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Bias is something we all experience, but knowing how to account for our implicit biases versus

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our explicit biases requires some self-reflection.

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And so today, we'll review the discussion led by Dr. Craig Lillehei from the 2022 Update

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Course in this week's Update Course Rewind.

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Let's start out with a case.

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A pediatric surgical intern leaves her team into a patient room for rounds.

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She's an African American and the only person of color on her team.

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She begins to introduce herself, but is interrupted by a white parent who says, "Finally, someone

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has come to take my meal tray."

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The white pediatric surgery attending is visibly uncomfortable and says nothing.

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As a pediatric surgeon with a duty of compassionate care to patients and a mentor committed to

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diversity, inclusion and protection of trainees, what do we do in that circumstance?

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I wonder how often we're exposed to similar behavior and we may come up with any number

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of excuses.

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Well, it's a very stressful situation or I don't want to undermine that relationship

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with the parent or I'll talk to them later and set this right.

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Well, speak up and use the opportunity to correct the patient's mistake.

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Another what we said to describe in our discussion of this is a surgical intern has been victimized

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by racialized stereotype that could be characterized as microaggression.

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Now microaggressions are verbal, nonverbal, environmental, slights, snubs, invalidations

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or insults that send hostile derogatory or negative messages to individuals based solely

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on their marginalized group membership.

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Micro, it's anything but micro.

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We sort of, they're referred to as small repeatedly that the individuals are repeatedly

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experiencing them, but they have a cumulative impact, isolation, self doubt.

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That's the kind of behavior that we've got to turn around.

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And acting as a bystander without speaking up compounds the harm.

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Unfortunately, it really can't be undone even if you come forward later.

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So what's the personal practice change?

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Well, what we're asking is that for us to be upstanders, bystanders who respond with

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action to these microaggressive behaviors.

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That's the only way we're going to change it professionally for our hospitals, for our

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institutions, for our patients.

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One of these references was Dr. Meera Kotagal.

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Dr. Kotagal is a pediatric surgeon from Cincinnati Children's Hospital Medical Center, and her

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research focuses on disparities in patient care and patient outcomes.

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She's really worked to define and identify microaggressions in the hospital system.

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Specific questions come to mind.

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How do I not alienate the family?

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How do I not create a difference or avoid making the intern more uncomfortable?

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And I think one of the biggest things to think about in those moments is intent versus impact.

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So very often families, what they're doing, those implicit biases are not intentional,

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right?

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They don't necessarily recognize that that's what they're doing in that moment.

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If we separate intent from impact, it's easier to respond to understanding the impact and

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talking about what the impact is and not worrying so much about what the intent is.

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Because the intent is sort of irrelevant.

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The impact already exists.

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And so I think that helps alleviate us from that anxiety about how the family, you approach

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it as like, hey, you maybe didn't intend this, but let me help you understand how that impacted

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the person who was standing there.

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Well, thank you, Meera.

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And I hope that insight about intent will get rid of all those excuses that sort of

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come to mind in my own.

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Thanks for joining Dr. Lillehei and Dr. Kotagal, along with the rest of the APSA Professional

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Development Committee for this update course rewind.

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Remember to check out the StayCurrent app for more content related to pediatric surgery

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and more.