Stereotype Threat and Health Disparities: What Medical Educators and Future Physicians Need to Know

Abstract

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.

This is a preview of subscription content, log in to check access.

Figure 1

References

  1. 1.

    Devine PG, Brodish AB. Modern classics in social psychology. Psychol Inq;14(3–4):196–202

  2. 2.

    Steele CM, Aronson J. Stereotype threat and the intellectual test performance of African Americans. J Pers Soc Psychol. 1995;69(5):797–811.

    CAS  PubMed  Google Scholar 

  3. 3.

    Spencer SJ, Steele CM, Quinn DM. Stereotype threat and women’s math performance. J Exp Soc Psychol. 1999;35:4–28.

    Google Scholar 

  4. 4.

    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.

    PubMed  Google Scholar 

  5. 5.

    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.

    PubMed  Google Scholar 

  6. 6.

    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.

    PubMed  Google Scholar 

  7. 7.

    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.

    CAS  PubMed  Google Scholar 

  8. 8.

    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).

  9. 9.

    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.

    CAS  PubMed  Google Scholar 

  10. 10.

    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).

  11. 11.

    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).

  12. 12.

    Schmader T, Johns M. Converging evidence that stereotype threat reduces working memory capacity. J Pers Soc Psychol. 2003;85(3):440–52.

    PubMed  Google Scholar 

  13. 13.

    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.

    PubMed  Google Scholar 

  14. 14.

    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.

    PubMed  Google Scholar 

  15. 15.

    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.

    Google Scholar 

  16. 16.

    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.

    Google Scholar 

  17. 17.

    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.

    Google Scholar 

  18. 18.

    Henry JD, Hippel CV, Shapiro L. Stereotype threat contributes to social difficulties in people with schizophrenia. Br J Clin Psychol. 2009.

  19. 19.

    Horton S, Baker J, Pearce GW, Deakin JM. On the malleability of performance: implications for seniors. J Appl Gerontol. 2008;27:446–65.

    Google Scholar 

  20. 20.

    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.

    PubMed  Google Scholar 

  21. 21.

    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.

    PubMed  Google Scholar 

  22. 22.

    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.

    PubMed  Google Scholar 

  23. 23.

    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.

    CAS  PubMed  Google Scholar 

  24. 24.

    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.

    PubMed  Google Scholar 

  25. 25.

    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.

    PubMed  Google Scholar 

  26. 26.

    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).

  27. 27.

    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).

  28. 28.

    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.

    Google Scholar 

  29. 29.

    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.

    Google Scholar 

  30. 30.

    Osborne JW. Race and academic disidentification. J Educ Psychol. 1997;89(4).

  31. 31.

    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.

    PubMed  Google Scholar 

  32. 32.

    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.

    PubMed  Google Scholar 

  33. 33.

    Spencer S. Stereotype threat. Annu Rev Psychol. 2009.

  34. 34.

    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.

    PubMed  Google Scholar 

  35. 35.

    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.

    PubMed  Google Scholar 

  36. 36.

    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.

    Google Scholar 

  37. 37.

    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.

    PubMed  Google Scholar 

  38. 38.

    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.

    PubMed  Google Scholar 

  39. 39.

    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.

    PubMed  Google Scholar 

  40. 40.

    Trivedi AN, Ayanian JZ. Perceived discrimination and use of preventive health services. J Gen Intern Med. 2006;21(6):553–8.

    PubMed  Google Scholar 

  41. 41.

    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.

    PubMed  Google Scholar 

  42. 42.

    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.

    PubMed  Google Scholar 

  43. 43.

    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.

    PubMed  Google Scholar 

  44. 44.

    van Ryn M. Research on the provider contribution to race/ethnicity disparities in medical care. Med Care. 2002;40(1 Suppl):I140–51.

    PubMed  Google Scholar 

  45. 45.

    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.

    PubMed  Google Scholar 

  46. 46.

    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.

    PubMed  Google Scholar 

  47. 47.

    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.

    PubMed  Google Scholar 

  48. 48.

    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

  49. 49.

    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.

