Reporting Mechanisms for Workplace Microaggressions Against Surgeons

Objectives: Microaggressions in healthcare create a detrimental and disruptive workplace for surgeons. However, no studies describe perpetrator characteristics, types of micro aggressions experienced or how microagressions are reported. We sought to investigate perpetrator characteristics and reporting mechanisms for surgeons who experienced workplace microaggressions.

Methods: For this cross-sectional cohort study, we developed and internally validated a web-based survey to assess surgeons' experiences with micro aggressions. We distributed the survey through nine American College of Surgeons (ACS) online Communities from November 2022 to January 2023. All ACS Communities comprised members who completed surgical training and had experience in the surgical workforce. Microaggressions included: (1) employer/coworker being unwelcoming or unfriendly, (2) having my opinion being overlooked in a group discussion, (3) being ignored at work, (5) employer/coworker treating me differently, and (5) presumption of work being inferior. Microaggressions were rated on a Likert scale of 1 (Never) to 5 (Extremely Often). Perpetrator characteristics included: supervisors, surgeon colleagues, support staff, students/trainees, and patients/families. Microaggression reporting mechanisms included both informal (reporting to a colleague or mentor), formal (reporting to human resources, a diversity/equity/inclusion representative, a Title VII or XI representative, or the Department Chair), and confronting the perpetrator directly (yes/no for each reporting mechanism). Analyses included descriptive and chi-squared statistics, t-tests, and bivariate logistic regression.

Results: Of 377 ACS survey respondents, 254 (67.4%) experienced workplace microaggressions. Women (p < 0.001), younger surgeons (p=0.002), surgeon educators (p < 0.001) and fellowship trained surgeons (p=0.001) were more likely to experience microaggressions. A total of 143 (of 254, 56.3%) respondents reported their microaggression experiences in one or more ways. Demographic and occupational variables did not differ between surgeons who reported their experience with microaggressions compared to those who did not report. Supervisors and surgeon colleagues perpetrated all types of microaggressions reported, and support staff perpetrated all types of microaggressions except creating an unwelcoming or unfriendly environment (Figure 1). Surgeons who reported microaggression experiences utilized a median of 1 type of reporting mechanisms [IQR 0-3], although 46.2% of surgeons did not report their microaggression experiences. Reporting mechanisms differed based on the role of the perpetrator but specific reporting mechanisms were utilized more frequently than others (Figure 2). The most common reporting mechanisms included informal reporting to a colleague and directly confronting the perpetrator. Surgeons who reported experiences with microaggressions were less likely to say they would choose a career in surgery again (p=0.025) compared to surgeons who did not report micro aggression experiences.

Conclusions: Almost half of surgeons who experienced microaggressions did not report their experience though common informal or formal mechanisms. When they did report, informal mechanisms were used more frequently than formal. Despite utilizing appropriate mechanisms to address microaggressions, surgeons reporting microaggression experiences expressed a form of career regret.