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Journal of General Internal Medicine

Open Access 20-11-2023 | Original Research: Qualitative Research

Stereotype Threat and Gender Bias in Internal Medicine Residency: It is Still Hard to be in Charge

Authors: Annabel K. Frank, MD, Jackie J. Lin, MD, Sophia Bellin Warren, MD, Justin L. Bullock, MD, Patricia O’Sullivan, EdD, Lauren E. Malishchak, MD, Rebecca A. Berman, MD, Maria A. Yialamas, MD, Karen E. Hauer, MD, PhD

Published in: Journal of General Internal Medicine

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Abstract

Background

Despite similar numbers of women and men in internal medicine (IM) residency, women face unique challenges. Stereotype threat is hypothesized to contribute to underrepresentation of women in academic leadership, and exploring how it manifests in residency may provide insight into forces that perpetuate gender disparities.

Objective

To quantify the prevalence of stereotype threat in IM residency and explore experiences contributing to that stereotype threat.

Design

We used a mixed methods study design. First, we surveyed IM residents using the Stereotype Vulnerability Scale (SVS) to screen for stereotype threat. Second, we conducted focus groups with women who scored high on the SVS to understand experiences that led to stereotype threat.

Participants

The survey was sent to all IM residents at University of California, San Francisco (UCSF), in September–November 2019. Focus groups were conducted at UCSF in Spring 2020.

Approach

The survey included an adapted version of the SVS. For focus groups, we developed a focus group guide informed by literature on stereotype threat. We used a thematic approach to data analysis. The mixed methods design enabled us to draw metainferences by integrating the two data sources.

Key Results

Survey response rate was 61% (110/181). Women were significantly more likely than men to have a score indicating stereotype threat vulnerability (77% vs 0%, p < 0.001). Four themes from focus groups characterized women’s experiences of gender bias and stereotype threat: gender norm tension, microaggressions and sexual harassment, authority questioned, and support and allyship.