    PubMed  Google Scholar 

  50. 50.

    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.

    PubMed  Google Scholar 

  51. 51.

    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.

    PubMed  Google Scholar 

  52. 52.

    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.

    PubMed  Google Scholar 

  53. 53.

    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.

    PubMed  Google Scholar 

  54. 54.

    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.

    PubMed  Google Scholar 

  55. 55.

    Schmader T, Johns M, Forbes C. An integrated process model of stereotype threat effects on performance. Psychol Rev. 2008;115(2):336–56.

    PubMed  Google Scholar 

  56. 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.

    PubMed  Google Scholar 

  57. 57.

    Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;282(6):583–9.

    CAS  PubMed  Google Scholar 

  58. 58.

    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.

    PubMed  Google Scholar 

  59. 59.

    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.

    PubMed  Google Scholar 

  60. 60.

    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.

    CAS  PubMed  Google Scholar 

  61. 61.

    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.

    PubMed  Google Scholar 

  62. 62.

    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.

    Google Scholar 

  63. 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.

    CAS  PubMed  Google Scholar 

  64. 64.

    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.

    CAS  PubMed  Google Scholar 

  65. 65.

    Greenfield S, Kaplan S, Ware JE Jr. Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985;102(4):520–8.

    CAS  PubMed  Google Scholar 

  66. 66.

    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.

    CAS  PubMed  Google Scholar 

  67. 67.

    Rao JK, Weinberger M, Kroenke K. Visit-specific expectations and patient-centered outcomes: a literature review. Arch Fam Med. 2000;9(10):1148–55.

    CAS  PubMed  Google Scholar 

  68. 68.

    Steele CM. Stereotyping and its threat are real. Am Psychol. 1998;53(6):680–1.

    Google Scholar 

  69. 69.

    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.

    PubMed  Google Scholar 

  70. 70.

    Major B, O’Brien LT. The social psychology of stigma. Annu Rev Psychol. 2005;56:393–421.

    PubMed  Google Scholar 

  71. 71.

    Oyserman D, Fryberg SA, Yoder N. Identity-based motivation and health. J Pers Soc Psychol. 2007;93(6):1011–27.

    PubMed  Google Scholar 

  72. 72.

    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.

    Google Scholar 

  73. 73.

    Steele CM. A threat in the air. How stereotypes shape intellectual identity and performance. Am Psychol. 1997;52(6):613–29.

    CAS  PubMed  Google Scholar 

  74. 74.

    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.

    PubMed  Google Scholar 

  75. 75.

    Steele CM. Race and the schooling of Black Americans. The Atlantic Monthly. 1992:68–78.

  76. 76.

    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.

    Google Scholar 

  77. 77.

    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.

    CAS  PubMed  Google Scholar 

  78. 78.

    Cohen GL, Garcia J, Apfel N, Master A. Reducing the racial achievement gap: a social-psychological intervention. Science. 2006;313:1307–10.

    CAS  PubMed  Google Scholar 

  79. 79.

    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.

    PubMed  Google Scholar 

  80. 80.

    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.

    Google Scholar 

  81. 81.

    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.

    Google Scholar 

  82. 82.

    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.

    PubMed  Google Scholar 

  83. 83.

    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.

    PubMed  Google Scholar 

  84. 84.

    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.

    Google Scholar 

  85. 85.

    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.

  86. 86.

    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.

    PubMed  Google Scholar 

  87. 87.

    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).

  88. 88.

    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).

  89. 89.

    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).

  90. 90.

    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).

  91. 91.

    Marx DM, Roman JS. Female role models: protecting women’s math test performance. Pers Soc Psychol Bull. 2002;28(9).

  92. 92.

    Walton GM, Cohen GL. A question of belonging: race, social fit, and achievement. J Pers Soc Psychol. 2007;92(1):82–96.

    PubMed  Google Scholar 

  93. 93.

    Education CoGM. Minorities in medicine: an ethnic and cultural challenge for physician training: U.S. department of health and human services. 2005.

  94. 94.

    Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington: National Academy Press; 2002.

    Google Scholar 

  95. 95.

