Microaggression, defined as a subtle, powerful, and often unintentional form of discrimination (Wong, Derthick, David, Sawn, & Okazaki, 2014), has recently received interest as a means of describing ongoing acts of disrespect and intolerance toward minorities. The concept has come to refer to brief and even commonplace verbal and nonverbal interactions perceivable as hostile slights toward members of oppressed groups (Lilienfield, 2017). Proponents of the concept argue that concern is justified based on the observation that, even as overt prejudice appears to decline, very real racial disparities continue to exist. Are microaggressions at work within academia a demonstration of implicit bias causing persistent inequities in health care? The focus of this article is the presence and effects of microaggressions within academia, specifically within nursing faculty. Despite the considerable efforts by schools of nursing to better address diversity, inclusion, and equity, we propose that unaddressed microaggressions contribute to ongoing racial disparities within nursing academia.
DANGEROUS CONSEQUENCES
The contrast of racial realities within academia sets the stage for the damaging effects of microaggressions. For example, during an interview for tenure promotion, a minority faculty member is asked if English is her first language. The faculty member is turned down for promotion as she watches other, seemingly equally qualified nonminority candidates move forward. Based on personal experience, the faculty member could perceive that question as a reinforcement of stereotype, a subtle reminder that minorities are continued to be seen as persistent foreigners. Because the comment is subtle and perhaps not intentionally hostile, the recipient is left with self-doubt, blaming herself for the perception of "otherness" (Wong-Padoongpatt, Zane, Okazaki, & Saw, 2017).
The consequences of such interactions reach beyond mere frustration. It has been acknowledged that overt racism has adverse effects on physical and mental health (White-Davis et al., 2018), an understanding leading to the demand that racism be addressed in the curricula of US health care academia. There is now evidence that microaggressions may be physically damaging and that racial disparities continue to be experienced by faculty within academia (Wong-Padoongpatt et al., 2017). Faculty members experiencing microaggressions may perceive that they are not welcome, that they are "others," less likely to be promoted as their nonminority counterparts.
This perception is convincingly reinforced by a visible reality. Minority faculty in the United States are represented at levels well below population averages and even well below student body averages (Myers, 2016). Among the highest levels of faculty, the news is even worse - racial minorities comprise about 20 percent of tenured faculty (Myers, 2016). By most standards, faculty at our nursing schools lag behind even these dismal numbers (National Advisory Council for Nursing Education and Practice, 2010).
Although racial disparities within academia are evident, acceptance of microaggression theory is far from universal. Some critics question the validity of microaggressions as a concept, pointing to limited supporting evidence. Lilienfeld (2017), while agreeing that measurable disparities continue to exist between minority and nonminority individuals, points out that microaggression is an "open concept," making it difficult to clearly define or identify. Social critics, however, are skeptical of the nature of the debate, suggesting that undue focus on microaggressions promotes oversensitivity. Still, others question the very existence of microaggressions, defending racially motivated slights as harmless and insignificant (Wong-Padoongpatt et al., 2017).
It is undeniable that the nature of microaggressions makes them difficult to define, and it is understandable that this lack of clarity can be troubling. Yet, although some question the existence of microaggressions, others argue that the insidious nature of microaggressions makes them more damaging than overt hostilities. We argue that it is, in fact, the subtle, insidious, and ambiguous nature of microaggressions that makes them so potentially harmful and therefore such an important concept to explore and evaluate.
WHY IT MATTERS
Despite efforts to reduce racial inequalities, disparities in health care persist and minorities remain underrepresented within health professions. In this setting, microaggressions emphasize the unwelcoming notion to both faculty and students that minorities continue to be "others." Subtle comments reinforcing the feeling of otherness magnify the lack of opportunity and create a sense of invisibility. Faculty experiencing microaggressions in the form of exclusion or being ignored may perceive that their views are not valued equally. Far from being the product of oversensitivity, these perceptions mirror the unfortunate reality of noticeable minority underrepresentation within faculty, tenured positions, and administration.
Critics may continue to dismiss microaggressions as oversensitive perpetuation of the culture of victimhood. Proponents may argue that overt racism alone does not explain persisting racial inequalities. The debate is destined to continue until more definitive studies are made quantifying the concept of microaggressions. One thing is clear: The United States is far from achieving the goal of a diversified health workforce. In spite of general consensus on the benefits of diversity in academia, studies on strategies to reduce and/or prevent racial microaggressions are lacking. Simply teaching providers about health care inequities has proven insufficient to reach actual equity. Previous approaches have focused on disparity statistics and cultural competence training, approaches that identify symptoms of racism but do little to challenge the implicit biases that sustain them. And yet, it is this implicit bias that gives rise to the action of microaggression (White-Davis et al., 2018).
RECOMMENDATIONS
Despite the challenges, strategies are required to address implicit bias and microaggression in a manner that allows minority faculty to excel and perform at their full capacity. To reduce the impact of microaggression, mechanisms must be developed to study and understand the consequences of subtle discriminations and implicit bias at work in the culture of academia. We recommend that institutions do the following.
Develop Functional Department-Level Diversity Committees
Diversity committees should include representatives from the university office of diversity and faculty administration, as well as student, alumni, and faculty members with a demonstrated passion for equity issues. The committee should ensure that a strategic plan is in place to provide direction and measurable goals. Examples of effective strategic planning include clearly written statements of support and policies encouraging recruitment and retention of minority faculty. Policies should ensure that support is in place for minority faculty and that ongoing issues, like implicit bias and microaggressions, are systematically addressed with routine, evidence-based training.
Diversity Committee members should present existing diversity policies and resources as part of new student/faculty/staff orientation. Administration representation and support of diversity at hiring demonstrate a department-level commitment to equity.
Incorporate Curriculum Dedicated to Exploring Implicit Bias
Implicit bias training should be incorporated into core curricula, in addition to routine training for administrators, faculty, and members of committees responsible for admission, appointment, promotion, and tenure. Effective curriculum content and training models should review awareness and consequences of implicit bias and increase participants' awareness of their own implicit bias. Models supported by evidence include the gender bias habit-breaking intervention as well as the prejudice habit-breaking intervention (Forscher, Mitamura, Dix, Cox, & Divine, 2017).
Develop and Implement an Anonymous Reporting System
Microaggressive behaviors must be reported easily without any fear of retaliation. Sincere commitment by the leadership to promptly address concerns will encourage a welcoming atmosphere for all.
CONCLUSION
Recruiting, retaining, and promoting qualified minorities need to start in academia. Increasing accountability to minority students and faculty in academia begins with understanding the impact of subtle but significant microaggressions. To foster diversity, it is important to realize the harms that these encounters can inflict in marginalized groups. Strong institutional commitment will cultivate and sustain a supportive environment that promotes respect, dignity, and the elimination of all forms of oppression in academia.
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