This review aims to comprehensively consolidate and synthesize the existing body of empirical research on the perceptions and experiences of healthcare professionals, trainees, and students concerning microaggression interactions within diverse clinical settings. The review protocol was registered with the international prospective register of systematic reviews (PROSPERO CRD42024546443). We employed the Joanna Briggs Institute’s mixed-methods systematic review approach. Comprehensive electronic database searches were conducted across eight databases (Medline, Embase, CINAHL, PsycINFO, Scopus, Web of Science, Social Science Database, and ProQuest Dissertation and Theses) from their respective inception dates up to October 1, 2023. The selection criteria included studies reporting instances of interprofessional or intra-professional microaggressions occurring in clinical environments among healthcare professionals, trainees, and students identifying as heterosexual and without disabilities. In total, 37 studies met the eligibility criteria and were included in our review. Our analysis revealed three primary themes: Racial Microaggressions in the Clinical Environment, Gender Microaggressions in the Clinical Environment, and Religious Microaggressions in the Clinical Environment. Research must delve deeply into these experiences to better understand their long-term consequences, while policy initiatives should be designed to establish equitable, inclusive, and respectful healthcare environments. Collaborative endeavors bridging research and policy are paramount to dismantling barriers and nurturing an inclusive healthcare landscape.
Ackerman-BargerK.GoldinP.JacobsN. N.JohnsonC. D.LondonM.BoatrightD. (2022). Effect of microaggressions on medical residents’ program satisfaction and depression. Journal of Best Practices in Health Professions Diversity, 15(1), 1–14.
2.
Al RashedA.Al YousefR.AlhoutiF. (2022). Microaggressions: Prevalence and perspectives of residents and fellows in post-graduate medical education in Kuwait. Frontiers in Surgery, 9, Article 907544. https://doi.org/10.3389/fsurg.2022.907544
3.
AliH. M.LeeS. Y.Jashek-AhmedF.SeguyaA.FaucettE.Van BeckJ.StapletonE.PeerS.HusainI. A.WiedermannJ.SalanoV.;Global OHNS. (2023). Gender disparities in otolaryngology: A case report reflecting global perspectives. The Laryngoscope, 133(3), 547–551. https://doi.org/10.1002/lary.30455
4.
AlimiY.BevilacquaL. A.SnyderR. A.WalshD.JacksonP. G.DeMariaE. J.TuttleJ. E.AltieriM. S. (2023). Microaggressions and implicit bias in surgical training: An undocumented but pervasive phenomenon. Annals of Surgery, 277(1), e192–e196. https://doi.org/10.1097/sla.0000000000004917
5.
BarnesK. L.DunivanG.SussmanA. L.McGuireL.McKeeR. (2020). Behind the mask: An exploratory assessment of female surgeons’ experiences of gender bias. Academic Medicine, 95(10), 1529–1538. https://doi.org/10.1097/acm.0000000000003569
6.
BarnesK. L.McGuireL.DunivanG.SussmanA. L.McKeeR. (2019). Gender bias experiences of female surgical trainees. Journal of Surgical Education, 76(6), e1–e14. https://doi.org/10.1016/j.jsurg.2019.07.024
7.
BrooksJ. T.PorterS. E.MiddletonK. K.CarsonE. W.OdeG. E. (2023). The majority of black orthopaedic surgeons report experiencing racial microaggressions during their residency training. Clinical Orthopaedics and Related Research, 481(4), 675–686. https://doi.org/10.1097/corr.0000000000002455
8.
BrownC.DanielR.AddoN.KnightS. (2021). The experiences of medical students, residents, fellows, and attendings in the emergency department: Implicit bias to microaggressions. AEM Education and Training, 5(S1), 49–56. https://doi.org/10.1002/aet2.10670
9.
BullockJ. L.LockspeiserT.del Pino-JonesA.RichardsR.TeheraniA.HauerK. E. (2020). They don’t see a lot of people my color: A mixed methods study of racial/ethnic stereotype threat among medical students on core clerkships. Academic Medicine, 95(11S), S58–S66. https://doi.org/10.1097/acm.0000000000003628
10.
CedeñoB.ShimkinG.LawsonA.ChengB.PattersonD. G.KeysT. (2023). Positive yet problematic: Lived experiences of racial and ethnic minority medical students during rural and urban underserved clinical rotations. The Journal of Rural Health, 39(3), 545–550. https://doi.org/10.1111/jrh.12745
11.
ChatterjeeP.WarnerL. N.BasilM. C.ChristopherM.ManningK.FisherH. N.RexrodeK. M.SolomonS. R.KakozaR. M.YialamasM. A. (2021). “Make the Implicit Explicit”: Measuring perceptions of gender bias and creating a gender bias curriculum for internal medicine residents. Advances in Medical Education and Practice, 12, 49–52. https://doi.org/10.2147/AMEP.S292166
12.
