Revealing hidden experiences: Gendered microaggressions and surgical faculty burnout



      Studies report higher burnout in women faculty surgeons compared to men. However, few studies have examined underlying mechanisms for these gendered differences. Gendered differences in microaggression experiences may explain part of the relationship between gender and burnout. We aimed to investigate the relationship between gender, gendered microaggressions, and burnout and test the hypothesis that microaggressions contribute to the relationship between gender and burnout.


      In this 2021 study, a survey was distributed to surgical faculty at 7 institutions. Variables included gender identity, race, average hours worked recently, the Oldenburg Burnout Inventory, and a modified Racial and Ethnic Microaggressions Scale to assess gendered microaggressions. To assess the relationship between surgical faculty gender and burnout, and if this relationship could be explained by microaggressions, a mediation model was tested.


      A total of 109 participants (40% female) completed the survey and were included in analysis. The hypothesized indirect effect of gender on burnout (M = 2.70/5, SD = 0.81), through gender-based microaggressions (M = 1.7/5, SD = 1.9), was significant, B = −0.25, SE B = 0.09, confidence interval (−0.44 to −0.09): women surgeons reported higher levels of gendered microaggressions, which predicted higher levels of burnout. The overall model was significant (R2 = .16, F[6,102] = 3.33, P < .01). Race, specialty, hours worked, and years of experience were all not significant in the model.


