Assessing the Prevalence of Microaggressions in Plastic Surgery Training: A National Survey

Abstract

Background: There has been increased awareness of microaggressions occurring during medical training. However, the prevalence and characteristics of microaggressions specifically in plastic surgery residency remain unknown. We aimed to fill this literature gap by conducting a nationwide survey to better understand and characterize microaggressions in plastic surgery training. Methods: A survey was distributed between March and May 2021 via the American Society of Plastic Surgeons Resident Representatives to 1014 integrated and 214 independent track plastic surgery trainees in the United States. Multiple Pearson’s chi-square of independence and Fisher exact tests evaluated comparisons of microaggressions by sex, race, Hispanic origin, sexual orientation, and year in training. A multivariate regression analysis assessed associations between variables. Results: One hundred twenty-five participants responded to the survey (response rate: 10.2%). Of those who responded, 68.8% had experienced microaggressions in the past year. Female trainees experienced microaggressions more frequently than male trainees ( P < 0.05). Asian trainees had higher odds to be a target of microaggressions compared with White trainees ( P = 0.013). Nonheterosexual trainees were more likely to have experienced microaggressions compared with heterosexual trainees ( P < 0.05). Independent trainees were more likely to experience microaggressions than PGY 1–2 and 3–4 integrated residents ( P < 0.05). Conclusions: Approximately seven in every 10 trainees stated that they experienced microaggressions in the past year. Females, racial minorities, sexual minorities, and independent trainees had higher odds of reporting that they experienced microaggressions. Further studies are needed to assess the implementation of strategies that address this problem to resolve inequities.

Exploring female otolaryngologists’ experiences with gender bias and microaggressions: A cross sectional Canadian survey

“…This study was able to study the intersectionality of gender and race/ethnicity with microaggression. This current study reinforces the previous literature that trainees are more at risk for gender bias and microaggressions [27,[36][37][38]. In the domain analysis of the current study, the frequency severity, and total MESS score was higher for trainees than attendings in the domain of sexual objectification.…”

“…Only 7% reported these events and nearly one-third (30.8%) of residents experienced retaliation due to reporting of microaggressions [36]. Further studies in plastic surgery and emergency medicine confirmed these results [37,38]. For example, misidentification as a non-clinician staff, the most common form of microaggression in the emergency medicine study, occurred more commonly with trainees than attendings, more commonly with women than men, and more commonly with non-White than White respondents [38].…”

“…Education and faculty development on how to manage these experiences are crucial and the goal is to support bystanders to become “upstanders”. “Upstanders” are those who take action, intervene, and speak up for trainees/colleagues who are experiencing microaggressions [ 37 , 40 ]. Universities and teaching faculty members have an ethical and legal obligation to provide a safe learning environment for their trainees.…”

Closing the Gap: Training Experiences and Career Outcomes for Underrepresented Minorities in Plastic Surgery

“…One key finding of our study was that UIM and non-UIM faculty were equally likely to hold leadership positions such as chair/chief, editorial board position, fellowship director and program director. This is an impressive achievement, considering the high prevalence of microaggressions experienced by female and minority physicians 28 in addition to the diversity, equity, and inclusion (DEI) related work that many UIM faculty assume, along with traditional activities associated with attaining promotion in academia. This DEI work, referred to by some as minority tax, 29 , 30 includes dedicating significant time and energy to mentorship of other UIM trainees, outreach into undeserved communities, and participation in diversity focused committees.…”

Implementing pathways to anesthesiology: Promoting diversity, equity, inclusion, and success

“…31,66,[69][70][71] As stated previously, the driving factors for workforce and advancement inequities are historical injustices as well as ongoing systemic barriers to the success of URiM individuals, which may be modifiable or mitigated. These challenges include implicit biases in the advancement process, 31,[72][73][74] micro-and macroaggressions, 37,[75][76][77] deficiency of optimal mentors, 31,78,79 disparate access and information regarding opportunities for advancement, 74,79 disparate expectations (e.g., the "minority tax," the "glass ceiling," and the "glass cliff"), 45,74,[80][81][82] and other insidious factors.…”