Conclusions

Gender-based stereotype threat is highly prevalent among women IM residents. This phenomenon poses a threat to confidence and ability to execute patient care responsibilities, detracting from well-being and professional development. These findings indicate that, despite robust representation of women in IM training, further attention is needed to address gendered experiences and contributors to women’s vulnerability to stereotype threat.
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Literature
1.
Butkus R, Serchen J, Moyer DV, et al. Achieving gender equity in physician compensation and career advancement: a position paper of the American College of Physicians. Ann Intern Med. 2018;168(10):721-723.
2.
Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of hospital mortality and readmission rates for medicare patients treated by male vs female physicians. JAMA Intern Med. 2017;177(2):206-213. PubMedPubMedCentralCrossRef
3.
Mehrotra A, Morris M, Gourevitch RA, et al. Physician characteristics associated with higher adenoma detection rate. Gastrointest Endosc. 2018;87(3):778-786.e5. PubMedCrossRef
4.
Wallis CJ, Ravi B, Coburn N, Nam RK, Detsky AS, Satkunasivam R. Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. BMJ. 2017;359:j4366. PubMedPubMedCentralCrossRef
5.
Pololi LH, Civian JT, Brennan RT, Dottolo AL, Krupat E. Experiencing the culture of academic medicine: gender matters, a national study. J Gen Intern Med. 2013;28(2):201-207. PubMedCrossRef
6.
Fassiotto M, Hamel EO, Ku M, et al. Women in academic medicine: measuring stereotype threat among junior faculty. J Womens Health. 2016;25(3):292-298. CrossRef
7.
Hu YY, Ellis RJ, Hewitt DB, et al. Discrimination, abuse, harassment, and burnout in surgical residency training. N Engl J Med. 2019;381(18):1741-1752. PubMedPubMedCentralCrossRef
8.
Winkel AF, Telzak B, Shaw J, et al. The role of gender in careers in medicine: a systematic review and thematic synthesis of qualitative literature. J Gen Intern Med. 2021;36(8):2392-2399. PubMedPubMedCentralCrossRef
9.
Stead W, Manne-Goehler J, Blackshear L, et al. Wondering if I’d get there quicker if I was a man: factors contributing to delayed academic advancement of women in infectious diseases. Open Forum Infect Dis. 2023;10(1):ofac660.
10.
Iyer MS, Way DP, MacDowell DJ, Overholser BM, Spector ND, Jagsi R. Bullying in academic medicine: experiences of women physician leaders. Acad Med. 2023;98(2):255. PubMedCrossRef
11.
12.
13.
Barnes KL, McGuire L, Dunivan G, Sussman AL, McKee R. Gender bias experiences of female surgical trainees. J Surg Educ. 2019;76(6):e1-e14. PubMedCrossRef
14.
Cochran A, Hauschild T, Elder WB, Neumayer LA, Brasel KJ, Crandall ML. Perceived gender-based barriers to careers in academic surgery. Am J Surg. 2013;206(2):263-268. PubMedCrossRef
15.
16.
17.
Klein R, Julian KA, Synder ED, et al. From the Gender Equity in Medicine (GEM) workgroup. Gender bias in resident assessment in graduate medical education: review of the literature. J Gen Intern Med. 2019;34(5):712-719. PubMedPubMedCentralCrossRef
18.
Kolehmainen C, Brennan M, Filut A, Isaac C, Carnes M. Afraid of being “witchy with a ‘B’”: a qualitative study of how gender influences residents’ experiences leading cardiopulmonary resuscitation. Acad Med. 2014;89(9):1276-1281. PubMedPubMedCentralCrossRef
19.
Sharma M. Applying feminist theory to medical education. The Lancet. 2019;393(10171):570-578. CrossRef
20.
Crenshaw K. On Intersectionality: Essential Writings. New York: The New Press; 2017.
21.
Spencer SJ, Steele CM, Quinn DM. Stereotype threat and women’s math performance. J Exp Soc Psychol. 1999;35(1):4-28. CrossRef
22.
23.
Creswell JW, Clark VL. Designing and Conducting Mixed Methods Research. Thousand Oaks (CA): Sage Publications; 2017.
24.
Bunniss S, Kelly DR. Research paradigms in medical education research. Med Educ. 2010;44(4):358-366. PubMedCrossRef
25.
Sandelowski M. What’s in a name? Qualitative description revisited. Res Nurs Health. 2010;33(1):77-84. PubMed
26.
Bullock JL, Lockspeiser T, Del Pino-Jones A, Richards R, Teherani A, Hauer KE. They don’t see a lot of people my color: a mixed methods study of racial/ethnic stereotype threat among medical students on core clerkships. Acad Med. 2020;95(11S):S58-S66. PubMedCrossRef
27.
Spencer SJ. The Effect of Stereotype Vulnerability on Women’s Math Performance. [Doctoral thesis]. Ann Arbor (MI): University of Michigan; 1993.
28.
Morgan, DL. The Focus Group Guidebook. London: Sage Publications Limited; 1997.
29.
Santen SA, Yamazaki K, Holmboe ES, Yarris LM, Hamstra SJ. Comparison of male and female resident milestone assessments during emergency medicine residency training: a national study. Acad Med. 2020;95(2):263-268. PubMedCrossRef
