Asian American Med Students Experience Microaggressions

A recent paper by Zhang and colleagues explored the effect of microaggressions on Asian American medical students.

Microaggressions were first described by groundbreaking African American psychiatrist Chester Pierce in the 1970s, referring to the “subtle yet damaging humiliations and indignities experienced by African Americans.” Psychologist and researcher Derald Wing Sue later expanded the concept to include Asian Americans. He writes:

“Microaggressions are the everyday verbal, nonverbal, and environmental slights, snubs, or insults, whether intentional or unintentional, which communicate hostile, derogatory, or negative messages to target persons based solely on their marginalized group membership. In many cases, these hidden messages may invalidate the group identity or experiential reality of target persons, demean them on a personal or group level, communicate they are lesser."

Zhang and colleagues surveyed 305 Asian American medical students and followed up with four focus groups. They found that 70 percent of those surveyed experienced a variety of microaggressions, with significant effects on their learning environments.

Asian Americans currently constitute 28.7 percent of all medical students. The increasing prevalence of Asian Americans in medicine often leads to a dismissal of their concerns. While Asian Americans are often called “over-represented” in medicine (which doesn’t account for the vast diversity under the umbrella term and erases minoritized experiences within the category), they are still only about 7 percent of the total US population, and as minorities, are frequently stereotyped, misunderstood, and targets of discrimination. America’s still-fresh experience with COVID-19 uncovered and amplified anti-Asian hate.

Zhang’s study suggests that the fractious effect of microaggressions impairs medical training and professional development, thus disrupting the cohesiveness of medical teams, healthcare accessibility, and quality. The authors suggest adding histories and perspectives of Asian Americans to DEI programs would help reduce microaggressions and build healthcare teams.

Microaggressions frequently reported include:

• Being implied to be a perpetual foreigner – not really American, a citizen, or a professional
• Assumptions of timidness
• Assumed to be a “model minority” – not seeing individual experiences, and silencing dissent
• Misidentification as another Asian American individual
• Gender biases added to racial bias (Asian American women reported receiving more microaggressions than Asian American men)
• Being tied to the COVID-19 pandemic

Students reported anger, frustration, and burnout at having to manage feelings generated by these encounters, as well as frustration with a lack of institutional support. Shang, Kim, and Cheng reported similar findings in a 2021 paper on discrimination encountered by Asian American and Asian Canadian healthcare workers during COVID-19. Bullock and colleagues suggest that there is no one-size-fits-all solution to these problems, but offer this guide for microaggressions coming from patients:

1. Recognize the microaggression (this requires mindfulness, empathy, and education)
2. Analyze the microaggression (considering power dynamics, identities, intents, and impacts)
3. Consider types of response (student preferences, intent versus impact on student and bystanders, patient acuity and mental status, frequency of offense, quality or duration of student or team's relationship with patient)
4. Respond in real-time (bear witness, intervene with the patient, and or pause and exit the room)
5. Check-in immediately with the recipient of the injury (ask the student for their preferences for follow-up, or confirm preferences discussed in pre-brief)
6. Follow up. (Could include team debriefing, student debriefing, discussing with the patient, and reassigning student)

© 2025 Ravi Chandra, M.D., D.F.A.P.A.

(A more thorough version of this article, including implications for our political, cultural, and social psychology, is available at MOSF 20.3: Asian American Medical Students, Microaggressions, and DEI Initiatives.)

Source: Based on Thubten Jinpa's work.