Patients’ experience of stereotype threat in clinical settings and encounters may be one contributor to health care disparities. Stereotype threat occurs when cues in the environment make negative stereotypes associated with an individual’s group status salient, triggering physiological and psychological processes that have detrimental consequences for behavior. By recognizing and understanding the factors that can trigger stereotype threat and understanding its consequences in medical settings, providers can prevent it from occurring or ameliorate its consequences for patient behavior and outcomes. In this paper, we discuss the implications of stereotype threat for medical education and trainee performance and offer practical suggestions for how future providers might reduce stereotype threat in their exam rooms and clinics.
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Devine PG, Brodish AB. Modern classics in social psychology. Psychol Inq;14(3–4):196–202
Steele CM, Aronson J. Stereotype threat and the intellectual test performance of African Americans. J Pers Soc Psychol. 1995;69(5):797–811.
Spencer SJ, Steele CM, Quinn DM. Stereotype threat and women’s math performance. J Exp Soc Psychol. 1999;35:4–28.
Keller J, Dauenheimer D. Stereotype threat in the classroom: dejection mediates the disrupting threat effect on women’s math performance. Pers Soc Psychol Bull. 2003;29(3):371–81.
Cadinu M, Maass A, Rosabianca A, Kiesner J. Why do women underperform under stereotype threat? Evidence for the role of negative thinking. Psychol Sci. 2005;16(7):572–8.
Croizet JC, Despres G, Gauzins ME, Huguet P, Leyens JP, Meot A. Stereotype threat undermines intellectual performance by triggering a disruptive mental load. Pers Soc Psychol Bull. 2004;30(6):721–31.
Blascovich J, Spencer SJ, Quinn D, Steele C. African Americans and high blood pressure: the role of stereotype threat. Psychol Sci. 2001;12(3):225–9.
Cadinu M, Maass A, Frigerio S, Impagliazzo L, Latinotti S. Stereotype threat: the effect of expectancy on performance. Eur J Soc Psychol. 2003;33(2).
Kray LJ, Thompson L, Galinsky A. Battle of the sexes: gender stereotype confirmation and reactance in negotiations. J Pers Soc Psychol. 2001;80(6):942–58.
Stone J. Battling doubt by avoiding practice: the effects of stereotype threat on self-handicapping in white athletes. Pers Soc Psychol Bull. 2002;28(12).
Smith JL, White PH. An examination of implicitly activated, explicitly activated, and nullified stereotypes on mathematical performance: it’s not just a woman’s issue. Sex Roles. 2002;47(3–4).
Schmader T, Johns M. Converging evidence that stereotype threat reduces working memory capacity. J Pers Soc Psychol. 2003;85(3):440–52.
Nguyen HH, Ryan AM. Does stereotype threat affect test performance of minorities and women? A meta-analysis of experimental evidence. J Appl Psychol. 2008;93(6):1314–34.
Walton GM, Spencer SJ. Latent ability: grades and test scores systematically underestimate the intellectual ability of negatively stereotyped students. Psychol Sci. 2009;20(9):1132–9.
Gonzales PM, Blanton H, Williams KJ. The Effects of stereotype threat and double-minority status on the test performance of Latino women. Pers Soc Psychol Bull. 2002;28:659–70.
Croizet J-C, Claire T. Extending the concept of stereotype and threat to social class: the intellectual underperformance of students from low socioeconimic backgrounds. Pers Soc Psychol Bull. 1998;24:588–94.
Spencer B, Castano E. Social class is dead. Long live social class! Stereotype threat among low socioeconomic status individuals. Soc Justice Res. 2007;20:418–32.
Henry JD, Hippel CV, Shapiro L. Stereotype threat contributes to social difficulties in people with schizophrenia. Br J Clin Psychol. 2009.
Horton S, Baker J, Pearce GW, Deakin JM. On the malleability of performance: implications for seniors. J Appl Gerontol. 2008;27:446–65.
Hess TM, Auman C, Colcombe SJ, Rahhal TA. The impact of stereotype threat on age differences in memory performance. J Gerontol B Psychol Sci Soc Sci. 2003;58(1):P3–11.
Hess TM, Hinson JT, Hodges EA. Moderators of and mechanisms underlying stereotype threat effects on older adults’ memory performance. Exp Aging Res. 2009;35(2):153–77.
Chasteen AL, Bhattacharyya S, Horhota M, Tam R, Hasher L. How feelings of stereotype threat influence older adults’ memory performance. Exp Aging Res. 2005;31(3):235–60.
