LGBTQ+ Microaggressions in Health Care: Piloting an Observation Framework in a Standardized Patient Assessment

Area of Science:

• Medical Education
• Health Disparities
• Sociology of Health

Background:

• Microaggressions are subtle, often unintentional, hostile communications targeting marginalized groups.
• In healthcare, microaggressions against LGBTQ+ individuals can erode trust and lead to disengagement from services.
• Observing and quantifying these behaviors is crucial for developing effective interventions.

Purpose of the Study:

• To preliminarily validate a framework for observing LGBTQ+ microaggressions in clinical settings.
• To assess the reliability and presence of specific microaggression categories within healthcare encounters.
• To evaluate the impact of a clinical skills intervention on reducing microaggressions.

Main Methods:

• A framework was developed to code microaggressions in video-recorded clinical skills assessments.
• Coders analyzed encounters where medical students interviewed standardized patients from sexual and gender minority backgrounds.
• Construct reliability and the frequency of eight microaggression categories were assessed.

Main Results:

• Heteronormative and cisnormative language/assumptions were observed in 85.3% of encounters with sexual and gender minority standardized patients.
• A clinical skills intervention significantly reduced identity-based referrals (20.0% to 4.9%, p=0.01).
• Other microaggression categories showed varying prevalence, indicating pervasive issues.

Conclusions:

• LGBTQ+ microaggressions are prevalent in healthcare settings, necessitating targeted educational strategies.
• The validated framework provides a tool for identifying and quantifying these microaggressions.
• Further development of scales for patients and observers can assess the impact of microaggressions and guide future interventions.