It is past due time we talk about microaggressions on interviews (a thread #MedTwitter #AcademicTwitter):

First, microaggressions are harmful! Despite their name, they signal “you don’t belong here” to marginalized groups.

Second, interview days are already nerve-wrecking.
One comment or experience has the ability to undermine an interview day. Applicants may not have the ability to report immediately and anonymously or may fear retribution for doing so. Interview day microaggressions put applicants in an awkward spot in addition to the harm.
They are also not rare experiences. As a Black woman, I have experienced them at multiple institutions and different levels. I’m sharing my stories as examples of what happens, but I have no doubt there are many others, even within your institution, that need to be responded to.
College: I had an in-person panel interview for a full-tuition scholarship. One POC on the panel repeatedly asked, “where are you from?” I was 17 and eager to please, but also knew I didn’t have to share that my ancestors were traumatized thru slavery. I got flustered and bombed.
Med school: A diversity website wrote, we need more physicians of color because they are more likely to serve in underserved communities. While true, the reason we need more representation in medicine is because minoritized groups have been kept out. PERIOD. I didn’t apply there.
Residency: A peds program’s “community service” was teaching young kids about nutrition while their moms had weight loss education “to reduce their next pregnancy’s risk.” The program just assumed that Black women will keep having kids without investigating their beliefs. EWW!
Fellowship: I shared with a current fellow my interest in working with Black and Brown youth. Their response, “well you should definitely come here because we work at the juvenile detention center!” Their immediate perception was through the harmful lens of youth incarceration 🤦🏾‍♀️
This non-exhaustive list negatively impacted my view of each institution.

I didn’t have an opportunity to report most. When I shared once, I was told how the person had a “good heart” and is a leader so nothing can be done. Message received: power matters more than my hurt.
As interview season closes and institutions have new awareness of anti-racism, microaggressions need to be taken seriously with prompt, anonymous reporting & action that doesnt question or gaslight the recipient, but focuses on the speaker: education +/- removal from interviewing
Applicants are seeking signs in every interaction that signal safety at your institution. Microaggressions are one of the most violent forms of othering during the interview process. We need a culture shift. We need to start talking about them and making safer interviews

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More from @RFentonMD

17 Oct 20
How to counsel about health w/o talking about weight (@Margaret1473)

First, just bc obesity is associated with a condition doesnt mean its the cause. Correlation doesn’t mean causation! There’s no evidence showing wt loss (isolated from nutrition & exercise) improves health.
2. dieting/weight loss is not sustainable for 9/10 people. Most regain the weight...and risk feeling like failures.

3. Every body has a set point range it likes to maintain. The body works hard to keep it, like increasing hunger on a diet. Yoyo dieting increases the set point😳
4. Weight is not an indicator of health. Ex: There are athletes of all sizes, including higher weights. There’s a also a thing called the obesity paradox that shows people who are overweight or “stage 1 obesity” (BMI 30-35) actually live longer than those that are normal weight.
Read 15 tweets
15 Oct 20
Some UIM applicants have approached me about if they should "go there" in an essay or interview aka tell THOSE stories where they witnessed racism at work in healthcare. My thoughts in a thread (I welcome others):

Own the motivation for your interest in health and stay focused.
I wrote about an experience in my residency essay and honed in on the patient's condition & what I offered to intervene. The team perceived the family was non-adherent while I saw a a Black mother who was a fierce advocate. I sat with her. I learned about the barrier to follow-up
and the stressors (new and ongoing) at home that challenged the family. I brought that knowledge to rounds along with my overnight events and exam findings to rounds along with the patient's perspective so that our plans reflected their experiences and were more successful.
Read 9 tweets
11 Sep 20
With in-person rotations back in full swing, it’s time for a thread about managing rough feedback. This is geared towards #MedStudentTwitter, but hopefully applicable to everyone whether you are giving or receiving feedback.

Here we go...
@HollandStanton @m3betch
Why I care: I got called “shy”, “unengaged”, a “passive learner”, & a “great pediatrician on my OB rotation”🙃. Critical feedback can hurt. I had to learn how to receive it and also how to change my actions so that the comments reflected my commitment. Thanks to mentors, I did.
First, I had to learn as a person who liked being liked and getting good grades to not take feedback personally, even when it sounds personal. Even though feedback is the basis of grading, people often get little training in it or uncomfortable giving/asking for it.
Read 14 tweets
19 May 20
Just finished a convo about medical errors. It reminded me of my first real mistake. Thankfully, I was surrounded by a community that helped me learn from it without falling into shame. Culture is SO important for preventing & processing errors. I even wrote this to normalize it: Image
Many don’t have a “good” mistake experience. I was involved in a different situation where learners were blamed instead of taught. I asked an intern to do something that turned out to be incorrect. Our supervisor yelled at the intern w/o acknowledging that they were my directions
I could have done nothing and let the intern take the rap, but that is the literal opposite of my character. I also had concerns about how the supervisor was managing the team. The interns were afraid to speak up about plans out of fear of embarrassment. My team’s morale dropped
Read 7 tweets
10 Mar 20
#TalkingToTeens101: Let’s Talk About Gender & Sexuality, the #tweetorial

Talking abt gender starts at the beg of the visit. Introduce urself, ur pronouns, then ask patients their name & pronouns.

Ex: “I’m Dr. Fenton & I use she/her pronouns. What name & pronouns do you use?”
1
If a teen is w a parent, ask more privately. I keep it open-ended: “how do you describe your gender?” For teens looking at me confused, I explain like this: “people can identify as male, female, non-binary, a combination, or no gender at all. How do you identify?”
2
Asking for & using a patient’s affirmed name/pronouns is important to do at ALL visits, but asking abt gender identity is not always necessary; it depends on visit reason. For example, it is clutch for well visits, but not for many acute complaints. No need to ask just to know.
3
Read 15 tweets
21 Feb 20
Rotating on the peds trauma service, I met a Black young man who was shot in the abdomen. The word was it was “gang activity”. No one bothered to ask more questions.

I walked in the room and saw a boy who was scared. He feared the outcomes of surgery and getting shot again.

1/
He looked anxiously at his mother whenever she came to his bedside. With tough love in her eyes, she explained that she asked him to move out and live with an older brother due to conflicts at home. Her expression seemed to question if she made the right decision

2/
Alone, I asked him what happened that night. He said he was hanging with girl friends who decided to buy weed. He went out with them to meet the dealer. The dealer tried to rob them, and when he resisted, he got shot. I just listened. His face already filled with enough shame

3/
Read 7 tweets

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