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

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.