commonly cited reasons for experiencing microaggressions. Increased microaggression frequency was associated with a positive depression screen in a dose-response relationship, with second, third, and fourth (highest) quartiles of microaggression frequency having odds ratios of 2.71 (95% CI: 1-7.9), 3.87 (95% CI: 1.48-11.05), and 9.38 (95% CI: 3.71-26.69), relative to the first quartile. Medical students who experienced at least one microaggression weekly were more likely to consider medical school transfer (14.5% vs 4.7%, p<0.001) and withdrawal (18.2% vs 5.7%, p<0.001) and more likely to believe microaggressions were a normal part of medical school culture (62.3% vs 32.1%) compared to students who experienced microaggressions less frequently. CONCLUSIONS: To our knowledge, this is the largest study on the experiences and influences of microaggressions among a national sample of US medical students. Our major findings were that microaggressions are frequent occurrences and that the experience of microaggressions was associated with a positive depression screening and decreased medical school satisfaction.