Exploring the impact of microaggressions on the genetic counseling student-supervisor relationship: A qualitative study.
disability
genetic counseling
microaggressions
racial and ethnic minorities
supervision
supervisory working alliance
Journal
Journal of genetic counseling
ISSN: 1573-3599
Titre abrégé: J Genet Couns
Pays: United States
ID NLM: 9206865
Informations de publication
Date de publication:
15 Feb 2024
15 Feb 2024
Historique:
revised:
03
07
2023
received:
01
12
2022
accepted:
27
12
2023
medline:
15
2
2024
pubmed:
15
2
2024
entrez:
15
2
2024
Statut:
aheadofprint
Résumé
Genetic counseling students with minoritized identities have reported experiencing microaggressions throughout graduate training, including from fieldwork supervisors. However, the impacts of these fieldwork experiences have not been thoroughly investigated. As supervision is known to be integral to genetic counseling students' skill development and success, the purpose of this qualitative study was to explore the impact of microaggressions on student training, with a specific focus on the supervisory working alliance. To achieve this goal, we conducted 11 interviews with recent genetic counseling graduates (2019-2021) who reported experiencing at least one microaggression from a fieldwork supervisor during graduate school training. Purposive sampling was used to prioritize interviewees who identified as underrepresented in the field due to race, ethnicity, gender identity, sexual orientation, and/or disability status. All interviewees were initially recruited as part of a larger mixed-methods study investigating the frequency and types of microaggressions genetic counseling students experience from fieldwork supervisors. Interview questions explored the time period before a microaggression event, during the event, and after. Qualitative thematic analysis resulted in four themes, three of which are presented in this paper: (1) Impact of microaggressions, (2) Barriers to reporting microaggressions, and (3) Experience reporting microaggressions. Microaggressions from supervisors were shown to impair the psychological well-being of participants and hinder learning opportunities. These experiences led participants to question their choice of profession and avoid time in clinic, ultimately constraining the development of strong supervisory working alliances. Some participants did not report microaggressions due to fear of negative repercussions, and those who did described defensive responses which harmed students' relationships with program leadership. This study reveals opportunities for supervisors to improve student training conditions by centering students' feelings and experiences, increasing open and honest communication, and extending psychosocial tools to supervision. Additionally, graduate programs are encouraged to establish structured reporting protocols for students and evaluate current shortcomings in equity and inclusion initiatives.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Authors. Journal of Genetic Counseling published by Wiley Periodicals LLC on behalf of National Society of Genetic Counselors.
Références
Alicea, C. C. M., & Johnson, R. E. (2021). Creating community through affinity groups for minority students in communication sciences and disorders. American Journal of Speech-Language Pathology, 30(5), 2028-2031. https://doi.org/10.1044/2021_AJSLP-20-00342
Alvarado-Wing, T. E., Marshall, J., Best, A., Gomez, J., & Cragun, D. (2021). Exploring racial and ethnic minority individuals' journey to becoming genetic counselors: Mapping paths to diversifying the genetic counseling profession. Journal of Genetic Counseling, 30(6), 1522-1534. https://doi.org/10.1002/jgc4.1419
Association of American Medical Colleges, & University of Massachusetts Medical School. (n.d.). Diversity Engagement Survey (DES). Association of American Medical Colleges. https://www.aamc.org/media/20911/download?attachment
Bhat, C. S., & Davis, T. E. (2007). Counseling supervisors' assessment of race, racial identity, and working alliance in supervisory dyads. Journal of Multicultural Counseling and Development, 35(2), 80-91. https://doi.org/10.1002/j.2161-1912.2007.tb00051.x
Bordin, E. S. (1983). A working alliance based model of supervision. The Counseling Psychologist, 11(1), 35-42. https://doi.org/10.1177/0011000083111007