EhieO.MuseI.HillL.BastienA. (2021). Professionalism: Microaggression in the healthcare setting. Current Opinion in Anesthesiology, 34(2), 131–136. https://doi.org/10.1097/aco.0000000000000966
13.
The EndNote Team. (2013). EndNote. In (Version EndNote X9) [64 bit]. Clarivate.
14.
EspaillatA.PannaD. K.GoedeD. L.GurkaM. J.NovakM. A.ZaidiZ. (2019). An exploratory study on microaggressions in medical school: What are they and why should we care?Perspectives on Medical Education, 8(3), 143–151. https://doi.org/10.1007/s40037-019-0516-3
15.
FaridH.Stack-DunniberH.MolinaR.NosalC.MendiolaM.HackerM. (2021). Discrimination, microaggressions, and perceptions of institutional response in an academic obstetrics and gynecology department. Cureus, 13(6), e15993. https://doi.org/10.7759/cureus.15993
FloresG. M.BañuelosM. (2021). Gendered deference: Perceptions of authority and competence among Latina/o physicians in medical institutions. Gender & Society, 35(1), 110–135. https://doi.org/10.1177/0891243220979655
18.
GilliamC.RussellC. J. (2021). Impact of racial microaggressions in the clinical learning environment and review of best practices to support learners. Current Problems in Pediatric and Adolescent Health Care, 51(10), 101090. https://doi.org/10.1016/j.cppeds.2021.101090
19.
GoulartM. F.HuayllaniM. T.Balch SamoraJ.MooreA. M.JanisJ. E. (2021). Assessing the prevalence of microaggressions in plastic surgery training: A national survey. Plastic and Reconstructive Surgery. Global Open, 9(12), e4062. https://doi.org/10.1097/gox.0000000000004062
20.
GreenwoodL. D. (2022). Racial microaggression among managed care employees affecting job satisfaction and quality of life. Grand Canyon University [ProQuest dissertations & theses].
21.
HongQ. N.PluyeP.FàbreguesS.BartlettG.BoardmanF.CargoM.DagenaisP.GagnonM.-P.GriffithsF.NicolauB.VedelI. (2018). Mixed methods appraisal tool (MMAT), version 2018. Registration of Copyright (#1148552), Canadian Intellectual Property Office, Industry Canada.
22.
IbrahimD.RileyR. (2023). Female medical students’ experiences of sexism during clinical placements: A qualitative study. Healthcare, 11(7), 1002.
23.
KayC.BernsteinJ.YassN.WoodardJ.TesfatsionS.ScholcoffC. (2022). Faculty physician and trainee experiences with micro- and macroaggressions. Journal of General Internal Medicine, 37(13), 3419–3425. https://doi.org/10.1007/s11606-022-07423-6
24.
KimS. S.RobertsT. M. E.KhusboJ. E.WatriboonruangW.ParksA.LewczykJ. (2022). Asian American nursing students’ experiences of racial microaggressions amid the COVID-19 pandemic: Focus group discussions. Nurse Education in Practice, 64, 103459. https://doi.org/10.1016/j.nepr.2022.103459
25.
KoechH.AlbaneseJ.SaeksD.HabashiK.StrawserP.HallM.Jr.KimK.MaitraS. (2023). Minority resident physicians’ perspectives on the role of race/ethnicity, culture, and gender in their surgical training experiences. Journal of Surgical Education, 80(6), 833–845. https://doi.org/10.1016/j.jsurg.2023.03.009
26.
LettE.OrjiW. U.SebroR. (2018). Declining racial and ethnic representation in clinical academic medicine: A longitudinal study of 16 US medical specialties. PLoS One, 13(11), e0207274. https://doi.org/10.1371/journal.pone.0207274
27.
LizarondoL.SternC.CarrierJ.GodfreyC.RiegerK.SalmondS.ApostoloJ.KirkpatrickP.LovedayH. (2020). Chapter 8: Mixed methods systematic reviews. In AromatarisE.MunnZ. (Eds.), JBI manual for evidence synthesis. JBI Global. https://doi.org/10.46658/JBIMES-20-09
28.
MacIntoshT.HernandezM.MehtaA. S. (2022). Identifying, addressing, and eliminating microaggressions in healthcare. HCA Healthcare Journal of Medicine, 3(3), 189–196. https://doi.org/10.36518/2689-0216.1418
29.
MasonB. S.RossW.OrtegaG.ChambersM. C.ParksM. L. (2016). Can a strategic pipeline initiative increase the number of women and underrepresented minorities in orthopaedic surgery?Clinical Orthopaedics and Related Research, 474(9), 1979–1985. https://doi.org/10.1007/s11999-016-4846-8
30.