      Gendered microaggressions mediate the relationship between gender and burnout, providing a potential mechanism for the higher rates of burnout in women surgeons evident in prior research. These multi-institutional data provide a focus for targeted initiatives that could decrease both burnout rates and the impact of gender bias on surgical faculty.
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        • Nassar A.K.
        • Reid S.
        • Kahnamoui K.
        • et al.
        Burnout among academic clinicians as it correlates with workload and demographic variables.
        Behav Sci (Basel). 2020; 10: 94
        • Kuilanoff E.
        Burnout and our professional identity crisis as clinical educators.
        Acad Med. 2021; 96: 616-617
        • LaDonna K.A.
        • Cowley L.
        • Touchie C.
        • et al.
        Wrestling with the invincibility myth: exploring physicians’ resistance to wellness and resilience-building interventions.
        Acad Med. 2022; 97: 436-443
        • Galaiya R.
        • Kinross J.
        • Arulampalam T.
        Factors associated with burnout syndrome in surgeons: a systematic review.
        Ann R Coll Surg Engl. 2020; 102: 401-407
        • Shanafelt T.D.
        • Balch C.M.
        • Bechamps G.
        • et al.
        Burnout and medical errors among American surgeons.
        Ann Surg. 2010; 251: 995-1000
        • Wang L.J.
        • Tanious A.
        • Go C.
        • et al.
        Gender-based discrimination is prevalent in the integrated vascular trainee experience and serves as a predictor of burnout.
        J Vasc Surg. 2020; 71: 220-227
        • Kinslow K.
        • Sutherland M.
        • McKenney M.
        • et al.
        Reported burnout among US general surgery residents: a survey of the association of program directors in surgery members.
        Ann Med Surg (Lond). 2020; 60: 14-19
        • Dimou F.M.
        • Eckelbarger D.
        • Riall T.S.
        Surgeon burnout: a systematic review.
        J Am Coll Surg. 2016; 222: 1230-1239
        • Hu Y.Y.
        • Ellis R.J.
        • Hewitt D.B.
        • et al.
        Discrimination, abuse, harassment, and burnout in surgical residency training.
        N Engl J Med. 2019; 381: 1741-1752
        • Barnes K.L.
        • McGuire L.
        • Dunivan G.
        • et al.
        Gender bias experiences of female surgical trainees.
        J Surg Educ. 2019; 76
        • Moss-Racusin C.A.
        • Dovidio J.F.
        • Brescoll V.L.
        • et al.
        Science faculty’s subtle gender biases favor male students.
        PNAS. 2012; 109
        • Milkman K.L.
        • Akinola M.
        • Chugh D.
        What happens before? A field experiment exploring how pay and representation shape bias on the pathway into organizations.
        J Appl Psychol. 2015; 100
        • Salles A.
        • Awad M.
        • Goldin L.
        Estimating implicit and explicit gender bias among health care professionals and surgeons.
        JAMA Netw Open. 2019; 2
        • Erwin J.
        The IAT: how and when it works.
        Association for Psychological Science: Observer, 2007
        • Alimi Y.
        • Bevilacqua L.A.
        • Snyder R.A.
        • et al.
        Microaggressions and implicit bias in surgical training: an undocumented but pervasive phenomenon.
        Ann Surg. 2021; (PMID: 33843793.
        • Torres M.B.
        • Salles A.
        • Cochran A.
        Recognizing and reacting to microaggressions in medicine and surgery.
        JAMA Surg. 2019; 154
        • Halbesleben J.R.B.
        • Demerouti E.
        The Construct validity of an alternative measure of burnout: investigating the English translation of the Oldenburg Burnout Inventory.
        Work Stress. 2005; 19: 208-220
        • Smeds M.R.
        • Thrush C.R.
        • McDaniel F.K.
        • et al.
        Relationships between study habits, burnout, and general surgery resident performance on the American Board of Surgery in-training examination.
        J Surg Res. 2017; 217: 217-225
        • Walker A.
        • Hines J.
        • Brecknell J.
        Survival of the grittiest? Consultant surgeons are significantly grittier than their junior trainees.
        J Surg Educ. 2016; 73: 730-734
        • Yang Y.
        • Wright D.
        Gendered microaggressions in science, technology, engineering, and mathematics.
        Leadersh Res Educ. 2017; 4
        • Nadal K.L.
        The Racial and Ethnic Microaggressions Scale (REMS): construction, reliability, and validity.
        J Couns Psychol. 2011; 58: 470-480
        • Baron R.M.
        • Kenny D.A.
        The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations.
        J Pers Soc Psychol. 1986; 5: 1173-1182
        • Hayes A.F.
        Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach.
        2nd ed. Guilford Press, New York2018
        • Marshall A.L.
        • Dyrbye L.N.
        • Shanafelt T.D.
        • et al.
        Disparities in burnout and satisfaction with work-life integration in U.S. physicians by gender and practice setting.
        Acad Med. 2020; 95: 1435-1443
        • Chesak S.S.
        • Cutshall S.
        • Anderson A.
        • et al.
        Burnout among women physicians: a call to action.
        Curr Cardiol Rep. 2020; 22: 45
        • Burgos C.M.
        • Josephson A.
        Gender differences in the learning and teaching of surgery: a literature review.
        Int J Med Educ. 2014; 5: 110-124
        • Yeo H.L.
        • Abelson J.S.
        • Symer M.M.
        • et al.
        Association of time to attrition in surgical residency with individual resident and programmatic factors.
        JAMA Surg. 2018; 153: 511-517
        • Cochran A.
        • Hauschild T.
        • Elder W.B.
        • et al.
        Perceived gender-based barriers to careers in academic surgery.
        Am J Surg. 2013; : 206
        • Stephens E.H.
        • Heisler C.A.
        • Temkin S.M.
        • et al.
        The current status of women in surgery: how to affect the future.
        JAMA Surg. 2020; 155: 876-885
        • Bernardi K.
        • Shah P.
        • Lyons N.B.
        • et al.
        Perceptions on gender disparity in surgery and surgical leadership: a multicenter mixed methods study.
        Surgery. 2020; 167: 743-750
        • Crown A.
        • Berry C.
        • Khabele D.
        • et al.
        The role of race and gender in the career experiences of Black/African American academic surgeons: a survey of the Society of Black Academic Surgeons and a call to action.
        Ann Surg. 2021; 273: 827-831
        • Berwick S.
        • Calev H.
        • Matthews A.
        • et al.
        Mistaken identity: frequency and effects of gender-based professional misidentification of resident physicians.
        Acad Med. 2021; 96: 869-875
        • Jain N.
        • Rome B.N.
        • Foote M.B.
        • et al.
        Sex-based role misidentification and burnout of resident physicians: an observational study.
        Ann Surg. 2020; (Epub ahead of print. PMID: 33196486.
        • Sarsons H.
        Interpreting signals in the labor market: evidence from medical referrals.
        • Dossa F.
        • Zeltzer D.
        • Sutradhar R.
        • Simpson A.N.
        • Baxter N.N.
        Sex differences in the pattern of patient referrals to male and female surgeons.
        JAMA Surg. 2021 Nov 10; (Epub ahead of print)e215784
        • Ghosh-Choudhary S.
        • Carleton N.
        • Flynn J.L.
        • et al.
        Strategies for achieving gender equity and work-life integration in physician-scientist training.
        Acad Med. 2022; 97: 492-496
        • Wu D.
        • Saint-Hilaire L.
        • Pineda A.
        • et al.
        The efficacy of an anti-oppression curriculum for health professionals.
        Family Med. 2019; 51: 22-30
        • Wagner K.C.
        • Yates D.
        • Walcott Q.
        Engaging men and women as allies: a workplace curriculum module to challenge gender norms about domestic violence, male bullying and workplace violence and encourage ally behavior.
        Work. 2012; 42: 107-113
        • Coe I.R.
        • Wiley R.
        • Bekker L.G.
        Organisational best practices towards gender equality in science and medicine.
        Lancet. 2019; 393: 587-593
        • FitzGerald C.
        • Martin A.
        • Berner D.
        • et al.
        Interventions designed to reduce implicit prejudices and implicit stereotypes in real world contexts: a systematic review.
        BMC Psychol. 2019; 7: 29
        • Dossett L.A.
        • Mulholland M.W.
        • Newman E.A.
        Michigan Promise Working Group for Faculty Life Research. Building high-performing teams in academic surgery: the opportunities and challenges of inclusive recruitment strategies.
        Acad Med. 2019; 94: 1142-1145
        • Dimick J.B.
        • Mulholland M.W.
        Design principles for building a leadership development program in a department of surgery.
        Ann Surg. 2018; 267: 39-41
        • Harris C.A.
        • Dimick J.B.
        • Dossett L.A.
        Cultural complications: why, how, and lessons learned.
        Am J Surg. 2021; 221: 609-611
        • Lawrence J.A.
        • Davis B.A.
        • Corbette T.
        • Hill E.V.
        • Williams D.R.
        • Reede J.Y.
        Racial/ethnic differences in burnout: a systematic review.
        J Racial Ethn Health Disparities. 2022; 9: 257-269