From Bystander-to-Upstander: A Novel Intervention Framework to Address Microaggressions in a Pediatric Academic Medical Center

Sonia A Ballal; Lori R Newman; Dennis J Spencer; Patrice Melvin; Donna Luff; Eva Gómez; Alan M Leichtner; Julie Irish; Stephen D Brown; Valerie L Ward

doi:10.1016/j.acap.2024.102630

From Bystander-to-Upstander: A Novel Intervention Framework to Address Microaggressions in a Pediatric Academic Medical Center

Acad Pediatr. 2024 Dec 27:102630. doi: 10.1016/j.acap.2024.102630. Online ahead of print.

Authors

Sonia A Ballal¹, Lori R Newman², Dennis J Spencer³, Patrice Melvin⁴, Donna Luff⁵, Eva Gómez⁶, Alan M Leichtner⁷, Julie Irish⁸, Stephen D Brown⁹, Valerie L Ward¹⁰

Affiliations

¹ Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: [email protected].
² Harvard Medical School, Boston, MA; Center for Educational Excellence and Innovation, Boston Children's Hospital, Boston, MA.
³ Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
⁴ Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA; Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA.
⁵ Harvard Medical School, Boston, MA; Immersive Design Systems, Boston Children's Hospital, Harvard Medical School, Boston, MA.
⁶ Clinical Education and Informatics, Quality and Practice, Boston Children's Hospital, Boston, MA.
⁷ Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Center for Educational Excellence and Innovation, Boston Children's Hospital, Boston, MA.
⁸ Center for Educational Excellence and Innovation, Boston Children's Hospital, Boston, MA.
⁹ Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA; Office of Ethics, Boston Children's Hospital, Boston, MA; Center for Bioethics, Harvard Medical School, Boston, MA.
¹⁰ Harvard Medical School, Boston, MA; Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA; Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA; Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA.

PMID: 39733868
DOI: 10.1016/j.acap.2024.102630

Abstract

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.

Keywords: Bystander; Educational Intervention; Microaggression; Upstander.