TOP 15 - A Simulation Approach to Enhancing Upstander Responses to Microaggressions Amongst Pediatric Fellows

Publication Number: 1775.TOP 15

Megan Schmalz, Baylor College of Medicine, Houston, TX, United States; Jared Rubenstein, Baylor College of Medicine, Houston, TX, United States; Daniel Lemke, Baylor College of Medicine, Houston, TX, United States

Background: Microaggressions in the clinical learning environment negatively impact psychological safety, professional development, and team culture. Despite this, pediatric fellows often lack formal training and practical tools to recognize and respond to such incidents in real time.

Objective: To address this gap, we developed and implemented a novel curriculum combining didactic instruction with simulation-based learning to enhance pediatric fellows’ recognition of and response to microaggressions.

Design/Methods: We designed a two-part curriculum consisting of a didactic session followed by a simulation session. During the didactic component, participants learned structured algorithms for responding to discriminatory behaviors, which they then applied in simulation exercises featuring two unique, realistic cases. These scenarios were derived from microaggressions observed or reported to the authors and emphasized the transition from passive bystanding to active upstanding behavior. The curriculum was delivered during the fall of 2025 at educational conferences for pediatric fellows across multiple subspecialties at a quaternary, stand-alone children’s hospital.

Anonymous pre- and post-intervention surveys, based on Kirkpatrick’s model, incorporated Likert-scale and free-text items. Quantitative analyses, including paired t-tests, assessed participants’ prior experiences, comfort identifying microaggressions, confidence in responding effectively, and likelihood of intervening in future incidents. Qualitative responses underwent thematic analysis.