‘It hurts even when it’s not about us.’ Reframing microaggressions in medical education in Japan: Qualitative research

<b>Introduction:</b> Microaggressions are common in medical education but have been studied mainly in Western contexts. This study explored medical students' experiences of microaggressions in Japan to contextualize them within broader sociocultural structures. <b>Methods:</b> Participants were recruited through the Japan Association for Medical Student Societies (Igakuren), the sole nationwide representative body. Eligible individuals were current executive committee members or physicians within six years of graduation who had previously served. Data gained from in-depth online interviews were analyzed using a thematic analysis. <b>Results:</b> Twenty-one participants reported diverse microaggressions during clinical training. To capture these, the conventional microaggression triangle (source, recipient, bystander) was expanded with a fourth element: topic. Three themes emerged: (i) microaggressions about marginalized patients, (ii) hierarchy and dehumanization of students, and (iii) managing microaggressions. These findings highlight how hierarchical norms and structural inequities perpetuate microaggressions in medical education in Japan. <b>Discussion:</b> Microaggressions in Japan reflect structural inequities and entrenched hierarchies, including gender-based discrimination, rather than isolated interpersonal slights. Addressing them requires empowering students, preparing faculty for constructive intervention, and reforming hierarchical norms. This study provides a culturally grounded perspective to advance global discussions on equity in health professions education.