Abstract
<title>Abstract</title> <p>Background Microaggressions are subtle forms of bias that may shape students’ experiences within medical training environments, yet evidence on their prevalence and social patterning across medical education contexts remains limited. This study examined the prevalence of microaggression categories, subgroup differences, and associations with learning environment satisfaction among medical students. Understanding the most common forms of microaggressions and the most affected student groups is important for identifying inequities, informing targeted interventions, and fostering inclusive learning environments. Methods We conducted an exploratory cross-sectional survey of medical students within the International Collaboration and Exchange Program (ICEP) Global consortium in 2023, involving 36 medical schools. Of approximately 800 eligible students, 596 responded. The survey assessed eight microaggression categories adapted from Sue et al.’s taxonomy and a five-item Learning Environment Satisfaction (LES) composite. Cochran’s Q was used to compare prevalence across categories. Chi-square tests examined subgroup differences by ethnicity, gender, and nativity. Mann–Whitney U tests and Spearman correlations assessed associations between microaggression exposure, frequency, and LES. Bonferroni-adjusted thresholds were applied for category-level analyses. Results Reported microaggression exposure varied significantly across categories (p < 0.001). Work and Places of Learning (63.3%), Microinvalidations (57.5%), and Alien in Own Land (56.9%) were the most reported categories, whereas Second-Class Citizen/Assumptions of Criminality (26.4%) and Denial of Individual Racism (27.7%) were least reported. Ethnic differences were observed across all categories, with the most consistent higher exposure reported among Middle Eastern/North African and mixed-ethnicity students. Women reported higher prevalence of Microinvalidations and Work and Places of Learning, while non-native students reported higher prevalence of Alien in Own Land and Assumption of Inferiority. Associations with learning environment satisfaction were generally small, with Microinvalidations showing the most consistent negative association. Conclusions Microaggressions were frequently reported and socially patterned across multiple domains within this ICEP sample. Ethnic disparities were widespread, whereas gender and nativity differences were more domain specific. Although associations with learning environment satisfaction were modest, Microinvalidations showed consistent relevance. These findings support the need for institutional efforts to strengthen recognition, response, and psychologically safe reporting within medical education environments.</p>