Bordin, E. S. (1994). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252-260. https://doi.org/10.1037/h0085885
British Medical Association. (2020). A charter for medical schools to prevent and address racial harassment. British Medical Association. https://www.bma.org.uk/media/2030/bma-med-school-charter-implementation.pdf
Brunsma, D. L., Embrick, D. G., & Shin, J. H. (2017). Graduate students of color: Race, racism, and mentoring in the white waters of academia. Sociology of Race and Ethnicity, 3(1), 1-13. https://doi.org/10.1177/2332649216681565
Bullock, J. L., O'Brien, M. T., Minhas, P. K., Fernandez, A., Lupton, K. L., & Hauer, K. E. (2021). No one size Ffts all: A qualitative study of clerkship medical students' perceptions of ideal supervisor responses to microaggressions. Academic Medicine: Journal of the Association of American Medical Colleges, 96(11S), S71-S80. https://doi.org/10.1097/ACM.0000000000004288
Carmichael, N., Redlinger-Grosse, K., & Birnbaum, S. (2021a). Examining clinical training through a bicultural lens: Experiences of genetic counseling students who identify with a racial or ethnic minority group. Journal of Genetic Counseling, 31(2), 411-423. https://doi.org/10.1002/jgc4.1506
Carmichael, N., Redlinger-Grosse, K., & Birnbaum, S. (2021b). Supporting a sense of inclusion and belonging for genetic counseling students who identify as racial or ethnic minorities. Journal of Genetic Counseling, 30(3), 813-827. https://doi.org/10.1002/jgc4.1381
Clark, C. R., Mercer, S. H., Zeigler-Hill, V., & Dufrene, B. A. (2012). Barriers to the success of ethnic minority students in school psychology graduate programs. School Psychology Review, 41(2), 176-192. https://doi.org/10.1080/02796015.2012.12087519
De Stefano, J., Hutman, H., & Gazzola, N. (2017). Putting on the face: A qualitative study of power dynamics in clinical supervision. The Clinical Supervisor, 36(2), 223-240. https://doi.org/10.1080/07325223.2017.1295893
Dewey, C., McCarthy Veach, P., LeRoy, B., & Redlinger-Grosse, K. (2022). Experiences of United States genetic counseling supervisors regarding race/ethnicity in supervision: A qualitative investigation. Journal of Genetic Counseling, 31(2), 510-522. https://doi.org/10.1002/jgc4.1521
Efstation, J. F., Patton, M. J., & Kardash, C. M. (1990). Measuring the working alliance in counselor supervision. Journal of Counseling Psychology, 37(3), 322-329. https://doi.org/10.1037/0022-0167.37.3.322
Egan, R., Maidment, J., & Connolly, M. (2017). Trust, power and safety in the social work supervisory relationship: Results from Australian research. Journal of Social Work Practice, 31(3), 307-321. https://doi.org/10.1080/02650533.2016.1261279
Guevara, J. P., Wade, R., & Aysola, J. (2021). Racial and ethnic diversity at medical schools - why aren't we there yet? The New England Journal of Medicine, 385(19), 1732-1734. https://doi.org/10.1056/NEJMp2105578
Haskins, N., Whitfield-Williams, M., Shillingford, M. A., Singh, A., Moxley, R., & Ofauni, C. (2013). The experiences of black master's counseling students: A phenomenological inquiry. Counselor Education and Supervision, 52(3), 162-178. https://doi.org/10.1002/j.1556-6978.2013.00035.x
Hwang, W. C., & Goto, S. (2008). The impact of perceived racial discrimination on the mental health of Asian American and Latino college students. Cultural Diversity & Ethnic Minority Psychology, 14(4), 326-335. https://doi.org/10.1037/1099-9809.14.4.326
Jackson, D., Davison, I., Adams, R., Edordu, A., & Picton, A. (2019). A systematic review of supervisory relationships in general practitioner training. Medical Education, 53(9), 874-885. https://doi.org/10.1111/medu.13897
Johansson, I., Holm, A. K., Lindqvist, I., & Severinsson, E. (2006). The value of caring in nursing supervision. Journal of Nursing Management, 14(8), 644-651. https://doi.org/10.1111/j.1365-2934.2006.00709.x
Kilminster, S. M., & Jolly, B. C. (2000). Effective supervision in clinical practice settings: A literature review. Medical Education, 34(10), 827-840. https://doi.org/10.1046/j.1365-2923.2000.00758.x
Lilly, J. M., Hillyer, J., Jaggers, E., & Garnigan, K. (2022). A “totally, acceptably racist environment”: Examining anti-black racism in a school of social work. Journal of Social Work Education, 1-16, 391-406. https://doi.org/10.1080/10437797.2022.2119357
MacFarlane, I., Veach, P. M., & LeRoy, B. (2014). Genetic counseling research: A practical guide. Oxford University Press.