Cole JC, Michailidou K, Jerome L, Sumnall HR. The effects of stereotype threat on cognitive function in ecstasy users. J Psychopharmacol. 2006;20(4):518–25.
Quinn DM, Kahng SK, Crocker J. Discreditable: stigma effects of revealing a mental illness history on test performance. Pers Soc Psychol Bull. 2004;30(7):803–15.
Suhr JA, Gunstad J. “Diagnosis Threat”: the effect of negative expectations on cognitive performance in head injury. J Clin Exp Neuropsychol. 2002;24(4):448–57.
Keller J. Blatant stereotype threat and women’s math performance: Self-handicapping as a strategic means to cope with obtrusive negative performance expectations. Sex Roles. 2002;47(3–4).
Klein O, Pohl S, Ndagijimana C. The influence of intergroup comparisons on Africans’ intelligence test performance in a job selection context. J Psychol. 2007;141(5).
von Hippel W, von Hippel C, Conway L, Preacher KJ, Schooler JW, Radvansky GA. Coping with stereotype threat: denial as an impression management strategy. J Pers Soc Psychol. 2005;89(1):22–35.
Steele CM, Spencer SJ, Aronson J. Contending with group image: the psychology of stereotype and social identity threat. Adv Exp Soc Psychol. 2002;34:379–440.
Osborne JW. Race and academic disidentification. J Educ Psychol. 1997;89(4).
Davies PG, Spencer SJ, Steele CM. Clearing the air: identity safety moderates the effects of stereotype threat on women’s leadership aspirations. J Pers Soc Psychol. 2005;88(2):276–87.
Goff PA, Steele CM, Davies PG. The space between us: stereotype threat and distance in interracial contexts. J Pers Soc Psychol. 2008;94(1):91–107.
Spencer S. Stereotype threat. Annu Rev Psychol. 2009.
Becker G, Newsom E. Socioeconomic status and dissatisfaction with health care among chronically ill African Americans. Am J Public Health. 2003;93(5):742–8.
Becker G, Gates RJ, Newsom E. Self-care among chronically ill African Americans: culture, health disparities, and health insurance status. Am J Public Health. 2004;94(12):2066–73.
Grady M, Edgar T. Racial disparities in healthcare: highlights from focus group findings. In: Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparites in Healthcare. Washington: The National Academies Press; 2003:392–405.
Hatzfeld JJ, Cody-Connor C, Whitaker VB, Gaston-Johansson F. African-American perceptions of health disparities: a qualitative analysis. J Natl Black Nurses Assoc. 2008;19(1):34–41.
Gaston-Johansson F, Hill-Briggs F, Oguntomilade L, Bradley V, Mason P. Patient perspectives on disparities in healthcare from African-American, Asian, Hispanic, and Native American samples including a secondary analysis of the Institute of Medicine focus group data. J Natl Black Nurses Assoc. 2007;18(2):43–52.
Blanchard J, Lurie N. R-E-S-P-E-C-T: patient reports of disrespect in the health care setting and its impact on care. J Fam Pract. 2004;53(9):721–30.
Trivedi AN, Ayanian JZ. Perceived discrimination and use of preventive health services. J Gen Intern Med. 2006;21(6):553–8.
Van Houtven CH, Voils CI, Oddone EZ, et al. Perceived discrimination and reported delay of pharmacy prescriptions and medical tests. J Gen Intern Med. 2005;20(7):578–83.
Burgess DJ, van Ryn M, Malat J, Matoka M. Understanding the provider contribution to race/ethnicity disparities in pain treatment: insights from social cognitive research on stereotyping. Pain Med. 2006;7:119–34.
van Ryn M, Fu SS. Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health? Am J Public Health. 2003;93(2):248–55.
van Ryn M. Research on the provider contribution to race/ethnicity disparities in medical care. Med Care. 2002;40(1 Suppl):I140–51.
van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians’ perceptions of patients. Soc Sci Med. 2000;50(6):813–28.
Green AR, Carney DR, Pallin DJ, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med. 2007;22(9):1231–8.
Marx DM, Stapel DA. Distinguishing stereotype threat from priming effects: on the role of the social self and threat-based concerns. J Pers Soc Psychol. 2006;91(2):243–54.
Saha S, Freeman M, Toure J, Tippens KM, Weeks C, Ibrahim S. Racial and ethnic disparities in the VA Health Care System: a systematic review. J Gen Intern Med. 2008
Trinacty CM, Adams AS, Soumerai SB, et al. Racial differences in long-term adherence to oral antidiabetic drug therapy: a longitudinal cohort study. BMC Health Serv Res. 2009;9:24.