McDonaghM.PetersonK.ChangS.ShekelleP. (2013). Avoiding bias in selecting studies. In Agency for Healthcare Research and Quality (ARHQ) (Eds.), Methods guide for effectiveness and comparative effectiveness reviews. AHRQ (United States). https://www.ncbi.nlm.nih.gov/books/NBK126701
31.
MillerS. M.MaulT. M.WeiJ. L. (2023). Physician experiences of workplace racial and gender microaggressions. International Journal of Pediatric Otorhinolaryngology, 168, 111516. https://doi.org/10.1016/j.ijporl.2023.111516
32.
MolinaM. F.LandryA. I.CharyA. N.Burnett-BowieS. M. (2020). Addressing the elephant in the room: Microaggressions in medicine. Annals of Emergency Medicine, 76(4), 387–391. https://doi.org/10.1016/j.annemergmed.2020.04.009
33.
MorrisonN.ZamanT.WebsterG.SorinolaO.BlackburnC. (2023). A qualitative study of racial microaggressions and the impact on medical students in the UK. BMJ Open, 13(5), e069009. https://doi.org/10.1136/bmjopen-2022-069009
34.
MosierR. D. (2022). The Glass Hospital (Auburn University, Publication Number 29288794) [ProQuest dissertations & theses].
35.
MurrarS.AzamL.PadelaA. I. (2023). A religious minority tax in healthcare? Insights from Muslim American physicians. SSM—Qualitative Research in Health, 4, 100316. https://doi.org/10.1016/j.ssmqr.2023.100316
36.
MyersA.WilliamsM.PekmezarisR. (2023). Intersectionality and its impact on microaggression in female physicians in academic medicine. Women’s Health Reports, 4(1), 298–304. https://doi.org/10.1089/whr.2022.0101
37.
NardiD.WaiteR.NowakM.HatcherB.Hines-MartinV.StacciariniJ.-M. R. (2020). Achieving health equity through eradicating structural racism in the United States: A call to action for nursing leadership. Journal of Nursing Scholarship, 52(6), 696–704. https://doi.org/10.1111/jnu.12602
38.
NfonoyimB.MartinA.EllisonA.WrightJ. L.JohnsonT. J. (2021). Experiences of underrepresented faculty in pediatric emergency medicine. Academic Emergency Medicine, 28(9), 982–992. https://doi.org/10.1111/acem.14191
39.
NowellL. S.NorrisJ. M.WhiteD. E.MoulesN. J. (2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16(1). https://doi.org/10.1177/1609406917733847
40.
Osseo-AsareA.BalasuriyaL.HuotS. J.KeeneD.BergD.Nunez-SmithM.GenaoI.LatimoreD.BoatrightD. (2018). Minority resident physicians’ views on the role of race/ethnicity in their training experiences in the workplace. JAMA Network Open, 1(5), e182723. https://doi.org/10.1001/jamanetworkopen.2018.2723
41.
PageM. J.McKenzieJ. E.BossuytP. M.BoutronI.HoffmannT. C.MulrowC. D.ShamseerL.TetzlaffJ. M.AklE. A.BrennanS. E.ChouR. (2021). The PRISMA 2020 statement: An updated guideline for systematic reviews. Systematic Reviews, 10, 89. https://doi.org/10.1186/s13643-021-01626-4
42.
PariniS.LucidiD.AzzolinaD.VerdiD.FrigerioI.GumbsA. A.SpolveratoG. (2021). Women in surgery Italia: National survey assessing gender-related challenges. Journal of the American College of Surgeons, 233(5), 583–592.e582. https://doi.org/10.1016/j.jamcollsurg.2021.08.675
43.
PeriyakoilV. S.ChaudronL.HillE. V.PellegriniV.NeriE.KraemerH. C. (2020). Common types of gender-based microaggressions in medicine. Academic Medicine, 95(3), 450–457. https://doi.org/10.1097/acm.0000000000003057
44.
Pusey-ReidE.Blackman-RichardsN. (2022). The importance of addressing racial microaggression in nursing education. Nurse Education Today, 114, 105390. https://doi.org/10.1016/j.nedt.2022.105390
45.
Pusey-ReidE.GonaC. M.Lussier-DuynsteeP.GallG. (2022). Microaggressions: Black students’ experiences—A qualitative study. Journal of Professional Nursing, 40, 73–78. https://doi.org/10.1016/j.profnurs.2022.03.004
46.
