Ballal Sonia A, Newman Lori R, Spencer Dennis J, Melvin Patrice, Luff Donna, Gómez Eva, Leichtner Alan M, Irish Julie, Brown Stephen D, Ward Valerie L
Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Harvard Medical School, Boston, MA; Center for Educational Excellence and Innovation, Boston Children's Hospital, Boston, MA.
Acad Pediatr. 2024 Dec 27:102630. doi: 10.1016/j.acap.2024.102630.
Microaggressions undermine health professionals' performance in patient care, research, and education. This study aimed to develop and evaluate an intervention addressing microaggressions in healthcare settings by empowering bystanders to act as upstanders across an academic medical center (AMC). This was achieved through an educational intervention that included a novel framework, didactics, video demonstrations, and practice with realistic scenarios. Methods Participants were faculty, trainees, education experts, clinical and administrative staff from a large, urban pediatric AMC. Participants were recruited from 3 training sessions, and taught the "Be Aware" and "ACT" framework, a novel tool for bystanders to use when witnessing microaggressions. Pre-training, retrospective pre-post, and 10-week follow-up surveys evaluated changes in awareness, confidence, and intervention rates. Quantitative analyses were conducted using generalized linear mixed effects models across the 3 surveys to assess participants' changes in confidence. Qualitative analysis used inductive content analysis. Results Among the 205 attendees, 134 (65.4%) completed the pre-training survey. The study cohort (n=108) included those who completed the pre-training survey with either the retrospective pre-post (n=24), 10-week follow-up (n=26), or both (n=58). Participants reported increased confidence in intervening during microaggressions, with confidence rising from 7.5% pre-training to 24.2% at 10-week follow-up (p=0.004). Qualitative analysis revealed a shift from passive response to active intervention, with participants applying the "Be Aware" and "ACT" framework during actual incidents. Conclusions The "Be Aware" and "ACT" framework increased and sustained awareness and confidence in addressing microaggressions. This AMC-wide intervention successfully equipped participants to move from passive bystanders to active upstanders.
微侵犯行为会损害医疗保健专业人员在患者护理、研究和教育方面的表现。本研究旨在开发并评估一种干预措施，通过使旁观者能够在学术医疗中心（AMC）中成为挺身而出者，来解决医疗环境中的微侵犯行为。这是通过一项教育干预措施实现的，该措施包括一个新颖的框架、教学内容、视频演示以及在现实场景中的实践。方法参与者包括来自一个大型城市儿科AMC的教职员工、实习生、教育专家、临床和行政人员。参与者从3次培训课程中招募，并学习了“提高意识”和“采取行动”框架，这是一种旁观者在目睹微侵犯行为时使用的新颖工具。培训前、回顾性前后对比以及10周随访调查评估了意识、信心和干预率的变化。使用广义线性混合效应模型对这3项调查进行定量分析，以评估参与者信心的变化。定性分析采用归纳性内容分析。结果在205名参与者中，134人（65.4%）完成了培训前调查。研究队列（n = 108）包括那些完成了培训前调查以及回顾性前后对比（n = 24）、10周随访（n = 26）或两者都完成（n = 58）的人。参与者报告称，在微侵犯行为发生时进行干预的信心有所增加，信心从培训前的7.5%上升到10周随访时的24.2%（p = 0.004）。定性分析显示，从被动反应转向了主动干预，参与者在实际事件中应用了“提高意识”和“采取行动”框架。结论“提高意识”和“采取行动”框架提高并持续增强了应对微侵犯行为的意识和信心。这种全AMC范围的干预措施成功地使参与者从被动旁观者转变为主动挺身而出者。
