Grass Emily, Astemborski Caroline, Lewis James M
Department of Emergency Medicine, Prisma Health Upstate, Greenville, SC, USA.
University of South Carolina School of Medicine Greenville, Greenville , United States.
BMC Med Educ. 2024 Dec 18;24(1):1491. doi: 10.1186/s12909-024-06481-0.
Microaggressions, subtle and often unintentional acts of hostility, have been recognized as a significant issue in healthcare, adversely affecting learners' emotional and physical well-being. Current strategies for addressing microaggressions are broad frameworks without empirical substantiation that leave learners without a clear direction for intervention. This study introduces a novel scripted, succinct, bystander intervention tool to combat microaggressions. The intervention tool developed by the research team, named I-RANT, follows the script of introduction, role naming, affirming the target, negating the microaggression, and transitioning within patient encounters. The study goal was to assess the ability of a training session to impact learners' recognition of microaggressions, confidence in intervening, and competency in applying the I-RANT tool.
A pre-experimental study was conducted with 97 second-year medical students at a large academic center in the Southeast United States. The I-RANT tool was taught through a 90-minute training session. The session included an introduction lecture, small group discussions, and role-play scenarios. Pre- and post-intervention surveys assessed microaggression recognition via a multiple-choice questionnaire (MCQ) and self-reported confidence in intervening on a Likert scale. Differences were compared via paired T-test. Role-play scenarios were observed by trained faculty and graded for competence using a rubric.
Participants showed significant improvement in microaggression identification with increase in MCQ score from 4.17 (SD 0.75) pre-intervention to 4.74 (SD 0.42) post-intervention (p < .001) and increased self-reported confidence from 3.2 (SD 1.0) to 4.2 (SD 0.63) (p < .001). Trained faculty evaluated a random sampling of students' role-play scenarios (n = 30) revealing that 97% of sampled students demonstrated competence in utilizing the I-RANT tool.
The I-RANT training session empowered learners to address microaggressions. Learners demonstrated a statistically significant improvement in recognition of microaggressions and confidence in intervening. The majority of learners demonstrated competency in utilizing the I-RANT tool by the end of the training session.
This study supports the effectiveness of our training session in enhancing medical students' ability to recognize and address microaggressions. I-RANT empowers learners with a tool to intervene against microaggressions within patient encounters.
微侵犯，即微妙且通常无意的敌意行为，已被公认为医疗保健领域的一个重要问题，对学习者的身心健康产生不利影响。当前应对微侵犯的策略是宽泛的框架，缺乏实证依据，这使得学习者在干预方面缺乏明确的方向。本研究引入了一种新颖的、脚本化的、简洁的旁观者干预工具来对抗微侵犯。研究团队开发的干预工具名为I-RANT，遵循介绍、角色命名、肯定目标、否定微侵犯以及在医患互动中过渡的脚本。研究目标是评估一次培训课程对学习者识别微侵犯的能力、干预的信心以及应用I-RANT工具的能力的影响。
在美国东南部的一个大型学术中心，对97名二年级医学生进行了一项预实验研究。通过90分钟的培训课程教授I-RANT工具。该课程包括一次介绍讲座、小组讨论和角色扮演场景。干预前后的调查通过多项选择题问卷（MCQ）评估微侵犯识别情况，并通过李克特量表自我报告干预的信心。通过配对T检验比较差异。由训练有素的教员观察角色扮演场景，并使用评分标准对能力进行评分。
参与者在微侵犯识别方面有显著改善，MCQ分数从干预前的4.17（标准差0.75）提高到干预后的4.74（标准差0.42）（p <.001），自我报告的信心从3.2（标准差1.0）提高到4.2（标准差0.63）（p <.001）。训练有素的教员对学生角色扮演场景的随机样本（n = 30）进行评估，结果显示97%的抽样学生在使用I-RANT工具方面表现出能力。
I-RANT培训课程使学习者有能力应对微侵犯。学习者在微侵犯识别和干预信心方面有统计学上的显著改善。大多数学习者在培训课程结束时表现出使用I-RANT工具的能力。
本研究支持我们的培训课程在提高医学生识别和应对微侵犯能力方面的有效性。I-RANT为学习者提供了一种在医患互动中干预微侵犯的工具。
