Characterizing Asian American medical students’ experiences with microaggression and the impact on their well-being

Figures & data

Table 1. Characteristics of the survey and focus group participants.

Student characteristics:		Survey participants (n = 305)	Focus group participants (n = 26)
Gender	Man	91	5
	Woman	201	21
	Gender Diverse^a	10	0
	Preferred not to say	3	0
Age	20–25	174
	26–30	107
	31–35	15
	35 +	8
MS Year	First	82	4
	Second	97	8
	Third	65	5
	Fourth	44	5
	Fifth or higher	17	4
Generational Status	First	18
	1.5^b	67
	Second	196
	Third	15
	Fourth or higher	9
Location of medical school in US	East	46
	Midwest	145
	South	39
	West	68
	Preferred not to say	7
Self-identified race/ethnicity	Chinese	112	7
	Multiracial	45	2
	Korean	30	6
	Vietnamese	30	4
	Indian	25	2
	Taiwanese	21	1
	Filipino	17	2
	Other^c	24	2
	Preferred not to say	1	0

^aGender diverse gender identities include transgender man, transgender woman, non-binary individuals, and gender queer individuals.

^b1.5 generational status was defined as individuals born outside of the US and came to the US as a child (age 17 of younger).

^cOthers included: Bangladeshi, Cambodian, White, Japanese, Latino/a, Nepalese, Pakistani, Singaporean, Thai, Hmong, Burmese, Tongan, Samoan.

Figure 1. Characterizing the microaggressions experienced by Asian American medical students by (a) theme; and (b) perpetrator.

Frequency from 213 surveys where participants had at least one experience with microaggression. Participants were able to select multiple choices.

Table 2. Themes regarding types of and students’ responses to microaggression experienced during medical training.

Topic:	Theme:	Description:	Frequency:
Microaggression based on:	Perpetual foreigner	Students are assumed to not belong where they are, either based on citizenship or profession.	15
	Assumption of timidness	Assumption is made about students as being quiet or timid and is reflected as lacking self-confidence in their interaction with patients.	9
	Model minority myth	The use of the model minority myth can be harmful when it diminishes the differing experiences of Asian American individuals.	8
	Misidentification as another Asian American individual	Students are mistaken for another Asian American, including other students.	7
	Intersectionality with gender identity	Students who identify as Asian American and female have an additional layer of discrimination against them.	6
	Relation made to the global pandemic	Students are associated with starting or spreading the COVID-19 pandemic.	4
How student responded to situation:	Decision that the most appropriate response is no response	Students refuse to allow the microaggression to impact the way they act in the interaction.	5
	Justification for the perpetrator	Students provide a justification for the perpetrator’s response as a way to process the situation.	4
	Outright identify the microaggression	Students immediately respond to the perpetrator by pointing out the microaggression as harmful and insulting.	4
Reasons why students did not respond to microaggression experience:	Fear of Retaliation	There is concern about impact on students’ grades or relationships with the individuals involved in the situation. Most students fear the impact it will have on their ability to get into residency if they were to respond outwardly.	18
	Lack of a safe space for Asian American students	Asian Americans are often not considered underrepresented minorities or people of color, which invalidates their feelings of discrimination.	16
	Uncertain if experience was a microaggression	Students describe a microaggression but then question if the experience is ‘severe’ enough to be classified as a microaggression.	7
	Uncertain about how to respond appropriately	There is a general lack of knowledge on how to respond to the situation.	7
	The overwhelming burden of advocacy	Students do not want to feel constantly responsible for educating others on how to interact with people of color.	4

Table 3. Themes regarding the impact of microaggression Asian American medical students and suggestions for change in medical school training.

Topic:	Theme:	Description:	Frequency:
Emotional impact of microaggression student experience:	Anger and frustration	Students feel anger and frustration when encountering microaggression.	14
	Feelings of burnout	Students describe feelings of ‘burnout’ and express hopelessness after so many encounters with microaggression and often having to be the ones doing the advocacy work without seeing any effect in society.	8
	Impact on authenticity of self	Students are unable to act as themselves for fear of perpetuating stereotypes or eliciting experiences of microaggression.	6
	Apathy due to frequency of the experience	Students have developed fatigue from the high frequency of microaggression that it often does not bother them anymore.	5
	Negative impact on mental health	Students describe feelings of loneliness and isolation, particularly when seen as ‘perpetual foreigners’ and ‘exotic’. There is an increased level of anxiety and insecurity among students with multiple, repeated experiences of microaggression.	5
Suggestion to change the learning environment:	Supportive action from administration and faculty members	Students recommended more accountability and acknowledgement from the faculty members that they interact with, and this includes speaking up for AANHPI students. There is an emphasis in removing the onus from students to do the education and reparative work.	15
	Include Asian American experiences in medical school curriculum	Students suggested including AANHPI experiences within the curriculum, in two main areas: 1. Patient health outcomes and disparities; 2. People of color facing microaggression and racism.	12
	Include Asian identify in diversity, equity, and inclusion (D.E.I) Efforts	Asians should not be excluded as a minority group and should be included in the D.E.I. activities and conversations. This includes working alongside other student organizations that focus on other minority groups.	10
	Diversify the medical workforce	Students emphasized the need for advocacy within the medical field with individuals who understand the students’ experiences. In particular, there was a call for increasing Asian American visibility in leadership.	8
	Improve the students’ anonymous reporting system	Students lack trust in current feedback systems and suggest changes to the system to improve medical education experiences. Changes include honoring anonymity and seeing more action from administration.	8

Table

	Never	Rarely	Sometimes	Usually	Most of the time
… assume you were going to school for a different career (i.e., nursing, other healthy profession) based on your race?
… expect you to work harder than other students because of your race?
… expect you to do more work than other students in similar positions because of your race?
… assign you to projects that did NOT require interpersonal skills because of your race?
… receive feedback that you lacked social skills because of your race?
… imply that you were submissive because of you race?
… note that you were someone who always complies because of you race?
… label you as a follower (vs. leader) because of your race?
… describe you as shy or too quiet because of you race?
… delegate you work that does NOT require writing skills because of you race?
… give you work that does NOT utilize your speaking skills because of you race?
… tell you that your English is “good” because of you race?
… mistake you for another Asian person?
… call you by another Asian person’s name?
… brought up Asian cultural events or experiences in order to relate to you, but it was an ethnicity other than your own?
… associate you with the COVID-19 pandemic in a derogatory way because of you race?

Table

	Never	Rarely	Sometimes	Usually	Most of the time
… look away from you when you were speaking?
… ignore your ideas in meetings?
… ignore your suggestions?
… not take your recommendations seriously?
… attribute your comments to someone else?
… tell you were quiet even though you speak as must as other people?
… did not provide the opportunity for you to speak up after others have shared their thoughts?
… give more credit to your co-student (non-Asian) than you even though you both contributed equally?
… provide you less recognition for similar work done by others at the same level?
… call you by a nickname that was synonymous to something Asian (e.g., ninja or tiger mom)?
… mention your race in a conversation when it wasn’t relevant?
… imply you were brought onto a committee because of your race?
… ask you to speak-up in meetings?
… question your silence?