SamoraJ. B.DenningJ.HaralabatosS.LuongM.PoonS. (2020). Do women experience microaggressions in orthopaedic surgery? Current state and future directions from a survey of women orthopaedists. Current Orthopaedic Practice, 31(5), 503–507. https://doi.org/10.1097/bco.0000000000000909
47.
SandelowskiM.BarrosoJ. (2006). Handbook for synthesizing qualitative research. Springer Publishing Company.
48.
SargentM. C.SotileW.SotileM. O.RubashH.BarrackR. L. (2009). Quality of life during orthopaedic training and academic practice. Part 1: orthopaedic surgery residents and faculty. The Journal of Bone and Joint Surgery American, 91(10), 2395–2405. https://doi.org/10.2106/jbjs.H.00665
49.
SobelA. D.LavorgnaT. R.AmesS. E.TempletonK. J.MulcaheyM. K.;Collaborative Orthopaedic Educational Research Group. (2023). Interpersonal interactions and biases in orthopaedic surgery residency: Do experiences differ based on gender?Clinical Orthopaedics and Related Research, 481(2), 369–378. https://doi.org/10.1097/corr.0000000000002457
50.
SprowH. N.HansenN. F.LoebH. E.WightC. L.PattersonR. H.VervoortD.KimE. E.GrevingR.MazhiqiA.WallK.CorleyJ.AndersonE.ChuK. (2021). Gender-based microaggressions in surgery: A scoping review of the global literature. World Journal of Surgery, 45(5), 1409–1422. https://doi.org/10.1007/s00268-021-05974-z
51.
SternC.LizarondoL.CarrierJ.GodfreyC.RiegerK.SalmondS.ApóstoloJ.KirkpatrickP.LovedayH. (2020). Methodological guidance for the conduct of mixed methods systematic reviews. JBI Evidence Synthesis, 18(10), 2108–2118. https://doi.org/10.11124/JBISRIR-D-19-00169
52.
SudolN. T.GuaderramaN. M.HonsbergerP.WeissJ.LiQ.WhitcombE. L. (2021). Prevalence and nature of sexist and racial/ethnic microaggressions against surgeons and anesthesiologists. JAMA Surgery, 156(5), e210265. https://doi.org/10.1001/jamasurg.2021.0265
53.
SueD. (2010). Microaggressions and marginality: Manifestation, dynamics, and impact. John Wiley & Sons, Inc.
54.
SueD.NevilleH. A.SueD. W.SmithL. (2019). Counseling the culturally diverse: Theory and practice (8th ed.). John Wiley and Sons, Inc.
55.
SueD. W.CapodilupoC. M.TorinoG. C.BucceriJ. M.HolderA. M.NadalK. L.EsquilinM. (2007). Racial microaggressions in everyday life. American Psychologist, 62(4), 271–286. https://doi.org/10.1037/0003-066x.62.4.271
56.
ThomasT. (2019). Lived racial/ethnic microaggression experiences and the impacts on self-reported stress and health among female African American and Filipino registered nurses. University of California [ProQuest dissertations & theses].
57.
Thomas-HawkinsC.ZhaP.FlynnL.AndoS. (2022). Effects of race, workplace racism, and COVID worry on the emotional well-being of hospital-based nurses: A dual pandemic. Behavioral Medicine, 48(2), 95–108. https://doi.org/10.1080/08964289.2021.1977605
58.
ThumJ. A.ChangD.TataN.LiauL. M. (2021). Neurosurgeons in 2020: The impact of gender on neurosurgical training, family planning, and workplace culture. Neurosurgical Focus, 50(3), E11. https://doi.org/10.3171/2020.12.Focus20965
59.
TorresM. B.SallesA.CochranA. (2019). Recognizing and reacting to microaggressions in medicine and surgery. JAMA Surgery, 154(9), 868–872. https://doi.org/10.1001/jamasurg.2019.1648
60.
VelaM. B.ChinM. H.PeekM. E. (2021). Keeping our promise—Supporting trainees from groups that are underrepresented in medicine. The New England Journal of Medicine, 385(6), 487–489. https://doi.org/10.1056/NEJMp2105270
61.
WalkerC.GunasingheC.HarwoodH.EhsanA.AhmedF.DorringtonS.OnwumereJ.MeriezP.StanleyN.StollN.WoodheadC.HatchS. L.RheadR. (2023). Ethnic inequalities during clinical placement: a qualitative study of student nurses’ experiences within the London National Health Service. medRxiv, 2023.2002.2013.23285608. https://doi.org/10.1101/2023.02.13.23285608
62.
YangD. H.JustenM.LeeD.KimH.BoatrightD.DesaiM.TiyyaguraG. (2023). Experiences with racism among Asian American medical students. JAMA Network, 6(9), e2333067. https://doi.org/10.1001/jamanetworkopen.2023.33067
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