The guidelines appear to support anonymous reporting of microaggressions. Taken from the AMA Reference Committee Amendments on Constitution and Bylaws, May 2021

AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES

Resolution: 003(JUN-21)

Introduced by:American Academy of Pediatrics

Subject:Healthcare Organizational Policies and Cultural Changes to Prevent and Address Racism, Discrimination, Bias and MicroaggressionsReferred to:Reference Committee on Amendments to Constitution and Bylaws

Whereas, “Racism” refers to an organized system, rooted in an ideology of inferiority that categorizes, ranks and differentially allocates societal resources to human population groups; and

Whereas, Racism may or may not be accompanied by prejudice at the individual level

and Whereas, Explicit bias refers to the attitudes or beliefs we have about a person or group on a conscious level and includes the “-isms” such as racism, sexism, etc held by individualsii; and

Whereas, Implicit or unconscious bias refers to ingrained habits of thought that lead to errors in how we perceive, reason, remember and make decisions and that are unconscious or unintentional and may or may not align with our stated values or beliefsii;

Whereas, Microaggressions are brief, commonplace, daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative slights and insults toward marginalized populations, that implicitly communicate or at least engender hostility” ; and

Whereas, Microaggressions are very real forms of racism and discrimination, a “persistent daily low hum of racist abuse” that is not minor or micro in how it is experienced; and

Whereas, Microaggressions generate stresses equal to or worse than overt discrimination for underrepresented minority groups; and

Whereas, Recent research shows that regular exposure to perceived discrimination of any kind adversely affects the psychological and physical health of the recipients including depression, anxiety, burnout, trauma response, alcohol use, among others; and

Whereas, Patients tend to be in vulnerable states when seeking medical treatment and may be especially susceptible to psychological distress in response to racism or bias; and

Whereas, Racism in any form is especially detrimental when enacted by health care providers; and

Whereas, Many instances of racism and bias will likely stay unrecognized unless an ongoing intentional, reflective, and process-oriented practice is implemented; and

Whereas, Examining racism and bias should be viewed as a growth promoting, educational opportunity that has the potential to improve individual interactions and system level practices;

therefore be it RESOLVED, That our American Medical Association adopt the following guidelines for healthcare organizations and systems, including academic medical centers, to establish policies and an organizational culture to prevent and address systemic racism, explicit and implicit bias and microaggressions in the practice of medicine:

GUIDELINES TO PREVENT AND ADDRESS SYSTEMIC RACISM, EXPLICIT BIAS 10 AND MICROAGGRESSIONS IN THE PRACTICE OF MEDICINE

Health care organizations and systems, including academic medical centers, should establish policies to prevent and address discrimination including systemic racism, explicit and implicit bias and microaggressions in their workplaces.

An effective healthcare anti-discrimination policy should:

• Clearly define discrimination, systemic racism, explicit and implicit bias and microaggressions in the healthcare setting.

• Ensure the policy is prominently displayed and easily accessible.

• Describe the management’s commitment to providing a safe and healthy environment that actively seeks to prevent and address systemic racism, explicit and implicit bias and microaggressions.

• Establish training requirements for systemic racism, explicit and implicit bias, and microaggressions for all members of the healthcare system.

• Prioritize safety in both reporting and corrective actions as they relate to 26 discrimination, systemic racism, explicit and implicit bias and microaggressions.

• Create anti-discrimination policies that:specify to whom the policy applies (i.e., medical staff, students, trainees, 29 administration, patients, employees, contractors, vendors, etc.). – Define expected and prohibited behavior. – Outline steps for individuals to take when they feel they have experienced discrimination, including racism, explicit and implicit bias and microaggressions. – Ensure privacy and confidentiality to the reporter.

Provide a confidential method for documenting and reporting incidents. – Outline policies and procedures for investigating and addressing complaints and determining necessary interventions or action.

• These policies should include: – Taking every complaint seriously. – Acting upon every complaint immediately. – Developing appropriate resources to resolve complaints. – Creating a procedure to ensure a healthy work environment is maintained for complainants and prohibit and penalize retaliation for reporting. Communicating decisions and actions taken by the organization following a complaint to all affected parties. – Document training requirements to all the members of the healthcare system and establish clear expectations about the training objectives. In addition to formal policies, organizations should promote a culture in which discrimination, including systemic racism, explicit and implicit bias and microaggressions are mitigated and prevented. Organized medical staff leaders should work with all stakeholders to ensure safe, discrimination-free work environments within their institutions. Tactics to help create this type of organizational culture include:

• Surveying staff, trainees and medical students, anonymously and confidentially to assess: – Perceptions of the workplace culture and prevalence of discrimination, systemic racism, explicit and implicit bias and microaggressions. Ideas about the impact of this behavior on themselves and patients.

• Integrating lessons learned from surveys into programs and policies.

• Encouraging safe, open discussions for staff and students to talk freely about problems and/or encounters with behavior that may constitute discrimination, including racism, bias or microaggressions.

• Establishing programs for staff, faculty, trainees and students, such as Employee Assistance Programs, Faculty Assistance Programs, and Student Assistance Programs, that provide a place to confidentially address personal experiences of discrimination, systemic racism, explicit or implicit bias or microaggressions.

• Providing designated support person to confidentially accompany the person reporting an event through the process.

Received: 05/07/21 AUTHORS STATEMENT OF PRIORITYRacism, or discrimination based on race or ethnicity is responsible for increasing disparities in physical and mental health among Black, Indigenous, and people of color. We feel that this resolution is a top priority for this meeting as it will provide policy for our AMA’s new three-year roadmap to embed racial justice and advance health equity within the AMA and our health care system.i Bonilla-Silva E. Rethinking Racism: Toward a Structural Interpretation.American Sociological Review.1996;62(3):465–480.ii Sue DW, Capodilupo CM, Torino GC, et al. Racial microaggressions in everyday life: implications for clinical practice. Am Psychol. 2007;62(4):271-286.iii Kendi, I. X. (2019).How to be an antiracist. New York: One World.iv Solorzano D, Ceja M, Yosso T. Critical race theory, racial microaggressions, and campus racial climate: the experiences of African American college students. J Negro Educ. 2001;69(1/2):60-73.v Nadal KL, Wong Y, Griffin KE, Davidoff K, Sriken J. The adverse impact of racial microaggressions on college students’ self-esteem. J Coll Student Dev. 2014;55(5):461-474.