Duru OK, Gerzoff RB, Selby JV, et al. Identifying risk factors for racial disparities in diabetes outcomes: the translating research into action for diabetes study. Med Care. 2009;47(6):700–6.
Thrasher AD, Earp JA, Golin CE, Zimmer CR. Discrimination, distrust, and racial/ethnic disparities in antiretroviral therapy adherence among a national sample of HIV-infected patients. J Acquir Immune Defic Syndr. 2008;49(1):84–93.
Heisler M, Faul JD, Hayward RA, Langa KM, Blaum C, Weir D. Mechanisms for racial and ethnic disparities in glycemic control in middle-aged and older Americans in the health and retirement study. Arch Intern Med. 2007;167(17):1853–60.
Casagrande SS, Gary TL, LaVeist TA, Gaskin DJ, Cooper LA. Perceived discrimination and adherence to medical care in a racially integrated community. J Gen Intern Med. 2007;22(3):389–95.
Apter AJ, Boston RC, George M, et al. Modifiable barriers to adherence to inhaled steroids among adults with asthma: it’s not just black and white. J Allergy Clin Immunol. 2003;111(6):1219–26.
Schmader T, Johns M, Forbes C. An integrated process model of stereotype threat effects on performance. Psychol Rev. 2008;115(2):336–56.
Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;139(11):907–15.
Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;282(6):583–9.
Levinson W, Hudak PL, Feldman JJ, et al. “It’s not what you say ...”: Racial disparities in communication between orthopedic surgeons and patients. Med Care. 2008;46(4):410–6.
Gordon HS, Street RL Jr, Kelly PA, Souchek J, Wray NP. Physician-patient communication following invasive procedures: an analysis of post-angiogram consultations. Soc Sci Med. 2005;61(5):1015–25.
Greenlund KJ, Keenan NL, Anderson LA, Mandelson MT, Newton KM, LaCroix AZ. Does provider prevention orientation influence female patients’ preventive practices? Am J Prev Med. 2000;19(2):104–10.
Greenlund KJ, Giles WH, Keenan NL, Croft JB, Mensah GA. Physician advice, patient actions, and health-related quality of life in secondary prevention of stroke through diet and exercise. Stroke. 2002;33(2):565–71.
Brown JB, Stewart M, Ryan BL. Outcomes of patient-provider interaction. In: Teresa L, Thompson AMD, Miller KI, Parrott R, eds. Handbook of Health Communication. London: LEA; 2003:141–63.
Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49(9):796–804.
Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27(3 Suppl):S110–27.
Greenfield S, Kaplan S, Ware JE Jr. Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985;102(4):520–8.
Greenfield S, Kaplan SH, Ware JE Jr, Yano EM, Frank HJ. Patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988;3(5):448–57.
Rao JK, Weinberger M, Kroenke K. Visit-specific expectations and patient-centered outcomes: a literature review. Arch Fam Med. 2000;9(10):1148–55.
Steele CM. Stereotyping and its threat are real. Am Psychol. 1998;53(6):680–1.
Schectman JM, Schorling JB, Voss JD. Appointment adherence and disparities in outcomes among patients with diabetes. J Gen Intern Med. 2008;23(10):1685–7.
Major B, O’Brien LT. The social psychology of stigma. Annu Rev Psychol. 2005;56:393–421.
Oyserman D, Fryberg SA, Yoder N. Identity-based motivation and health. J Pers Soc Psychol. 2007;93(6):1011–27.
Crocker J, Major B, Steel C. Social stigma. In: Gilbert D, Fiske ST, Lindzey G, eds. The Handbook of Social Psychology. Vol 2. 4th ed. Boston: McGraw-Hill; 1998:504–553.
Steele CM. A threat in the air. How stereotypes shape intellectual identity and performance. Am Psychol. 1997;52(6):613–29.
Burgess DJ, Fu SS, van Ryn M. Why do providers contribute to disparities and what can be done about it? J Gen Intern Med. 2004;19(11):1154–9.
Steele CM. Race and the schooling of Black Americans. The Atlantic Monthly. 1992:68–78.
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;42:236–43.
Cohen GL, Garcia J, Purdie-Vaughns V, Apfel N, Brzustoski P. Recursive processes in self-affirmation: intervening to close the minority achievement gap. Science. 2009;324(5925):400–3.
Cohen GL, Garcia J, Apfel N, Master A. Reducing the racial achievement gap: a social-psychological intervention. Science. 2006;313:1307–10.
