Ethical Legal Topic Microaggressions in Clinical Training and Practice Maryann K. Overland, MD, Jennifer M. Zumsteg, MD, Edwin G. Lindo, JD, Maurice G. Sholas, MD, PhD, FAAPMR, Roberto E. Montenegro, MD, PhD, Georgina D. Campelia, PhD, Feature Editor: Debjani Mukherjee, PhD Feature Editor: Debjani Mukherjee, PhD Northwestern University Feinberg School of Medicine and Shirley Ryan AbilityLab The term microaggression was coined almost 50 years ago (1970) by Professor Chester Pierce and has reemerged as a topic of scholarly interest, a contested concept, a social media hashtag, and a polarizing issue in our current political climate. A classic article from 2007 by Derald Wing Sue and colleagues defines racial microaggressions as “brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that com- municate hostile, derogatory, or negative racial slights and insults towards people of color.” 1 Sue and colleagues further define three types of microaggressions. Microassaults are a “verbal or nonverbal attached meant to hurt the intended victim through name-calling, avoidant behavior, or purpose- ful discriminatory actions.” Microinsults are “communica- tions that convey rudeness and insensitivity and demean a person’ s racial heritage or identity.” Microinvalidations are “communications that exclude, negate or nullify the psy- chological thoughts, feelings, or experiential reality of a person of color” (p. 274). The term was first applied to race and racism, however, the term also applies to other margin- alized groups including women, people with disabilities, sexual and gender minorities, and religious minorities, among others. 2 There are critiques of the concept, includ- ing the observation that the research on microaggressions is “underdeveloped,” lacks scientific rigor, and may be “embedded in politics.” 3 Yet, there is agreement that insults, snubs, and slights undermine relationships and prac- tices and affect health care. In a recent PM&R ethics/legal column, guest edited by Julie Silver, MD, the topic of micro-inequities in medicine was explored. 4 In this series of invited commentaries, we will delve into microaggressions. Within medicine, there is a small but growing body of literature (see for example, Freeman and Stewart 5 ) including microaggressions expe- rienced by patients, healthcare professionals, and trainees. Various medical schools have embarked on microaggression awareness campaigns and incorporated this concept into education, as have some residency pro- grams. I have asked the authors to focus specifically on the experiences of healthcare professionals and trainees. The topic of microaggressions toward patients is a related but distinct area of concern. The invited authors were asked to respond to the following prompt: How does the experience of microaggressions impact the practice of medicine? How have your experiences or those of your colleagues under- scored the complexities of this concept? Illustrative examples, particularly from PM&R, are welcome. What are the ethical implications? Do you have sug- gestions for decreasing microaggressions, on the individual, group, institutional or societal level? Our first columnist, Maryann Katherine Overland, MD, is an assistant professor of medicine in the Division of Gen- eral Internal Medicine and the associate program director of primary care for the Internal Medicine Residency at the University of Washington. She highlights how trainees can be supported to mitigate the impact of microaggressions. Our second contribution is from Jennifer M. Zumsteg, MD, an associate professor of rehabilitation medicine and pro- gram director, PM&R Residency and Edwin Lindo, JD, a lecturer in the Department of Family Medicine and associ- ate director of critical teaching and equity at the Center for Critical Teaching and Equity at the Center for Leader- ship and Innovation in Medical Education, at the Univer- sity of Washington. They describe historical biases and draw on examples from PM&R residents. Our third PM R 11 (2019) 1004–1012 www.pmrjournal.org © 2019 American Academy of Physical Medicine and Rehabilitation https://dx.doi.org/10.1002/pmrj.12229