Introduction

This research project was born of an incident witnessed by a first-year medical student interested in urology shadowing her mentor in a clinical setting. It is important that we, as teachers and mentors, model behaviors for our future urologists to be empowered to address and respond to microaggressions in a professional and thoughtful manner.

The scenarios below are meant as examples only to illustrate our work.

Scenario 1

It was a routine workday at the hospital. A mid-career female faculty member ran into her senior male physician colleague in the hallway. She shared with him her recent acceptance into the prestigious AUA Leadership Program. He responded with a lukewarm congratulatory response, “I guess that’s good.” This was followed by the sotto voce remark, “It doesn’t hurt that you’re a woman.”

Scenario 2

Weekly academic conference had just concluded. An early-career female faculty member, who identified as BIPOC (Black, Indigenous, and Person of Color), was approached by her senior male physician colleague and supervisor to deliver a presentation on a topic related to DEI (diversity, equity, and inclusion). She responded with suggestions of topics related to her subspecialty, in which she was fellowship trained and widely published. He responded by indicating again that he would like her to speak about a DEI topic rather than a urological topic in her area of expertise. He reaffirmed his position by stating, “You would be great for this.”

What do you think happened in these scenarios? Neither of the women felt that they were well equipped to respond immediately in these situations, which brings us to a question: Do we teach our trainees and colleagues how to handle microaggressions as an affected party, bystander, or as an accidental culprit?

Merriam-Webster defines microaggressions as “a comment or action that subtly and often unconsciously or unintentionally expresses a prejudiced attitude toward a member of a marginalized group (such as a racial minority).” There is a mounting body of evidence reporting on the pervasiveness and psychological damage of microaggressions in clinical practice, and urology is not immune to this issue.^1,2 The mitigation of microaggressions in daily practice makes an intentional step toward making our profession a more inclusive and safe space for underrepresented minorities.

There are limited resources specific to urological practice and teaching environments providing practical approaches on how to interrupt microaggressions in day-to-day clinical practice. The goal of this article is to summarize validated teaching tools on the mitigation of microaggressions that have been successfully implemented in medical education in other medical fields. To date, there are no published validated teaching tools specific to urological education or practice on interrupting microaggressions.

Methods

We conducted a literature review search of PubMed and MedEdPORTAL (http://www.pubmed.gov). The initial search for terms “urology” and “microaggressions” did not produce any articles. The search broadened to include the term “microaggressions” yielded a total of 529 articles that matched to our search term. We included all English language articles from founding to October 22, 2022. All articles pertaining to validated teaching methods, curriculum development, or educational toolkits that were specifically related to addressing microaggressions were reviewed and analyzed. Replies to the editor and papers that did not report statistical results were excluded from our analysis. The workshops and toolkits validated by statistical analysis were comprehensively reviewed and tabulated.

Results

Our literature review yielded 6 workshops and toolkits that specifically addressed microaggressions and provided statistical results to validate their curriculum. A summary of the validated toolkits and workshops found in our review are displayed in the Table.

Table. Summary of Microaggressions-focused Workshops and Toolkits

Discussion

This article reviews the published literature on education methods pertaining to microaggressions, focusing on publications reporting results with statistical analyses. Six validated studies on the implementation and effectiveness of microaggressions workshops met our search criteria. The workshops were administered at medical schools or residency programs.We sought to evaluate these workshops on their strengths and weaknesses in consideration for future curriculum development in urological education.

Five out of the 6 validated workshops included medical students as their directed population, with only 1 workshop specifically targeting internal medicine residents. All the workshops included some form of lecture and pertinent terminology to familiarize attendees with the curriculum. All of the 6 reviewed workshops reported statistically significant improvements in their post-assessments. This meant either achieving a P value of < .05 or a >65% reported impact that their confidence when addressing microaggressions had improved. All workshops in the pre- and post-assessments asked about a change in “confidence” in relationship to how they approached microaggressions as either the observer, recipient, or offender. Important to point out is that the workshops included some form of role-play, where learners were able to take the position of the observer, recipient, or offender. This allowed attendees to see the microaggression from all perspectives including being in the position of intervening.

One limitation of the workshops worth noting is the lack of assessment of long-term behavioral modifications. Five out of the 6 studies did not utilize long-term (>1 month) post-workshop surveys. There are no data evaluating whether participants retained relevant information or initiated active bystander techniques. We recommend future studies and workshops that integrate a longitudinal assessment tool.

Our review of the medical literature demonstrates that there is a paucity of urological literature related to validated workshops or toolkits on microaggressions for urological providers and trainees. A review of the literature at large demonstrates validated workshops and toolkits in several different medical specialties that could be utilized as starting points for future curriculum development in urology. This knowledge gap provides a unique opportunity for amendments to the future education of urological trainees and colleagues fostering a more inclusive work environment.

Conclusion

Microaggressions are a widely acknowledged problem in the medical professional setting and society at large. This review provides a focused summary of validated teaching tools on the mitigation and response to microaggressions. Although a number of publications report on the pervasiveness of microaggressions in urological practice,^3,4 our comprehensive literature review yielded no validated teaching tools or curricula on microaggressions mitigation as it applies to the urological practice or education. As we are committed to making intentional strides toward diversity and inclusivity,⁵ the authors advocate for intentional curriculum development specific to this subject matter.