Stereotype Threat in Medical Education

Stereotype threat is a psychological phenomenon in which people feel at risk of confirming a negative stereotype about their group, even if they don’t believe the stereotype to be true. For example, a woman might be confident in her math abilities and the math abilities of other women, but still be aware of the stereotype that women aren’t good at math. This feeling of anxiousness is then associated with lower performance.

An interesting study by Katherine Woolf and colleagues suggests that in medical education, students of Asian origin might experience a different kind of stereoype threat. While they are perceived as smart and studious, they are also seen as too quiet and not good at interacting with patients. Moreover, they are often seen as being forced into medicine by their parents, all of which can lead to stereotype threat among them. For example, one teacher notes “Students that are of South Asian or Indian origin, tend to be, or come across as being far more academically knowledgeable and they can justify what they’re doing and they’re very very bright, but actually putting that into practice and both with communication and practical skills doesn’t seem to gel that well”. The study further suggests that Asian medical students are aware of these negative stereoypes and that this does influence their behavior. The auhors illlustrate this with the example of one of the Asian students in their study: “she recalled hearing clinical teachers talking about the number of students from ethnic minorities at medical school and how she believed that teachers presumed that as an Asian student with medical parents she had been forced into medicine (the stereotype). She perceived they purposely made life harder for her, resulting in her feeling under psychological pressure (stereotype threat) and forced to prove that she was worthy of being at medical school. To prevent people making stereotypical assumptions about her she avoided telling people about herself.”

“Being” a Doctor or “Working as” a Doctor?

About half of all new medical students in most Western countries are now female. However, are there differences in how they perceive their future jobs? Eva Johansson and Katarina Hamberg explored this question by analyzing the essays on the theme “to be a doctor” of Swedish medical students. While, overall, the essays written by men and women had a lot of themes in common, there were some interesting differences.

For example, female medical students seemed to approach the identity of being a doctor in a somewhat different way than male medical students. They more often expressed discomfort at “being” a doctor and constructed it as a job rather than an identity. As one participant put it: “If you say ‘to be’ it has a tendency to extend to much more than a job, to comprise your whole personality. At the same time it reduces your personality to what you achieve at work and nothing else. I think I am so much more than a med student.”

This is an interesting point as the degree to which something is part of one’s identity can have a plethora of consequences and the fact that female medical students struggle to integrate their job identity into their general identity may prove problematic. However, it is equally possible that over time these gender differences disappear.

Please feel free to share your own experiences on this matter in the comments.

Changing the Perceptions of Surgery

Surgery is not just struggling to recruit women – there has been a decline in the popularity of surgery among medical students in general. Luckily it seems that even brief and easy to organise interventions can make a difference. Rosemary Kozar and colleagues report on such an intervention in a short and interesting paper.

In their intervention, first year medical students listened to a panel of surgeons speak about their career satisfaction and lifestyle. The authors found that this did indeed change the perception of surgery. For example, the length of training was seen as less deterring after the intervention.

This study indicates that interest in different sub-disciplines of medicine might often be based on stereotypes and prejudices and that it is important for surgeons to be proactive and share their experiences with the next generation of doctors.

The Tough-Minded Female Surgeon? Not Necessarily.

Similar to other areas in the workplace where women are under-represented, it is often claimed that either women don’t have what it takes to succeed or that those women who do have what it takes aren’t “proper” women (whatever that is supposed to mean). Thus, women in surgery may find themselves in a double bind situation in which they are either too feminine for a surgeon or too masculine for a woman.

But what are women interested in surgery actually like. In what ways (if in any) do they differ from women in medicine not interested in surgery and from men interested in surgery? A study by Coulston, Vollmer-Conner and Malhi gives us some answers to that. They surveyed Australian medical students, asking them about their personalities, important goals in their careers and interest in a number of medical fields, including surgery. Their findings indicate that female medical students interested in a career in surgery are not all that different from other female medical students, although they do place significantly more importance on prestige. Compared to male medical students interested in surgery, on the other hand, they care less about prestige and financial reward and more about the ability to help people – a pattern that is observed as a general difference between male and female doctors. With regards to personality factors, the study showed that women interested in surgery did not show the traits stereotypically associated with surgery (e.g. tough-mindedness).

So in the end, although this study cannot tell us anything about what it takes to succeed in surgery, it certainly suggests that the field initially attracts all kinds of women (not just those who fit the stereotype of a surgeon). It leaves the question open whether this changes over time as medical students gain more experience with surgery and surgeons.