Gender and Institutional Differences in Preferred Resident Responses to Biased Statements in Medical Education: A...

Bias and microaggressions remain persistent challenges in medical education, threatening psychological safety and perpetuating inequities. How learners respond to these incidents and the influence of gender and institutional culture on these responses remain underexplored.

To evaluate preferred strategies for responding to biased statements among emergency medicine residents, comparing differences by gender and institutional affiliation.

In this cross-sectional study, an anonymous survey was distributed to residents at two academic institutions: the University of Utah and UT Southwestern. Participants ranked five possible responses to biased comments originating from patients, staff, peers, and learners. Descriptive statistics and Mann-Whitney U tests were used to analyze differences by gender and institution.

Among 100 respondents (52% female), the majority preferred active engagement-either addressing the bias directly or collaborating with an attending-across all scenarios. Ignoring bias was consistently the least preferred option. Gender differences were significant in responses to biased staff statements: men showed a stronger preference for addressing the issue themselves (p = 0.005), while women showed a stronger preference for collaborating with an attending (p = 0.03). Institutional differences were also observed (p < 0.05). UT Southwestern residents more often favoring attending-led/collaborative approaches in patient and staff scenarios, whereas University of Utah residents more often favored addressing bias themselves.

Residents generally favored proactive responses to biased statements, with distinct differences based on gender and institutional culture. These findings suggest the need for tailored bias response training that considers both individual and organizational factors. Further research should explore how other identity variables (e.g., race, sexual orientation) intersect with response preferences and how institutions can foster environments that empower all learners to address bias confidently.