Table 2. Self-reported Effects of Demeaning Behavior on Affected Individuals.

Effect	Illustrative Quotation [Participant]
Negative Effects
Emotional burden	“It happened with such frequency that it was really demoralizing.” [First-year resident, woman, black]
	“The amount of emotional energy and mental energy spent worrying about whether something about my appearance, or something immutable about who I am is causing [patient’s biased behavior]…it’s just a lot of time and energy and emotion that I could have spent learning…instead of doubting my abilities.” [First-year resident, woman, white]
Withdrawal from roles and rotation	“I know that I basically never went in the room again [after being the target of explicit biased behavior]…I wouldn’t examine him, I would just tell the intern, ‘How is he doing? Alright, cool. I’m not going to bother with it.’ So I didn’t see him again until he left. Actually I didn’t even see him then.” [Third-year resident, woman, black]
	“I didn’t rotate at the VA on purpose…it has been said that the VA has excellent medicine [clerkship] teaching, that it’s a great place to do wards. Let’s say it is the best place and I’m avoiding this experience because a large proportion of the patients treat women a certain way. Then that’s a very tangible effect.” [Fourth-year medical student, woman, black]
Decreased clinical learning and practice	“The unconscious piece of all of that mental energy that goes into dealing with these things on your own, it makes it impossible for you to perform at your best self.” [Third-year resident, woman, black]
	“It’s just a lot of time and energy and emotion that could’ve been spent learning about mixed connective tissue disease, or spending that mental energy on other things to further my professional career.” [First-year resident, woman, white]
Acceptance	“I tend to just accept it [the demeaning behavior] and then, internally, not pay attention to it.” [Fourth-year resident, woman, Asian]
	“I have experienced [demeaning] comments all the time from patients, but, most of the time, I don’t think they come from a bad place and they don’t mean to be hurtful…They’re not realizing the impact of their words.” [Third-year resident, woman, Asian]
Positive Effects
Growth in self-efficacy	“I felt proud in that moment [responding to demeaning comment]. I think about it a lot, because it was a good moment for me.” [Third-year resident, woman, Latina]
	“Practicing 6 years now, I’ve gotten a lot better about saying, whether it’s cursing, or whether it’s inappropriate comments, ‘Unfortunately, this is not working for me. I’m going to leave right now.’” [Hospitalist, woman, Latina]
Increase in feelings of inclusion	“It [debriefing and implementing a team response] made us all feel like we had done something. It felt more like a group effort...that we were together on this front.” [Third-year resident, woman, white]
	“The team validates the experience [via debrief] and offers a chance for the person to share more, and that creates an inclusive environment.” [Second-year resident, man, white]
Desire to seek leadership roles	“One of the things I’m most excited for with internship is the first day I get to take my first third-year medical student…and the opportunity to model my reaction to challenges or threats in the hospital after those people that I have come to admire.” [Fourth-year medical student, woman, white]
Role model responses	“It’s made me really excited to go into a teaching role...and to hopefully play that mentorship role for students who might have a similar experience.” [Fourth-year medical student, woman, South Asian]

Abbreviation: VA, Veterans Administration.