A testimonial for the PSW Microaggressions workshop:
“Excellent style, participative, good balance of discussion and material.”
“Very useful sessions on a subject that affect us and our trainees on a daily base”
Racism is widespread within the medical workforce according to the results of a BMA racism in medicine survey. Experiences of racism are significantly under-reported for fear of backlash and over three quarters (76%) of respondents experienced racism in their workplace on at least one occasion in the last two years. Experiences of racism are affecting doctors’ confidence and mental and physical wellbeing.
NHS equality, diversity and inclusion (EDI) improvement plan sets out six targeted actions to address the prejudice and discrimination – direct and indirect – that exists through behaviour, policies, practices and cultures against certain groups and individuals across the NHS workforce. My project to introduce microaggressions training to educators and trainees promotes workplace inclusion and aims to improve High impact action 4: Develop and implement an improvement plan to address health inequalities within the workforce and
High impact action 6: Create a workplace that ends bullying, discrimination, harassment, and physical violence at work.
NHS leaders should make sure we take action to:
- End all types of discrimination
- Use inclusive ways of working
- Create an environment where everyone feels safe
Progress is monitored by results from NHS staff survey and NETS survey for trainees.
Racism’s Impact on Health
Race microaggressions are subtle, often unintentional, acts of discrimination or bias that target individuals based on their racial background. If they are not recognised, they may go unnoticed or be dismissed as oversensitivity. These microaggressions can occur within training programs and educational institutions, contributing to a hostile and unwelcoming environment. To address this issue, the introduction of microaggressions training workshops has gained traction, offering significant benefits to both educators and trainees. Anyone can be an ally, but those with lived experience are more likely to be invested in driving cultural change within organisations.
Role of The Professional Support and Wellbeing Service (PSW)
The Professional Support and Wellbeing Service (PSW) guides doctors, dentists and pharmacists in training through supportive interventions that make a positive difference to their training and wellbeing in the East of England (EoE). A pharmacist clinical case manager with experience in Equality, Diversity and Inclusion (EDI) and a special interest in race microaggressions created and delivered workshops providing an overview of Microaggressions with activities to explore previous knowledge and personal experiences.
Summary of workshop
A virtual workshop provides an overview of critical race theory and encourages participants to explore the concept of race micro-aggressions, unconscious bias and stereotypes; describes how they impact trainees in the workplace and increases awareness of strategies to manage and reduce them (allyship and active bystander). Breakout rooms are included to facilitate vignettes and provide opportunities for reflection and discussion in smaller groups on areas such as: being asked “Where are you really from?” and “when someone mispronounces your name”. Participants receive protected time for conversations during breakout rooms and share feedback from these groups to the main group. Psychological safety for all trainees was prioritised and this was set out clearly in the rules of engagement of the workshop.
Learning from event via feedback survey
The events were attended by doctors in training and their educators. There was a 70% response rate to the feedback survey after the event.
90% of respondents rated the Effectiveness of workshop and Facilitator presentation style (including ability to engage with participants) as 8/10 or above.
Trainee Voice: Comments from participants who attended the workshop.
- “This course should be aimed at Educational and clinical supervisors and college tutors for organisational change – being part of juniors having awareness is useful however having to deal with senior management in hierarchy is very difficult unless there is active educational process to make them understand how junior team members feel and respond”
- “Involve seniors in the workshops, as they will likely be policy stakeholder to be involved”
- “This is an area that all staff should have including senior managers, should be made mandatory for everyone working in the NHS.”
- “Identify Channels on how to seek help without being singled out.”
Educator Voice: Comments from participants who attended the workshop.
- “The impact or perception of microaggression felt by what appears to be ‘common’ comments – important to validate someone’s experience, asked how they wish to proceed (action vs inaction)”
- “Whilst this session empowers individuals to report incidents, perhaps there needs to be work done on why one incident can affect one individual more than others”
- “Engaging during session – inclusive”
- “useful strategies to recognise and how to approach microaggression in a non confrontational way.”
Participants were keen to continue conversations and suggested widening the scope of the workshop for future iterations to include:
- More understanding of the legal framework that supports staff in the workplace and available avenues of help.
- Further discussions regarding effective solutions to aid speaking up eg Freedom to Speak Up Guardians when local support mechanisms are ineffective
- Challenging microaggressions in the workplace: More examples of how to identify or differentiate subtle microaggressions and more examples of micro-affirmations
- Addition of role play scenarios or Simulation with an opportunity to practice how to intervene or be an active bystander.
Responding to microaggressions in a way that both highlights the behaviour and impact, while moving the conversation forward takes practice, as described in a Kings fund blog. Both groups were vocal in their sessions and shared feedback on the necessity of providing similar sessions for all staff in the NHS, especially ongoing sessions for trainees and their educators. It is not easy to speak up, the creation of a safe psychological space by PSW for trainees and educators to come together to have these discussions was highly commended.
Understanding and addressing race microaggressions in training programs is essential for creating inclusive, respectful, and equitable educational environments. Microaggressions training workshops conducted in a safe psychological space with opportunity for sharing lived experiences offer significant benefits to both educators and trainees.
By raising awareness, improving communication, promoting equity, and empowering individuals to recognize and address microaggressions, we can work towards developing a more inclusive and harmonious workplace, where individuals of all racial backgrounds are valued and respected.
NHSE WTE EoE has an established novel approach to Multi-Professional learning which includes Virtual Reality simulation and Multi-Professional High fidelity simulation offered as part of the core medical and pharmacy foundation training programmes. EDI is an area that can be explored for future training options.
Farzana is a clinical case manager for NHS England (EoE) Professional Support and Wellbeing service providing supportive interventions to make a positive difference to doctors and pharmacists training and wellbeing. Farzana also works as a Pharmacy Faculty Workforce Lead in Herefordshire and Worcestershire, creating and implementing an ICS workforce strategy to address current workforce challenges across sectors.
She was the South West regional Clinical Fellow at NHS England leading work on Equality, diversity and inclusion (EDI) in pharmacy programmes. She used the lived experience of trainees to promote a truly inclusive training programme, incorporating EDI into the HEE National Quality assurance strategy and creating the SW Inclusion Manifesto with SW Inclusive Pharmacy Practice team.
Farzana completed the Welsh Government Public leaders of the future programme, Inclusive Leadership Programme and has championed the Royal Pharmaceutical Society (RPS) Inclusion and diversity strategy by contribution through RPS Task and finish groups.
Farzana is Pharmacy lead for Muslim Doctors Cymru, a volunteer group working to tackle health inequalities in ethnic minority communities and gave evidence at the Senedd, Health and social justice committee inquiry, held to understand issues relating to the implementation and delivery of the Anti-racist Wales Action Plan (the purpose of which is to eradicate racism in Wales)
Declaration of interests
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: None