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.
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.
摘要：
背景：微攻击导致边缘化群体的无意歧视。女学员在各级外科培训中任职人数不足,因此，微侵略是外科教育的一个重要课题。本研究旨在探讨基于性别的微攻击对手术学员的感知效果。
方法：IRB批准后，在开始手术住院之前和一年之后，我们向我们机构的实习生分发了一项匿名的Likert规模调查，该调查涉及微侵略的看法。使用Likert分析和Mann-WhitneyU检验对数据进行去识别和分析。后续焦点小组使用详细的主题分析进行了引导和转录分析。
结果：104名实习生中有69名（66％）对最初的调查做出了回应，34（49%）为女性。38名实习生中有19名(50%)回应跟进调查,10名（53%）为女性。与男性相比，女性更有可能相信他们可能经历微攻击(中位数=5,IQR4-5vs中位数=4,IQR3-4,p<0.0001),并且微攻击会影响他们的心理健康(中位数=4,IQR4-4vs中位数=3,IQR2-4,p<0.0002)。一年的随访数据同样显示，与男性受访者相比，女性在实习一年中更有可能频繁地经历微攻击（中位数=3，IQR3-3.75，中位数=1.5，IQR1-3，p<0.05），并且主观地感受到了微攻击对他们的心理健康的影响（中位数=3，IQR2.25-4，中位数=1.5，IQR1-2.25，p<0.05）。女性手术学员的焦点小组展示了与先前验证的基于性别的微侵害主题一致的模式，包括环境失效，被视为二等公民，和自卑的假设，各级培训。
结论：新学员在面对微攻击的威胁时会感到焦虑和缺乏准备。我们的研究表明，女性外科实习生比男性更容易担心微侵害，并经历微侵害及其负面影响。焦点小组的数据揭示了各级女性受训人员所经历的微攻击的广泛影响。因此，在开始手术住院医师之前，应该从建立正式的微攻击训练中受益。
方法：IRB批准后，在开始手术住院之前和一年之后，我们向我们机构的实习生分发了一项匿名的Likert规模调查，该调查涉及微侵略的看法。使用Likert分析和Mann-WhitneyU检验对数据进行去识别和分析。后续焦点小组使用详细的主题分析进行了引导和转录分析。
结果：104名实习生中有69名（66％）对最初的调查做出了回应，34（49%）为女性。38名实习生中有19名(50%)回应跟进调查,10名（53%）为女性。与男性相比，女性更有可能相信他们可能经历微攻击(中位数=5,IQR4-5vs中位数=4,IQR3-4,p<0.0001),并且微攻击会影响他们的心理健康(中位数=4,IQR4-4vs中位数=3,IQR2-4,p<0.0002)。一年的随访数据同样显示，与男性受访者相比，女性在实习一年中更有可能频繁地经历微攻击（中位数=3，IQR3-3.75，中位数=1.5，IQR1-3，p<0.05），并且主观地感受到了微攻击对他们的心理健康的影响（中位数=3，IQR2.25-4，中位数=1.5，IQR1-2.25，p<0.05）。女性手术学员的焦点小组展示了与先前验证的基于性别的微侵害主题一致的模式，包括环境失效，被视为二等公民，和自卑的假设，各级培训。
结论：新学员在面对微攻击的威胁时会感到焦虑和缺乏准备。我们的研究表明，女性外科实习生比男性更容易担心微侵害，并经历微侵害及其负面影响。焦点小组的数据揭示了各级女性受训人员所经历的微攻击的广泛影响。因此，在开始手术住院医师之前，应该从建立正式的微攻击训练中受益。
