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Microaggressions common in the medical workplace, Stanford study suggests

Women medical faculty report subtle prejudices and other microaggressions commonly occur in the workplace, a Stanford study finds.

It could be something as subtle as an attending physician charging into a room filled with doctors-in-training announcing: "Man up people! The ED just called. Let's go!" Or, perhaps, a woman doctor constantly being mistaken for a nurse.

Such prejudices and unconscious biases may be contributing to the persistent disparities faced by women in medicine, said VJ Periyakoil, MD, associate professor of medicine. She founded Project Respect to study microbehaviors -- those small, fleeting ways we interact with others -- in the workplace.

"Women doctors are leaving the field of medicine in disturbing numbers, and it's not exactly clear why," she said. "Four out of 10 go part-time or leave medicine altogether within six years of completing their training."

Evidence has shown that lower pay is one factor, but, perhaps, subtle sexism in the workplace could be another. She and colleagues set out to study whether such biases, which can sometimes seem innocuous, like the prick of a cactus, may be a contributing factor.

Periyakoil and colleagues wanted to know whether gender-based microaggressions are a common occurrence. Are men getting credit for women's ideas? Are women often encountering sexually inappropriate comments at work? Are women being relegated to mundane tasks? 

"If so, it's an important national topic, because it is known that such microaggressions can erode wellness and increase burnout," Periyakoil said. "If true, this could be the missing link that is really decreasing the morale of women in medicine."

Previous research has shown that repeated exposure to such micro-aggressive behavior in the workplace leads to decreased performance, heightened stress response, an erosion of a sense of confidence and well- being, and in the long-term, poor overall health.

To conduct the study, which appears in Academic Medicine, researchers collected real-life anecdotes of microaggressions reported by women faculty at four university medical schools -- Stanford, Harvard, Rochester, and the Medical University of South Carolina. Next, they recreated 34 of the most commonly reported anecdotes in videos using hired actors, along with an additional 34 fictional "control" versions of each situation. These 68 videos were then evaluated by a new sampling of 124 faculty (79 women and 45 men) from the four academic medical centers.

The researchers found that women medical faculty reported encountering the subtle prejudices depicted in the videos far more often than men, with 21 of the 34 examples occurring frequently. In stark contrast, male respondents reported these microaggressions to be uncommon, the study said. 

The most common microaggressions, reported in order of frequency, were instances of sexism, pregnancy and child care related bias, having abilities underestimated, encountering sexually inappropriate comments, being relegated to mundane tasks and feeling excluded/marginalized. The study concluded that:

Privilege is often invisible to those who have it, while bias and discrimination are readily apparent to those who experience it. Our study has identified that women in medicine, compared to their male counterparts, report microaggressions to be much more common in the workplace.

Diagnosing this problem could be the first step toward finding new ways to improve declining morale among women in medicine, Periyakoil said.

"Today, the number of women are equal to the number to men when they enter medical school, but there are far fewer women faculty than men or women in leadership positions," Periyakoil said. "Women keep jumping off the train. Why is this? I think we might be ignoring a subtle environmental toxin that stifles women in the workplace."

Photo by Justin Leibow

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