Start by reading this JAMA Piece of My Mind “Speak Up” which describes one physician’s experience with speaking up when witnessing micro-aggressions or biased comments or behavior in the clinical workplace.

Then read this post from STAT News that describes a medical student’s experience with racist comments during her clinical training and how it felt when no one spoke out against it.

Tools for Responding to Bias

Goal: Communicate a message of disapproval without damaging interpersonal relations

Be ready 

• Rehearse what you would do or say in situations before they occur
• You know what feels most natural for you
• Remember the Bystander effect
• No one else will probably say anything
• Consider saying something, even if it is a small effort

Decide whether to say anything 

• Silence is often interpreted as passive complicity
• Consider saying something simple like “that’s not cool” or “I don’t appreciate that”
• You don’t have to take a dramatic stand if you’re not comfortable or not able

Consider taking more time if:

• You know you respond badly in the heat of the moment
• You fear retaliation or mistreatment and need more support
• The situation is not appropriate (ie during a patient care emergency)

Stay calm 

• Try to speak calmly, or consider waiting until another time
• Try to avoid inducing defensiveness

Clarify or Restate what was said  

• Make sure you are understanding what was said
• Make the speaker think about what they said
• “So I am hearing you say….” Or even “excuse me, what was that you just said?”
• If a joke was made, ask the speaker to explain it to you
• When identifying the behavior, avoid labeling, name-calling or the use of loaded terms.
• Describe the behavior; don’t label the person.

Appeal to principles 

• “I’m surprised to hear you say that.  I think of you as more… (egalitarian, open-minded, etc).”

Change the subject (more effective than it sounds) 

• You may not change beliefs but you may change behavior

Reflect on what happened 

• Journaling or meditation
• Debriefing with a peer or college mentor

It’s never too late to bring it up 

• Defer until later: “let’s talk about this when we have more time”
• Bring it up later: “I’ve been thinking about what you said last week…”

Don’t get discouraged 

• You won’t know the lasting impact you’ll have later on, both for the speaker and those who were present

Know your resources 

• College mentors and college heads
• Other trusted faculty
• Student Affairs office

Traps to Avoid

Avoid making light of any comments, making jokes (which often backfire!), or getting defensive