30.
Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Med Teach. 2020;42(8):846-854. PubMedCrossRef
31.
Dedoose Version 9.0.62, cloud application for managing, analyzing, and presenting qualitative and mixed method research data (2022). Los Angeles (CA): SocioCultural Research Consultants, LLC www.​dedoose.​com.
32.
Nelson J. Using conceptual depth criteria: addressing the challenge of reaching saturation in qualitative research. Qual Res. 2017;17(5):554-570. CrossRef
33.
Barry CA, Britten N, Barber N, Bradley C, Stevenson F. Using reflexivity to optimize teamwork in qualitative research. Qual Health Res. 1999;9(1):26-44. PubMedCrossRef
34.
Schoonenboom J. Routledge Handbook for Advancing Integration in Mixed Methods Research. New York: Routledge; 2022. Chapter 4, Developing the Meta-Inference in Mixed Methods Research through Successive Integration of Claims. p. 55–70.
35.
Bartels C, Goetz S, Ward E, Carnes M. Internal medicine residents’ perceived ability to direct patient care: impact of gender and experience. J Womens Health. 2008;17(10):1615-1621. CrossRef
36.
Mueller AS, Jenkins TM, Osborne M, Dayal A, O’Connor DM, Arora VM. Gender differences in attending physicians’ feedback to residents: a qualitative analysis. J Grad Med Educ. 2017;9(5):577-585. PubMedPubMedCentralCrossRef
37.
Dayal A, O’Connor DM, Qadri U, Arora VM. Comparison of male vs female resident milestone evaluations by faculty during emergency medicine residency training. JAMA Intern Med. 2017;177(5):651-657. PubMedPubMedCentralCrossRef
38.
Ju M, van Schaik SM. Effect of professional background and gender on residents’ perceptions of leadership: Acad Med. 2019;94:S42-S47. PubMed
39.
Pennington CR, Heim D, Levy AR, Larkin DT. Twenty years of stereotype threat research: a review of psychological mediators. Pavlova MA, ed. PloS one. 2016;11(1):e0146487. PubMedPubMedCentralCrossRef
40.
Gartner RE, Sterzing PR. Gender microaggressions as a gateway to sexual harassment and sexual assault: expanding the conceptualization of youth sexual violence. Affilia. 2016;31(4):491-503. CrossRef
41.
42.
McIntyre RB, Paulson RM, Lord CG. Alleviating women’s mathematics stereotype threat through salience of group achievements. J Exp Soc Psychol. 2003;39(1):83-90. CrossRef
43.
Marx DM, Ko SJ. Superstars “like” me: the effect of role model similarity on performance under threat. Eur J Soc Psychol. 2012;42(7):807-812. CrossRef
44.
Marx DM, Roman JS. Female role models: protecting women’s math test performance. Pers Soc Psychol Bull. 2002;28(9):1183-1193. CrossRef
45.
Carnes M, Devine PG, Manwell LB, et al. Effect of an intervention to break the gender bias habit for faculty at one institution: a cluster randomized, controlled trial. Acad Med. 2015;90(2):221-230. PubMedPubMedCentralCrossRef
46.
Girod S, Fassiotto M, Grewal D, et al. Reducing implicit gender leadership bias in academic medicine with an educational intervention. Acad Med. 2016;91(8):1143-1150. PubMedCrossRef
47.
Aronson J, Fried CB, Good C. Reducing the effects of stereotype threat on African American college students by shaping theories of intelligence. J Exp Soc Psychol. 2002;38(2):113-125. CrossRef
48.
Blackwell LS, Trzesniewski KH, Dweck CS. Implicit theories of intelligence predict achievement across an adolescent transition: a longitudinal study and an intervention. Child Dev. 2007;78(1):246-263. PubMedCrossRef
49.
Johns M, Schmader T, Martens A. Knowing is half the battle: teaching stereotype threat as a means of improving women’s math performance. Psychol Sci. 2005;16(3):175-179. PubMedCrossRef
50.
Martens A, Johns M, Greenberg J, Schimel J. Combating stereotype threat: the effect of self-affirmation on women’s intellectual performance. J Exp Soc Psychol. 2006;42(2):236-243. CrossRef
51.
Woodcock A, Hernandez PR, Estrada M, Schultz PW. The consequences of chronic stereotype threat: domain disidentification and abandonment. J Pers Soc Psychol. 2012;103(4):635-646. PubMedPubMedCentralCrossRef
Metadata
Title
Stereotype Threat and Gender Bias in Internal Medicine Residency: It is Still Hard to be in Charge
Authors
Annabel K. Frank, MD
Jackie J. Lin, MD
Sophia Bellin Warren, MD
Justin L. Bullock, MD
Patricia O’Sullivan, EdD
Lauren E. Malishchak, MD
Rebecca A. Berman, MD
Maria A. Yialamas, MD
Karen E. Hauer, MD, PhD
Publication date
20-11-2023
Publisher
Springer International Publishing
Published in
Journal of General Internal Medicine
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-023-08498-5
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