African-American faculty at one academic medical center in the Midwest reported experiencing subtle verbal or behavioral slights, snubs, or insults—microaggressions—from patients, staff, trainees, and even fellow colleagues, according to results of a survey presented during the 2021 virtual AAN Annual Meeting.
More than 60 percent of those surveyed at the University of Michigan Medical Center said they had experienced a microaggression, reported study author Larry Charleston IV, MD, MSc, FAHS, director of the headache and facial pain division and director of faculty development for the department of neurology and ophthalmology at Michigan State University College of Human Medicine.
“I first heard the term, microaggression, a few years ago, and I thought this hits the nail on the head for a lot of things," said Dr. Charleston. “I wanted to find out if other African-American faculty were experiencing these behaviors, and if so, I wanted to learn how they felt about this and what we could do to address it."
For instance, one faculty member shared in the survey: “I was told by a male colleague high up in the department 'I don't want to blow sunshine at you but you were not hired based on merit,'" Dr. Charleston noted.
Another faculty member wrote in the survey: “A patient told me it was her 'right' to see a 'White physician with tenure.' After she was transferred per her request, she continued to bombard me with disrespectful messages," he added.
Microaggressions are often a source of unconscious or implicit bias, Dr. Charleston noted. “We need to develop programs for other providers and patients to create awareness of these microaggressions and to promote diversity. This can improve the work climate for neurologists, regardless of whether they work in private practices or academic settings. It could also increase job satisfaction, recruitment, and retention as we try to grow our already underrepresented profession."
Forty-one respondents, 68 percent of whom were women, answered at least one question from the survey, which included both open-ended and close-ended questions. About 2.44 percent of respondents were Hispanic or Latino, 85.37 percent African-American, and 7.32 percent non-Hispanic/White.
Among the 25 participants who answered all the close-ended questions, 16 percent said they experienced microaggressions 25 times or more, 8 percent 11 to 15 times, 16 percent six to 10 times, and 60 percent one to five times in the last six months.
Twenty participants said they experienced microaggressions from colleagues/faculty, eight from students, nine by other residents, 11 by leadership, 17 by patients, and 10 by staff. Notably, 84 percent reported experiencing microaggressions from someone outside their ethnicity or race.
The survey results are not surprising, said Roderick C. Spears, MD, FAAN, a clinical associate professor of neurology at the University of Pennsylvania and regional medical director of neurology for Penn Specialty practices. “It's also not surprising to see that Blacks represented most of the respondents. These findings align with common perceptions in academic medicine and are true from my experience in academic medicine," he added.
Dr. Spears noted that at his institution, unconscious bias training is now required for faculty members. This training should be implemented in neurology as a whole, and especially at academic institutions, which are responsible for educating neurologists, students, and residents.
The survey was conducted before the George Floyd situation last summer and before heightened attention was given to this issue, noted Dr. Spears. “I would highlight that this was done at a leading academic institution that's highly respected from a neurologic perspective. If it's happening there, it's probably happening everywhere because sometimes I think people equate intelligence to greater awareness or sensitivity, and that's not always true."
“I'm hoping it will bring about greater dialogue among neurologists, that we all bring valuable perspectives to the field because we serve a diverse patient population, and to best do that, I think we need to have an appropriate appreciation for where each of us is coming from," Dr. Spears concluded.
Dr. Charleston had no relevant disclosure for this study, but disclosed that he has served as a consultant, advisory board member, or has received honoraria from AbbVie/Allergan, Alder/Lundbeck, and Biohaven. He also serves on the advisory board of BrainWeekend and Ctrl M Health (stock options); has performed medical legal consultation for the Vaccine Injury Compensation Program; and is an associate editor of Headache: The Journal of Head and Face Pain. Dr. Spears had no disclosures to report.
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AAN Abstract P24.010: Charleston L. Identifying and understanding microaggressions among Michigan Medicine African-American faculty members.