An identity on guard: the impact of microaggressions on the professional identity formation of residents

PurposeThe development of a strong professional identity in medicine has important consequences for patient care, as proper identity formation impacts a physician's confidence, wellbeing, and performance. In non-medical professions, exposure to discrimination and stigma impacts how individuals construct their professional identity. Our study aims to explore how microaggressions from peers impact the professional identity formation of resident physicians. This work was guided by conceptual frameworks on professional identity formation that included socialization, role modelling, and hierarchical structures.MethodsWe conducted semi-structured interviews with [blinded] residents between July 2021 and November 2022. Participants were recruited utilizing both convenience and snowball sampling of residents who self-identified as having experienced microaggressions. During the iterative data collection, we adopted thematic analysis using open coding to identify overarching themes.ResultsWe interviewed 17 residents from five specialties. Overall, participants perceived that experiencing microaggressions impacted their sense of belonging in medicine, and had a negative impact on participants' progression in residency due to feelings of perceived incompetence, exhaustion at work, and missed opportunities. Participants also felt like they had to guard the diverse aspects of their identities to mitigate the experience of microaggressions. Barriers in addressing microaggressions included fear of personal and professional repercussions, and a sense of futility that reporting would lead to tangible change. More education about microaggressions, increasing transparency on reporting microaggressions, access to open-minded mentors, and creating a safe space to debrief may help mitigate the negative impacts of microaggressions on professional identity formation.ConclusionsOur study suggests that microaggressions between peers are a barrier to trainees' socialization into the medical profession, as they lead to feelings of exclusion and exhaustion that impact clinical performance. Education on how to identify, report and respond to microaggressions will help to improve the learning environment for vulnerable trainees.