Experienced or witnessed racism and microaggressions during medical education: an exploratory survey of medical learners at a large Canadian medical school
DOI:
https://doi.org/10.36834/cmej.79882Abstract
Background: As institutions strive to incorporate Equity, Diversity, Inclusion, Indigeneity, and Accessibility (EDIIA) principles into their policies and curricula, various forms of discrimination persist within the medical education system. The objective of this study was to understand learner experiences related to racism, discrimination and microaggressions in a large Canadian medical school to ultimately inform future efforts to address issues identified.
Methods: This survey-based study was distributed to all current medical students and residents at a large Canadian University. Questions focused on lived and witnessed experiences of microaggressions, discrimination or racism during medical education. We computed descriptive statistics and risk ratios for experienced or witnessed events.
Results: The survey response rate was 12.4% (321/2579), with 26% of participants self-identifying as Black, Indigenous or People of Color (BIPOC). During medical education, 30% of respondents reported experiencing racism or microaggressions, while 51% reported witnessing these events. Attending physicians (31%) and patients/families (22%) were most likely to be identified as responsible. Common proposed solutions by respondents included: Anonymous reporting systems, dedicated counsellors from BIPOC groups, education of healthcare professionals on microaggressions and discrimination and increased peer/faculty support.
Conclusions: Among participants, this study described a high rate of witnessed or experienced racism or microaggressions during medical education, leading to local interventions to improve the psychological safety of learners.
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References
1. Razack S, Naidu T. Honouring the multitudes: removing structural racism in medical education. Lancet. 2022 Dec 10;400(10368):2021–3. https://doi.org/10.1016/S0140-6736(22)02454-0
2. Douglas D, Ndumbe-Eyoh S, Osei-Tutu K, et al. Black Health Education Collaborative: the important role of Critical Race Theory in disrupting anti-Black racism in medical practice and education. CMAJ. 2022 Oct 24;194(41):E1422–4. https://doi.org/10.1503/cmaj.221503
3. Osei-Tutu K, Duchesne N, Barnabe C, et al. Anti-racism in CanMEDS 2025. Can Med Educ J. 2023 Mar 21;14(1):33–40. https://doi.org/10.36834/cmej.75844
4. Hu Y, Ellis RJ, Hewitt BD, et al. Discrimination, abuse, harassment, and burnout in surgical residency training. NEJM. 2019 Oct 31;381 (18): 1741-52. http://doi.org/10.1056/NEJMsa1903759
5. Suleman S, Garber KD, Rutkow L. Xenophobia as a determinant of health: an integrative review. J Pub Health Pol. 2018;39(4):407–23. https://doi.org/10.1057/s41271-018-0140-1
6. Pascoe EA, Richman LS. Perceived discrimination and health: a meta-analytic review. Psychol Bulletin. 2019 July; 135(4):531-54. https://doi.org/10.1037/a0016059
7. Paradies Y, Ben J, Denson N, et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS One. 2015;10(9):e0138511. https://doi.org/10.1371/journal.pone.0138511
8. Delgado R, Stefancic J. Critical Race Theory, Fourth Edition: An Introduction. NYU Press; 2023. 223 p.
9. Année préparatoire au doctorat en médecine. Available from: https://admission.umontreal.ca/programmes/annee-preparatoire-au-doctorat-en-medecine/. [Accessed on May 7, 2025].
10. Boyle J, E. Chan S, Joneja M, Gauthier S, Leung M. An identity on guard: the impact of microaggressions on the professional identity formation of residents. BMC Med Educ. 2025 Dec;25(1):1–10. https://doi.org/10.1186/s12909-025-06818-3
11. Mathieu J, Fotsing S, Akinbobola K, et al. The quest for greater equity: a national cross-sectional study of the experiences of Black Canadian medical students. CMAJ Open. 2022 Oct 24;10(4):E937–44. https://doi.org/10.9778/cmajo.20220192
12. Fisher HN, Chatterjee P, Warren SB, Yialamas MA. Witnessed microaggression experiences of internal medicine trainees: a single-site survey. J Gen Intern Med. 2022 Sep 1;37(12):3208–10.
13. Tong XC, Chopra S, Jordan H, Sibbald M, Geekie-Sousa A, Monteiro S. Did we create brave spaces? A realist evaluation report on simulation-based faculty development workshop in equity, diversity, inclusivity, and Indigenous reconciliation. Adv Simul. 2025 Dec;10(1):1–11. https://doi.org/10.1186/s41077-025-00346-2
14. Gu Y, Tenenbein M, Korz L, Busse JW, Chiu M. Simulation-based medical education in Canadian anesthesiology academic institutions: a national survey. Can J Anesth/J Can Anesth. 2024 Dec 1;71(12):1725–34. https://doi.org/10.1007/s12630-024-02720-6
15. Russell E, Hall AK, Hagel C, Petrosoniak A, Dagnone JD, Howes D. Simulation in Canadian postgraduate emergency medicine training - a national survey. CJEM. 2018 Jan;20(1):132–41. https://doi.org/10.1017/cem.2017.24
16. Young K, Punnett A, Suleman S. A little hurts a lot: exploring the impact of microaggressions in pediatric medical education. Pediatrics. 2020 Jul 1;146(1):e20201636. https://doi.org/10.1542/peds.2020-1636
17. Le Bureau d’intervention en matière de harcèlement change de nom. Article. 2022. Available from: https://nouvelles.umontreal.ca/article/2022/04/07/le-bureau-d-intervention-en-matiere-de-harcelement-change-de-nom/ [Accessed on May 15, 2025].
18. York M, Langford K, Davidson M, et al. becoming active bystanders and advocates: teaching medical students to respond to bias in the clinical setting. MedEdPORTAL. 17:11175. https://doi.org/10.15766/mep_2374-8265.11175
19. Shankar M, Albert T, Yee N, Overland M. Approaches for residents to address problematic patient behavior: before, during, and after the clinical encounter. JGME. 2019 Aug 1;11(4):371–4. https://doi.org/10.4300/JGME-D-19-00075.1
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Copyright (c) 2025 Samara Adler, Jérémie Boivin-Côté, Isabelle Gravel, Chaimaa Ouizzane, Samantha Bizimungu, Claude Julie Bourque, Jean-Michel Leduc
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