Active Bystander Training: Using Standardized Patient Methodology to Teach Residents to Navigate Microaggressions in Patient Encounters

Date of Review: July, 2023

This resource is designed to support the training of residents to be effective bystander/upstanders in the face of microaggressions directed to colleagues by patients in clinical environments. The primary curricular innovation is the use of Standardized Patients (SPs) to give residents a chance to practice a bystander framework that is shared prior to the SP encounter via a didactic workshop. The framework, WAKE (Work with who you are, Ask questions/make direct statements, involve Key people, and Employ distraction techniques), is an evidence-based behavior response framework validated primarily in college settings. The authors make the point that other intervention frameworks could be substituted in place of WAKE. Strengths of this curriculum include the use of SPs, which are a low-stakes method of delivering sensitive content, and the adaptability of this approach to other behavioral response frameworks that may be preferred (e.g., alternative approaches that are being rolled out as part of system-wide Equity/Diversity/Inclusion initiatives). One major challenge of this curriculum I that is requires substantial SP resources that some residency programs may not have access to. As the authors point out, SPs who participate in this program need focused training and feedback opportunities to role play with this type of content. Finally, while generally favorable, results indicate that just over half of residents reported that the activity was useful for their professional development, indicating opportunities for improvement in curricular design and/or implementation. — Loel Solomon, PhD, Kaiser Permanente School of Medicine

Corresponding Author’s Email:


University of Wisconsin, Madison

Where was the Curriculum Implemented:

Greensboro, North Carolina

Clinical Specialty:

Internal Medicine

Outcomes that Have Been Reported for the Curriculum:

Self-reported learner knowledge

Self-reported learner attitude

Measured learner behavior in real patient setting

Outcome and Study Design:


Level of Learner Assessment

Appreciation of content/attitude assessment (self-reflection, blogging with rubric)

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