Frantz CM, Cuddy AJ, Burnett M, Ray H, Hart A. A threat in the computer: the race implicit association test as a stereotype threat experience. Pers Soc Psychol Bull. 2004;30(12):1611–24.
Cohen GL, Steele CM, Ross LD. The mentor’s dilemma: providing critical feedback across the racial divide. Pers Soc Psychol Bull. 1999;25(10):1302–18.
Good C, Aronson J, Inzlicht M. Improving adolescents’ standardized test performance: An intervention to reduce the effects of stereotype threat. J Appl Dev Psychol. 2003;24:645–62.
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):175–9.
Purdie-Vaughns V, Steele CM, Davies PG, Ditlmann R, Crosby JR. Social identity contingencies: How diversity cues signal threat or safety for African Americans in mainstream institutions. J Pers Soc Psychol. 2008;94:615–30.
Ford AL, Yep GA. Working along the margins: developing community-based strategies for communicating about health with marginalized groups. In: Thompson TL, Dorsey AM, Miller KI, Parrott R, eds. Handbook of Health Communication. Mahwah: Lawrence Erlbaum Associates; 2003:241–262.
Marx DM, Ko SJ, Friedman RA. The Obama effect: how a salient role model reduces race-based performance differences. J Exp Soc Psychol. in press.
Marx DM, Goff PA. Clearing the air: the effect of experimenter race on target’s test performance and subjective experience. Br J Soc Psychol. 2005;44(Pt 4):645–57.
McIntyre RB, Lord CG, Gresky DM, Ten Eyck LL, Jay Frye G, Bond CF. A social impact trend in the effects of role models on alleviating women’s mathematics stereotype threat. Curr Res Soc Psychol. 2005;10(9).
Marx DM, Ko SJ, Friedman RA. The “Obama effect”: how a salient role model reduces race-based performance differences. J Exp Soc Psychol. 2009;45(4).
Marx DM, Goff PA. Clearing the air: the effect of experimenter race on target’s test performance and subjective experience. Br J Soc Psychol. 2005;44(4).
Marx DM, Stapel DA, Muller D. We can do it: the interplay of construal orientation and social comparisons under threat. J Pers Soc Psychol. 2005;88(3).
Marx DM, Roman JS. Female role models: protecting women’s math test performance. Pers Soc Psychol Bull. 2002;28(9).
Walton GM, Cohen GL. A question of belonging: race, social fit, and achievement. J Pers Soc Psychol. 2007;92(1):82–96.
Education CoGM. Minorities in medicine: an ethnic and cultural challenge for physician training: U.S. department of health and human services. 2005.
Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington: National Academy Press; 2002.
Minorities in Medical Education: Facts & Figures. Washington, D.C.: Association of American Medical Colleges; 2005.
Brotherton SE, Simon FA, Etzel SI. US graduate medical education, 2001–2002: changing dynamics. JAMA. 2002;288(9):1073–8.
Woolf K, Haq I, McManus IC, Higham J, Dacre J. Exploring the underperformance of male and minority ethnic medical students in first year clinical examinations. Adv Health Sci Educ Theory Pract. 2008;13(5):607–16.
Koenig JA, Sireci SG, Wiley A. Evaluating the predictive validity of MCAT scores across diverse applicant groups. Acad Med. 1998;73(10):1095–106.
Huff KL, Fang D. When are students most at risk of encountering academic difficulty? A study of the 1992 matriculants to U.S. medical schools. Acad Med. 1999;74:454–60.
Tekian A. Attrition rates of underrepresented minority students at the University of Illinois at Chicago College of Medicine, 1993–1997. Acad Med. 1998;73(3):336–8.
Edmond MB, Deschenes JL, Eckler M, Wenzel RP. Racial bias in using USMLE step 1 scores to grant internal medicine residency interviews. Acad Med. 2001;76(12):1253–6.
Lee KB, Vaishnavi SN, Lau SK, Andriole DA, Jeffe DB. Cultural competency in medical education: demographic differences associated with medical student communication styles and clinical clerkship feedback. J Natl Med Assoc. 2009;101(2):116–26.
Liebschutz JM, Darko GO, Finley EP, Cawse JM, Bharel M, Orlander JD. In the minority: black physicians in residency and their experiences. J Natl Med Assoc. 2006;98(9):1441–8.
Odom KL, Roberts LM, Johnson RL, Cooper LA. Exploring obstacles to and opportunities for professional success among ethnic minority medical students. Acad Med. 2007;82(2):146–53.
Erwin DO, Henry-Tillman RS, Thomas BR. A qualitative study of the experiences of one group of African Americans in pursuit of a career in academic medicine. J Natl Med Assoc. 2002;94(9):802–12.
