Impact of racial microaggressions in the clinical learning environment and review of best practices to support learners.

Microaggressions are brief, commonplace, and daily verbal, behavioral, and environmental slights towards marginalized groups. Underrepresented in medicine (UiM) learners experience a barrage of microaggressions in the pediatric clinical learning environment. Literature demonstrates that microaggressions are detrimental to the mental and physical well-being of the recipient. There is an urgent need to bring greater awareness and understanding of how microaggressions operate in the clinical learning environment, the impact they have on UiM learners and the educational and institutional strategies needed to best support learners. Several databases were searched using combinations of subject headings and keywords as described. While "microaggressions" is not yet an official medical subject heading (Mesh term) for the National Library of Medicine's databases, nonetheless there are numerous studies using the term microaggressions in the research literature about health care, medical education and learning environments. Items were limited to English language publications from the past 10 years. Microaggressions are rooted in power differentials and indirect assertion of power. The clinical learning environment contains learners at all levels along with patients and families. The impact of microaggressions leads to (1) othering (2) stunted professional identity formation and (3) racial battle fatigue. Both educational initiatives targeted at recognizing and responding to microaggressions and institutional anonymous reporting systems and policies are best practices to combat the negative impact of microaggressions. Institutions-at-large and graduate medical education need to create safe spaces for anonymous reporting, robust policies for addressing bias and educational initiatives for responding to microaggressions. Together these will begin to create safe spaces for our UiM learners in a system that so often perpetuates they do not belong.