Majmudar, G. (2019). Assessing the impact of diversity and inclusion among individuals in genetic counseling student cohorts [Unpublished Master's thesis]. Brandeis University.
Mathieu, J., Fotsing, S., Akinbobola, K., Shipeolu, L., Crosse, K., Thomas, K., Denis-LeBlanc, M., Gueye, A., & Bekolo, G. (2022). The quest for greater equity: A national cross-sectional study of the experiences of black Canadian medical students. CMAJ Open, 10(4), E937-E944. https://doi.org/10.9778/cmajo.20220192
National Society of Genetic Counselors. (2019). Professional Status Survey 2019: Demographics and Methodology.
Ogunyemi, D., Clare, C., Astudillo, Y. M., Marseille, M., Manu, E., & Kim, S. (2020). Microaggressions in the learning environment: A systematic review. Journal of Diversity in Higher Education, 13(2), 97-119. https://doi.org/10.1037/dhe0000107
Ramsey, K., Carmichael, N., Gutierrez-Kapheim, M., Dell-Suguitan, M. D., Lopez Santibanez Jacome, L., Bao, A. K., & Hoell, C. (2024). Exploring the occurrence of microaggressions in the genetic counseling student-supervisor relationship: A mixed-methods study. Journal of genetic counseling. Advance online publication. https://doi.org/10.1002/jgc4.1854
Smith, W. A., Allen, W. R., & Danley, L. L. (2007). “Assume the position. You fit the description”: Psychosocial experiences and racial battle fatigue among African American male college students. American Behavioral Scientist, 51(4), 551-578. https://doi.org/10.1177/0002764207307742
Strickler, A., Valenti, M. W., & Mihalo, J. R. (2018). Mechanisms for building working alliances in clinical supervision. Clinical Social Work Journal, 46, 361-373. https://doi.org/10.1007/s10615-018-0684-3
Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: Implications for clinical practice. The American Psychologist, 62(4), 271-286. https://doi.org/10.1037/0003-066X.62.4.271
Suguitan, M. D., Veach, P. M., LeRoy, B., Wherley, C., & Redlinger-Grosse, K. (2019). Genetic counseling supervisor strategies: An elaboration of the reciprocal-engagement model of supervision. Journal of Genetic Counseling, 28(3), 602-615. https://doi.org/10.1002/jgc4.1057
Telio, S., Ajjawi, R., & Regehr, G. (2015). The “educational alliance” as a framework for reconceptualizing feedback in medical education. Academic Medicine: Journal of the Association of American Medical Colleges, 90(5), 609-614. https://doi.org/10.1097/ACM.0000000000000560
Torres, L., Driscoll, M. W., & Burrow, A. L. (2010). Racial microaggressions and psychological functioning among highly achieving African-Americans: A mixed-methods approach. Journal of Social and Clinical Psychology, 29(10), 1074-1099. https://doi.org/10.1521/jscp.2010.29.10.1074
Tracy, S. (2020). Qualitative research methods: Collecting evidence, crafting analysis, communicating impact (2nd ed.). John Wiley & Sons.
Veach, P. M., Bartels, D. M., & Leroy, B. S. (2007). Coming full circle: A reciprocal-engagement model of genetic counseling practice. Journal of Genetic Counseling, 16(6), 713-728. https://doi.org/10.1007/s10897-007-9113-4
Wearne, S., Dornan, T., Teunissen, P. W., & Skinner, T. (2012). General practitioners as supervisors in postgraduate clinical education: An integrative review. Medical Education, 46(12), 1161-1173. https://doi.org/10.1111/j.1365-2923.2012.04348.x
Wherley, C., Veach, P. M., Martyr, M. A., & LeRoy, B. S. (2015). Form follows function: A model for clinical supervision of genetic counseling students. Journal of Genetic Counseling, 24(5), 702-716. https://doi.org/10.1007/s10897-015-9837-5
Wong, G., Derthick, A. O., David, E. J., Saw, A., & Okazaki, S. (2014). The what, the why, and the how: A review of racial microaggressions research in psychology. Race and Social Problems, 6(2), 181-200. https://doi.org/10.1007/s12552-013-9107-9