The prevalence and impact of microaggressions within orthopaedics in the United States of America: A systematic review

Microaggressions are being increasingly documented within the medical community. With their rising prevalence, there is concern that microaggressions can lead to suboptimal working environments, victim burnout, and compromised patient safety. Orthopaedics, known for macroaggressions like bullying and sexual discrimination, remains the least diverse specialty, potentially predisposing its staff to microaggressions. The aim of this paper was to determine the prevalence of microaggressions within Trauma and Orthopaedics, and ascertain the impact they have within the specialty. A systematic review was carried out using PRISMA guidelines. Publications pertaining to microaggressions in orthopaedics in the English language were included, with no restrictions relating to study location, date of publication or the victims of microaggressions. 29 papers were included in this systematic review, of which 10 papers were eligible for inclusion. The prevalence of microaggressions in orthopaedics based on gender was discussed in 5 papers, whilst microaggressions relating to race/ethnicity were discussed in 2 papers. A further 2 papers discussed microaggressions relating to both race and gender. All were published in the United States of America (USA). It was found that microaggressions are common in orthopaedics, with 80 % of respondents across 3 cross sectional surveys experiencing some form of microaggression. Microaggressions are a significant problem within the American orthopaedic community. They affect surgeons of all grades, and deter medical students from pursuing orthopaedics as a career. It is important to develop mitigating strategies to tackle this behaviour, in the hope that working environments and patient safety improve in orthopaedic departments.