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Identity Armor: Handling Bias from Patients and Peers

Bias in medicine is not just theoretical. It shows up in the clinic, the wards, and even in the classroom. Underrepresented students and trainees often find themselves navigating slights from peers, colleagues, or even patients who question their competence, accent, or appearance. These moments sting, and they accumulate.


The goal is not to ignore them or let them chip away at your confidence. The goal is to build an Identity Armor—protective strategies rooted in self-awareness, cultural pride, and practical tools for responding.


1. Recognize the Bias, Don’t Internalize It

Studies confirm that over 70% of women and racial/ethnic minority trainees report microaggressions in training (Sudol et al., 2021). Patients refusing care from physicians of color, peers questioning authority, or colleagues making stereotyped comments—these are systemic issues, not personal failings.


Identity Armor begins by reminding yourself: the bias reflects on them, not on you.


2. Ground Yourself in Your Story

Critical Race Theory emphasizes that lived experience is a source of knowledge and strength (Tsai & Lindo, 2021). Your cultural background, language, and traditions aren’t distractions from professionalism—they are assets. Whether it’s a playlist on your commute, food from home, or a reminder of your family’s sacrifices, grounding rituals can buffer the sting of bias.


3. Respond with Range, Not Reflex

Not every incident needs the same response. Upstander training shows that effective responses exist along a continuum (Hill Weller et al., 2023):

  • Indirect: Redirect or shift focus.

  • Direct: Clarify or reflect back (“Did you mean that the way it sounded?”).

  • Supportive: Check in afterward with the person targeted (if it’s not you).

Armor means having tools at the ready so you don’t absorb harm by default.


4. Build Your Network of Protection

Research on mentoring networks shows that persistence and belonging rise when minority learners have multiple mentors and allies, not just one (Campo, 2024). Identity Armor grows stronger when you have people who affirm your worth and share strategies. Seek out:

  • Affinity groups or cultural orgs.

  • Faculty and residents who openly advocate for diversity.

  • Peer circles where you can vent safely without judgment.


5. Protect Your Energy from the “Minority Tax”

Being asked to sit on every DEI committee or always educate others about racism can drain your bandwidth. Bush (2021) calls this the “minority tax.” Setting boundaries is not selfish—it’s survival.

  • “I can’t commit to this right now.”

  • “I’d love to support, but I need this to be recognized in my role.”

Armor means preserving your energy for the work that matters most.


6. Reframe Bias as Evidence of System Gaps

A biased patient request or dismissive peer comment can feel deeply personal. But systemic studies show that bias is patterned, not isolated (Alhassan et al., 2024; Butler et al., 2022). Reframing turns an attack on your identity into a signal that the institution still has work to do. That shift helps you protect your confidence while advocating for change.



Bias in medicine is real, and it is harmful. But you are not powerless. By grounding yourself in your story, equipping yourself with scripts, building networks, and setting boundaries, you create Identity Armor—a shield that allows you to keep showing up as yourself, without shrinking.


Your presence is not the problem. Bias is. And your resilience in the face of it becomes part of the solution.


References

  • Alhassan, Fatima, et al. “Microaggressions and the Emotional Toll on Learners of Color in Medicine.” Journal of Surgical Education, 2024.

  • Bonifacino, Emily, et al. “Minority Stress Theory and the Experiences of Underrepresented Residents.” Journal of Graduate Medical Education, vol. 13, no. 4, 2021, pp. 543–549.

  • Bush, Andrew A. “Equity and the Minority Tax in Medical Education.” Academic Medicine, vol. 96, no. 12, 2021, pp. 1701–1704.

  • Butler, Paris D., et al. “A Blueprint for Increasing Ethnic and Racial Diversity in U.S. Residency Training Programs.” Academic Medicine, vol. 97, no. 11, 2022, pp. 1632–1636.

  • Campo, Maritza Salazar, et al. “Mentoring Networks in Academic Medicine: A Longitudinal Exploration.” Chronicles of Mentoring and Coaching, vol. 8, no. 1, 2024, pp. 72–81.

  • Hill Weller, LaMisha, et al. “Tools for Addressing Microaggressions: An Interactive Workshop for Perioperative Trainees.” MedEdPORTAL, vol. 19, 2023, p. 11360.

  • Sudol, Neha T., et al. “Prevalence and Nature of Sexist and Racial/Ethnic Microaggressions Against Surgeons and Anesthesiologists.” JAMA Surgery, vol. 156, no. 5, 2021, e210265.

  • Tsai, Jennifer, and Eric Lindo. “Critical Race Theory in Medical Education.” Academic Medicine, vol. 96, no. 12, 2021, pp. 1705–1707.

 
 
 

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