    Minorities in Medical Education: Facts & Figures. Washington, D.C.: Association of American Medical Colleges; 2005.

  96. 96.

    Brotherton SE, Simon FA, Etzel SI. US graduate medical education, 2001–2002: changing dynamics. JAMA. 2002;288(9):1073–8.

    PubMed  Google Scholar 

  97. 97.

    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.

    PubMed  Google Scholar 

  98. 98.

    Koenig JA, Sireci SG, Wiley A. Evaluating the predictive validity of MCAT scores across diverse applicant groups. Acad Med. 1998;73(10):1095–106.

    CAS  PubMed  Google Scholar 

  99. 99.

    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.

    CAS  PubMed  Google Scholar 

  100. 100.

    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.

    CAS  PubMed  Google Scholar 

  101. 101.

    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.

    CAS  PubMed  Google Scholar 

  102. 102.

    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.

    PubMed  Google Scholar 

  103. 103.

    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.

    PubMed  Google Scholar 

  104. 104.

    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.

    PubMed  Google Scholar 

  105. 105.

    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.

    PubMed  Google Scholar 

  106. 106.

    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.

    PubMed  Google Scholar 

  107. 107.

    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.

    PubMed  Google Scholar 

  108. 108.

    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.

    PubMed  Article  Google Scholar 

  109. 109.

    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.

    PubMed  Article  Google Scholar 

  110. 110.

    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.

    CAS  PubMed  Google Scholar 

  111. 111.

    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.

    Google Scholar 

  112. 112.

    Danaher K, Crandall CS. Stereotype threat in applied settings re-examined. J Appl Soc Psychol. 2008;38:1639–55.

    Google Scholar 

  113. 113.

    Nagda BA. Breaking barriers, crossing borders, building bridges: communication processes in intergroup dialogues. J Soc Issues. 2006;62(3).

  114. 114.

    Nagda BA, Kim C-W, Truelove Y. Learning about difference, learning with others, learning to transgress. J Soc Issues. 2004;60(1).

  115. 115.

    Nagda BA, Zuniga X. Fostering meaningful racial engagement through intergroup dialogues. Group Process Intergroup Relat. 2003;6(1).

  116. 116.

    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.

    CAS  PubMed  Google Scholar 

  117. 117.

    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.

    CAS  PubMed  Google Scholar 

  118. 118.

    Plant EA, Devine PG. Internal and external motivation to respond without prejudice. J Pers Soc Psychol. 1998;75(3):811–32.

    Google Scholar 

  119. 119.

    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.

    Google Scholar 

  120. 120.

    Richeson JA, Trawalter S. Why do interracial interactions impair executive function? A resource depletion account. J Pers Soc Psychol. 2005;88(6):934–47.

    PubMed  Google Scholar 

  121. 121.

    Richeson JA, Shelton JN. When prejudice does not pay: effects of interracial contact on executive function. Psychol Sci. 2003;14:287–90.

    PubMed  Google Scholar 

  122. 122.

    Richeson JA, Trawalter S. The threat of appearing prejudiced and race-based attentional biases. Psychol Sci. 2008;19(2):98–102.

    PubMed  Google Scholar 

  123. 123.

    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.

  124. 124.

    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.

    PubMed  Google Scholar 

  125. 125.

    Pettigrew TF, Tropp LR. A meta-analytic test of intergroup contact theory. J Pers Soc Psychol. 2006;90(5):751–83.

    PubMed  Google Scholar 

  126. 126.

    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.

    PubMed  Google Scholar 

  127. 127.

    Pettigrew TF. Intergroup contact theory. Annu Rev Psychol. 1998;49:65–85.

    CAS  PubMed  Google Scholar 

  128. 128.

    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.

    Google Scholar 

Download references

Acknowledgements

This work was supported by a VA HSR&D Merit Review Entry Program award to Diana Burgess, Ph.D.

Conflict of Interest

None disclosed.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Diana J. Burgess PhD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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

Download citation

KEY WORDS

  • stereotypes
  • disparities
  • experience
  • performance
  • training