Hartford Hospital and the Institute of Living, Hartford, Connecticut, USA.
Hartford Hospital and the Institute of Living, US.
Perspect Med Educ. 2023 Dec 19;12(1):575-583. doi: 10.5334/pme.1251. eCollection 2023.
Increased attention to improving a culture of belonging in clinical learning environments has led to various approaches to addressing microaggressions. However, most approaches in the literature focus on responding or reacting to microaggressions with insufficient attention to building trust before microaggressions might occur. Research on microaggressions in clinical learning environments suggests anticipatory or pre-emptive conversations about microaggressions may foster greater trust. In this study, the authors explored how diverse participants perceived the experience of anticipatory conversations about potential microaggressions. Overall, the authors sought to gain a deeper understanding of how pre-emptive and anticipatory conversations may influence an organization's approach to addressing microaggressions in clinical learning environments.
The authors utilized constructivist grounded theory methodology and conducted individual qualitative interviews with 21 participants in an academic department within a larger health sciences center in the United States.
Findings suggest that anticipatory conversations about microaggressions were challenging due to existing norms in dynamic clinical learning and working environments. Participants shared that the idea of anticipating microaggressions elicited dissonance. Conversations about microaggressions could potentially be facilitated through leaders who role model vulnerability, organizational supports, and an individualized approach for each team member and their role within a complex hierarchical organization.
Anticipating and addressing microaggressions in clinical learning environments holds tremendous potential, however, any conversations about personal identity remain challenging in medical and healthcare environments. This study suggests that any attempts to address microaggressions requires attention to cultural norms within healthcare environments and the ways that hierarchical organizations can constrain individual agency.
提高对临床学习环境归属感文化的重视，导致了各种解决微侵犯问题的方法。然而，文献中的大多数方法都侧重于在微侵犯发生之前，用反应或应对微侵犯的方式，而对建立信任的重视不够。临床学习环境中的微侵犯研究表明，关于微侵犯的预期或先发制人的对话可能会培养更多的信任。在这项研究中，作者探讨了不同的参与者如何看待关于潜在微侵犯的预期对话的体验。总的来说，作者试图更深入地了解先发制人和预期的对话如何影响组织在临床学习环境中处理微侵犯的方法。
作者采用建构主义扎根理论方法，对美国一家大型健康科学中心内一个学术部门的 21 名参与者进行了个人定性访谈。
研究结果表明，由于动态临床学习和工作环境中的现有规范，关于微侵犯的预期对话具有挑战性。参与者表示，预先设想微侵犯的想法引起了不和谐。通过榜样式脆弱、组织支持和针对每个团队成员及其在复杂层级组织中的角色的个性化方法，有可能促进关于微侵犯的对话。
在临床学习环境中预先考虑和处理微侵犯具有巨大的潜力，然而，在医学和医疗保健环境中，任何关于个人身份的对话仍然具有挑战性。本研究表明，任何解决微侵犯的尝试都需要关注医疗保健环境中的文化规范，以及层级组织如何限制个人能动性的方式。
