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Common Types of Gender-Based Microaggressions in Medicine

Periyakoil, Vyjeyanthi S. MD; Chaudron, Linda MD, MS; Hill, Emorcia V. PhD; Pellegrini, Vincent MD; Neri, Eric MS; Kraemer, Helena C. PhD

doi: 10.1097/ACM.0000000000003057
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Purpose: Microaggressions are subtle verbal or nonverbal everyday behaviors that arise from unconscious bias, covert prejudice, or hostility. They may contribute to the persistent disparities faced by women in medicine. In this study, the authors sought to identify common microaggressions experienced by women faculty in medicine and to determine if specific demographic characteristics affect the reported frequencies of these microaggressions.

Method: The authors used chain referral sampling to collect real-life anecdotes about microaggressions from women faculty across the nation. Thirty-four unique experiences from those reported were identified and scripted then reenacted using professional actors to create 34 videos of the real-life microaggressions and 34 corresponding fictional “control” versions of the same situations. The videos, presented in a random order, were evaluated by faculty from 4 academic medical centers from 2016-2018.

Results: A total of 124 faculty (79 women, 45 men) participated. Women reported higher frequencies of microaggressions than men in 33 of the 34 videos depicting microaggressions (P value range: < .001 to .042, area under the curve [AUC] range: 0.60 to 0.69). No such differences were seen with the control videos. Women identified 21 microaggressions as occurring frequently. No significant differences were found with respect to participants’ age, race/ethnicity, academic rank, or years in medicine. Post hoc analyses showed that the microaggressions fell into 6 themes: encountering sexism, encountering pregnancy and child care related bias, having abilities underestimated, encountering sexually inappropriate comments, being relegated to mundane tasks, and feeling excluded/marginalized.

Conclusions: Privilege is often invisible to those who have it, whereas bias and discrimination are readily apparent to those who experience it. Knowledge of common microaggressions will allow for targeted individual, interpersonal, and institutional solutions to mitigate disparities in medicine.

V.S. Periyakoil is associate professor of medicine, director, Stanford Aging and Ethnogeriatrics Center, and director, Palliative Care Education and Training, Department of Medicine, Stanford University School of Medicine, Stanford, California.

L. Chaudron is professor of psychiatry, pediatrics, and OB/GYN, and associate vice president and senior associate dean for inclusion and culture development, University of Rochester Medical Center, Rochester, New York,

E.V. Hill is director of research and evaluation, Converge, Office for Diversity Inclusion and Community Partnership, Harvard Medical School, Boston, Massachusetts.

V. Pellegrini is professor of orthopedics and physical medicine, Medical University of South Carolina, Charleston, South Carolina.

E. Neri is research data analyst, Center on Stress and Health, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.

H.C. Kraemer is emerita professor of biostatistics in psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.

[footnote] *The videos used in this project and some of the verbatim comments from the study participants are available to individuals through the Project Respect portal (https://respect.stanford.edu) and through an app called “Stanford Project Respect” available in the Apple App Store.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: This study was reviewed and approved by the Stanford University institutional review board on May 12, 2015 and subsequently by the institutional review boards at the University of Rochester School of Medicine, Harvard Medical School, and the Medical University of South Carolina.

Previous presentations: Presented by Vyjeyanthi S. Periyakoil as an opening plenary at the Association of American Medical Colleges Council of Faculty and Academic Societies Spring Meeting, April 2019, in Atlanta, Georgia.

Correspondence should be addressed to Vyjeyanthi S. Periyakoil, Stanford University School of Medicine, 1701 Page Mill Rd, 2nd Floor Room 222, Palo Alto, CA 94304; email: periyakoil@stanford.edu; Twitter: @palliator.

© 2019 by the Association of American Medical Colleges