Maintaining your sense of self in medical education: How to recover from a microaggression

By Dr. Mala Joneja

Medical education institutions and teaching hospitals are investing a large amount of resources these days in promoting equity, diversity and inclusion. Medical schools and teaching hospitals are trying to be inclusive workplaces. Yet medical students and residents who are women, or who are from BIPOC communities, are still routinely exposed to microaggressions.

A microaggression is defined as a “mundane and often unintentional prejudice conveyed during an interaction”.

With the prefix micro- in the name attached to this phenomenon, I should point out that the effect or consequence of personally dealing with a microaggression can be rather large.

In fact, a frequent question that I am asked by medical students is:  what do I do if I’m if faced with a microaggression in the workplace?

As educators, we would hope that students would report it and that it would be addressed by the clinical preceptor. But what does the person on the receiving end of the microaggression do? What do they actually do to move forward?

I would like to share an experience with Queen’s medical students, that may provide some helpful guidance regarding how to recover from a microaggression.

Image of a stethoscope beside a cup of coffee drawing attention to the story shared by the author (a physician) of being mistaken for a food service worker by a guest presenter.

As a physician in the Department of Medicine for 15 years, I have become accustomed to people knowing who I am. It took a while, but I have established myself. Etherington Hall is where I have my office (there is my name on the wall outside my door) and Etherington Auditorium is where every Thursday morning at 7:45am, I co-chair Medical Grand Rounds with Dr. Stephen Archer (Chair, Department of Medicine). One Thursday morning, I arrived early as I usually do to meet the speaker. On this particular Thursday (before the COVID pandemic), our department was hosting a visiting professor from Harvard. He walked in at the back of the auditorium and came down the steps with his briefcase. He saw me at the bottom of the stairs and straightaway asked me if I was there to set up the food.

I explained to him that I was there as one of the professors and co-chairs, and I was there to meet him. He proceeded to give his talk and went back to Boston. The fact that he assumed that I was there with the food, bothered me and made it difficult for me to concentrate on whatever his topic was for grand rounds.

Several months later, I found an article in Academic medicine with the title: Mistaken Identity: Frequency and Effects of Gender-Based Professional Misidentification of Resident Physicians”

In this article the authors describe how common role misidentification is for women residents in medical education, and they describe the possible psychological and behavioral responses that can occur after this, but the article does not describe how to recover from this.

Although I didn’t take in much of our guest speaker’s lecture, I did recover by the end of the day. The incident had left me with this message: I do not, at first glance, look like an Associate Professor in the Department of Medicine. The fact is though, I did not, at first glance, look like an Associate Professor in the Department of Medicine, to this particular visiting speaker.

I actually had done nothing but my usual activity, showing up for work. In his mind, I looked like I was there to put out the food. His assumption, his error. I do believe, though, however gifted of a professor he may be, it should not be a huge stretch for him to entertain what is in fact a common narrative, the daughter of East Indian immigrants becoming a physician.

I recovered from this for a few reasons. First, I decided thatthe problem was not me, but the Harvard Professor who could not at first glance, think that I could be anything but the food person. This is the danger of having a fixed narrative in mind regarding who should be a professor. Or a doctor, or a surgeon. Or any profession.

By deciding that the problem was not me, I took back my power as Dr. Ivan Joseph would say.

Dr. Ivan Joseph,( recently gave a keynote lecture at the Dean’s Action Table Forum on EDI and told the audience quite frankly: don’t give other people the power to change the way you look at yourself.  As Dr. Joseph told us at the forum, I stopped giving the Harvard professor the power to assess who I was. (Note: this is not easy when you career trajectory is built upon impressing and demonstrating one’s worth). 

Other things helped me recover. After rounds I talked with my department chair who told me toremember who I was (who I was really, meaning all my work and accomplishments and not what the visiting speaker assumed).

And what also help a lot was after rounds and dealing with the slight derailment that comes with microaggressions, I went to work. I found that as I worked through my charts, my patient calls, the negative feelings became smaller and smaller until they finally dissolved. I was back to myself and going ahead with the work that gives me purpose and meaning.

When the Internal Medicine residents and I discuss microaggressions, we say that they are not so ‘micro’ and the story I have told illustrates why we say that. But it is possible to recover and I hope this post helps any student or resident who may experience a microaggression (which can make one feel excluded from their own profession) recover and keep going.

Any students from Queen’s Undergraduate Medicine who would like to reach out after reading this for further discussion are welcome to email Dr. Joneja:

Also consider checking out Ivan Joseph’s book You Got This: Mastering the Skill of Self-Confidence. (We’re not providing a link as to not promote any particular bookseller).

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