A Pilot Needs Assessment Addressing Gender-Based Microaggressions in Surgical Trainees

Abstract

Background: Microaggressions result in the unintentional discrimination of marginalized groups. Female trainees are underrepresented in all levels of surgical training, thus, microaggressions are a salient topic for surgical education. This study aims to explore the perceived effect of gender-based microaggressions on surgical trainees.

Methods: After IRB approval, an anonymous Likert-scaled survey on perceptions of microaggressions was distributed to interns at our institution prior to starting surgical residency and one year after. Data was de-identified and analyzed using Likert analysis and Mann-Whitney U testing. Follow-up focus groups were lead and transcriptions analyzed using detailed thematic analysis.

Results: Sixty-nine of 104 interns (66%) responded to the initial survey, 34 (49%) were female. Nineteen of 38 interns (50%) responded to the follow-up survey, 10 (53%) were female. Compared to male repondents, females were significantly more likely to believe they were likely to experience microaggressions (median = 5, IQR 4-5 vs median = 4, IQR 3-4, p < 0.0001) and that microaggressions would impact their mental health (median = 4, IQR 4-4 vs median = 3, IQR 2-4, p < 0.0002). One-year follow-up data similarly revealed that, compared to male respondents, females were significantly more likely to have experienced microaggressions on a frequent basis throughout intern year (median = 3, IQR 3-3.75 vs median = 1.5, IQR 1-3, p < 0.05) and to have subjectively felt the impact of microaggressions on their mental health (median = 3, IQR 2.25-4 vs median = 1.5, IQR 1-2.25, p < 0.05). A focus group of female surgical trainees demonstrated patterns consistent with previously validated themes on gender-based microaggressions, including environmental invalidations, being treated as a second class citizen, and assumption of inferiority, at all levels of training.

Conclusions: New trainees experience anxiety and lack preparedness when confronted with the threat of microaggressions. Our study reveals that female surgical interns are more likely than males to worry about microaggressions and to experience microaggressions and their negative effects. Focus group data exposes the wide-ranging impact of microaggressions experienced by female trainees of all levels. Thus, there should be benefit from instituting formal microaggression training prior to starting surgical residency.

Keywords: female experience; gender bias; microaggressions; surgical education; surgical training.