Woolf K, McManus IC, Gill D, Dacre J. The effect of a brief social intervention on the examination results of UK medical students: a cluster randomised controlled trial. BMC Med Educ. 2009;9:35.
Logel C, Walton GM, Spencer SJ, Iserman EC, von Hippel W, Bell AE. Interacting with sexist men triggers social identity threat among female engineers. J Pers Soc Psychol. 2009;96(6):1089–103.
Baldwin DC Jr, Daugherty SR, Rowley BD. Racial and ethnic discrimination during residency: results of a national survey. Acad Med. 1994;69(10 Suppl):S19–21.
Baldwin DC Jr, Daugherty SR, Rowley BD. Residents’ and medical students’ reports of sexual harassment and discrimination. Acad Med. 1996;71(10 Suppl):S25–7.
Sheehan KH, Sheehan DV, White K, Leibowitz A, Baldwin DC Jr. A pilot study of medical student ‘abuse’. Student perceptions of mistreatment and misconduct in medical school. JAMA. 1990;263(4):533–7.
Stricker LJ, Ward WC. Stereotype threat, inquiring about test takers’ ethnicity and gender, and standardized test performance. J Appl Soc Psychol. 2004;34:665–93.
Danaher K, Crandall CS. Stereotype threat in applied settings re-examined. J Appl Soc Psychol. 2008;38:1639–55.
Nagda BA. Breaking barriers, crossing borders, building bridges: communication processes in intergroup dialogues. J Soc Issues. 2006;62(3).
Nagda BA, Kim C-W, Truelove Y. Learning about difference, learning with others, learning to transgress. J Soc Issues. 2004;60(1).
Nagda BA, Zuniga X. Fostering meaningful racial engagement through intergroup dialogues. Group Process Intergroup Relat. 2003;6(1).
Vorauer JD, Main KJ, O’Connell GB. How do individuals expect to be viewed by members of lower status groups? Content and implications of meta-stereotypes. J Pers Soc Psychol. 1998;75(4):917–37.
Vorauer JD, Hunter AJ, Main KJ, Roy SA. Meta-stereotype activation: evidence from indirect measures for specific evaluative concerns experienced by members of dominant groups in intergroup interaction. J Pers Soc Psychol. 2000;78(4):690–707.
Plant EA, Devine PG. Internal and external motivation to respond without prejudice. J Pers Soc Psychol. 1998;75(3):811–32.
Plant EA, Devine PG. Interracial interactions: approach and avoidance. In: Elliott A, ed. Handbook of Approach and Avoidance Motivation. New York: Psychology Press; 2008:571–84.
Richeson JA, Trawalter S. Why do interracial interactions impair executive function? A resource depletion account. J Pers Soc Psychol. 2005;88(6):934–47.
Richeson JA, Shelton JN. When prejudice does not pay: effects of interracial contact on executive function. Psychol Sci. 2003;14:287–90.
Richeson JA, Trawalter S. The threat of appearing prejudiced and race-based attentional biases. Psychol Sci. 2008;19(2):98–102.
Saha S, Korthuis P, Cohn A, Sharp V, Moore R, Beach M. Physician interracial anxiety, patient trust, and satisfaction with HIV care. Presentation at the International Conference on Communication in Healthcare. Oslo, Norway. September 2008.
Apfelbaum EP, Sommers SR, Norton MI. Seeing race and seeming racist? Evaluating strategic colorblindness in social interaction. J Pers Soc Psychol. 2008;95(4):918–32.
Pettigrew TF, Tropp LR. A meta-analytic test of intergroup contact theory. J Pers Soc Psychol. 2006;90(5):751–83.
Page-Gould E, Mendoza-Denton R, Tropp LR. With a little help from my cross-group friend: reducing anxiety in intergroup contexts through cross-group friendship. J Pers Soc Psychol. 2008;95(5):1080–94.
Pettigrew TF. Intergroup contact theory. Annu Rev Psychol. 1998;49:65–85.
Higgins ET. Promotion and prevention as motivational duality: implications for evaluative processes. In: Trope SCY, ed. Dual-Process Theories in Social Psychology. New York: Guilford Press; 1999:503–525.
This work was supported by a VA HSR&D Merit Review Entry Program award to Diana Burgess, Ph.D.
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Burgess, D.J., Warren, J., Phelan, S. et al. Stereotype Threat and Health Disparities: What Medical Educators and Future Physicians Need to Know. J GEN INTERN MED 25, 169–177 (2010). https://doi.org/10.1007/s11606-009-1221-4