Neural responses to gender-based microaggressions in academic medicine
Published by Journal of Neuroscience Research, August 14, 2023
Gender-based microaggressions have been associated with persistent disparities between women and men in academia. Little is known about the neural mechanisms underlying those often subtle and unintentional yet detrimental behaviors. Here, we assessed the neural responses to gender-based microaggressions in 28 early career faculty in medicine (N= 16 female, N= 12 male sex) using fMRI. Participants watched 33 Project Respect paired videos of situations demonstrating gender-based microaggressions and control situations in academic medicine.
Videos were created by Dr. Periyakoil using real-life anecdotes about microaggression from women faculty and were scripted and reenacted using professional actors. Primary voxel-wise analyses comparing group differences in activation elucidated a significant group by condition interaction in a right-lateralized cluster across the frontal (inferior and middle frontal gyri, frontal pole, precentral gyrus, postcentral gyrus) and parietal lobes (supramarginal gyrus, angular gyrus).
Whereas women faculty exhibited reduced activation in these regions during the microaggression relative to the control condition, the opposite was true for men. Posthoc analyses showed that these patterns were significantly associated with the degree to which participants reported feeling judged for their gender in academic medicine. Lastly, secondary exploratory ROI analyses showed significant between-group differences in the right dorsolateral prefrontal cortex and inferior frontal gyrus. Women activated these two regions less in the microaggression condition compared to the control condition, whereas men did not. These findings indicate that the observation of gender-based microaggressions results in a specific pattern of neural reactivity in women early career faculty.
Results of primary fMRI cluster analyses. (a) Results showed a significant interaction of group by condition in a cluster in the right hemisphere that spanned subregions of the frontal (inferior and middle frontal gyri, frontal pole, precentral gyrus, postcentral gyrus) and parietal lobes (supramarginal gyrus, angular gyrus). (b) Within-group results showed that women had higher cluster activation in the control condition compared to the microaggression condition. The reverse was true for men. Between-group results indicated significant sex differences for the control condition but not the microaggression condition. Horizontal lines indicate mean values.
Examples of gender-based microaggressions scenarios (left) and the corresponding social situations of equity (right):
Elucidating the underlying neural mechanisms associated with gender-based microaggressions will generate practical implications for women faculty. Project Respect’s research findings can help craft effective behavioral interventions (e.g., fostering belongingness) tailored to reduce gender biases in healthcare. For example, our research findings might suggest that women in the healthcare workforce could benefit from training interventions that help them better manage interactions where they may face bias. All healthcare personnel will benefit from training that helps promote equitable and respectful professional interactions. The results of this study can also inform the development of fNIRS neurofeedback paradigms (e.g., Liu et al., 2016) that can provide women and men with vital information to voluntarily regulate their behavior in real-time
Six Common Types of Gender-Based Biases in Medicine
Published by AAMC, Academic Medicine: October 29, 2019
We conducted a multi-site research study to identify common themes of microaggressions and slurs experienced by women in medicine. We identified six common themes:
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Project Respect featured by the New York Times
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Our current research studies and projects are as below:
a. MICROAGGRESSIONS STUDY: Identifying and categorizing common microaggressive behaviors that occur in clinical (behaviors demonstrated by clinicians, patients, and their families) as well as nonclinical settings in healthcare. We have completed a four-university study identifying six common themes of microaggressions reported by women faculty.
b. MICRO-COMMUNICATION STUDY: Identifying and categorizing common patterns of micro communication in clinical encounters and how these impact patients’ adherence to treatment. Specifically, we are studying how clinicians communicate information about genetic cancer risk to patients with breast cancer, what they understand, what information they communicate to their families, and how their health behaviors are impacted. We are examining the impact of baseline moderators (age, gender, ethnicity, language, socioeconomic status) on patients’ understanding of their genetic risk and their next steps through the computation of a “teach-back score”. This is a NIMHD/NIH-funded mixed-methods study.
c. JUSTICE, EQUITY, DIVERSITY, AND INCLUSIVITY (JEDI) MINI-FELLOWSHIP: We are currently analyzing a dataset to understand the impact of our JEDI fellowship on faculty interpersonal interactions.
d. CULTURAL AND GENDER VARIATIONS AND THEIR IMPACT ON END-OF-LIFE CONVERSATIONS: In an NIA-funded randomized clinical trial, we are studying how gender and ethnicity impact end-of-life conversations and decision-making processes of diverse patients and the impact on their families.
e. QUALITATIVE STUDY TO UNDERSTAND RESEARCH RETICENCE IN MINORITY COMMUNITIES: In this study, we have conducted 18 focus groups in four languages (Cantonese, Mandarin, Tagalog and Spanish) to better understand cultural differences in understanding of and willingness to participate in clinical trials.
