Prevalence and Nature of Sexist Microaggressions Against Female Medical Students.

Abstract

Purpose: Sexism and microaggressions against females in the medical field are well-known occurrences. Although there is extensive research on the prevalence and effects of these microaggressions in residency and clinical practice, little research has been done at the level of medical students. 1,2 Medical schools are now composed of > 50% female students; however, gender discrepancies remain in clinical practice, and sexism during medical school training is likely a contributing factor. 3 The purpose of this study is to assess the frequency, nature, and psychological impact of sexist microaggressions against female medical students and relate findings to specialty preferences. Method: Students attending LCME-accredited U.S. medical schools participated in an online survey that was adopted from the Sexist Microaggressions Experiences and Stress Scale. 4 The nature of microaggressions was categorized into 8 domains: (1) leaving gender at the door (LGD) (i.e., downplaying feminine behaviors to succeed), (2) sexual objectification (SOB), (3) environmental invalidations (ENV) (i.e., gender discrimination in the work environment), (4) invalidation of the reality of women (INV) (i.e., denying that gender bias exists), (5) assumptions of traditional gender roles (TGR), (6) expectations of physical appearance (EXP), (7) inferiority (INF) (i.e., when women are assumed to be inferior to men), and (8) physical safety (SAF) (i.e., being pushed out of the way). At the end of the survey, participants indicated whether the microaggressions they experienced influenced their specialty of choice. An independent t test was used to compare the frequency and psychological impact of sexist microaggressions experienced between female and male participants. Results: Data obtained from 93 students (63 [67%] female) from 12 schools were analyzed. A total of 61 (96.8%) female medical students reported experiencing sexist microaggressions, most frequently in the LGD domain. Females reported experiencing significantly higher rate of microaggression than males in LGD (P < .001), INV (P = .013), INF (P < .001), and SAF (P = .017). Although there was no significant difference in rate between females and males for SOB and TGR, females experienced significantly more stress from these events than males (P = .021, P = .019). 24.5% of the participants indicated that the microaggressions they reported in the survey influenced their choice in specialty. Majority of these participants were female (82%) and reported higher frequency of microaggression than those who stated that their specialty choice was not influenced by such experiences (P < .05). Discussion: Gender bias in medicine is frequently manifested as microaggressions and starts as early as medical school, as evidenced by this study. Female medical students reported high rates of microaggressions with high levels of stress related to the events. LGD was the most common and the most stressful domain reported, possibly reflecting pressure to downplay femininity to succeed. Significance: These findings suggest that a high prevalence of microaggressions exists that stigmatize female medical students and contribute to the gender gap in medical specialties. Continued efforts to educate medical professionals on gender bias and the far-reaching effects of microaggressions can improve awareness and ability to respond to such events when they occur. The results from this study can guide efforts to recognize and decrease microaggressions and create a safer, more inclusive learning environment for female medical students.