Stereotype threat becomes an issue, and performance is impaired, when women are given tasks for which the criteria for success are framed in stereotypically male terms.^22,23 For example, in one study, women performed worse than men on a managerial task when their predecessor was described as a man with stereotypically male characteristics (i.e., with an aggressive style), but they performed equally well when their predecessor was described as a woman with stereotypically female characteristics (i.e., with a nurturing style).²² There is considerable evidence that attributes for successful performance in academic medicine, particularly at the higher levels of leadership, are consistent with male gender stereotypes rather than with female gender stereotypes.¹⁵ The mental model of a typical leader remains tenaciously male, especially in traditionally male-dominated fields, like academic medicine.¹⁵ Studies of actual leadership effectiveness find little to no difference in the effectiveness of male versus female leaders,^24,25 but many experimental studies confirm the assumption that men are more competent than women with identical credentials in high authority positions.^15,26,27 Schein coined the term “think-manager-think-male” to describe this phenomenon.²⁸

In a series of studies, the experimental manipulations used to trigger stereotype threat among women in leadership roles, which consisted of written and experiential reminders that few women are top leaders, mirror the experience of female faculty in academic medicine.^29-31 Women see few role models of female leaders in their work environments. The job requirements and criteria for promotion in academic medicine also reinforce the idea that success in the field requires stereotypically male qualities. For instance, a study found that tenure criteria from the 24 top-ranked medical schools included far more descriptors associated with stereotypically male behaviors than with female or neutral behaviors.³² This same study found that schools with tenure criteria containing the word “leader” had fewer gains in the number of tenured women compared with schools whose tenure criteria did not contain the word “leader.”³² It is possible that stereotype threat resulting from the negative performance expectations that the word “leader” evokes contributed to this difference by reducing female faculty members’ motivation to enter a tenure track.³² Similarly, a reduction in stereotype threat might have contributed to the marked increase in the number of female scientists who applied for and received the National Institutes of Health Director’s Pioneer Award after the emphasis on risk-taking, a stereotypically male attribute, was removed from the selection criteria.^33,34

Stereotype threat is more likely to occur when an individual is the only one from his or her group (“solo”) or is in a token minority (<15%) involved in an activity, because this status increases the salience of the group membership to himself or herself and to others.^35-39 Studies have found that women, but not men, expect to be negatively stereotyped⁴⁰ and have lower performance expectations⁴¹ when they are relatively isolated from their same-gender peers. In one experiment, women randomly assigned to the solo condition performed more poorly on a difficult math test than those assigned to the non-solo condition, likely due to stereotype threat.³⁶ Women who occupy leadership roles in academic medicine are likely to find themselves in the minority, since women account for only 19% of full professors and 13% of deans in academic medicine.¹⁴

We contend that the environment in academic medicine reinforces gender stereotypes in three ways: (1) occupational sex segregation; (2) the persistence of overt sexism, discrimination, and sexual harassment; and (3) social penalties for women who violate prescriptive gender stereotypes.

One of the most effective interventions to reduce stereotype threat is to tell members of the target group about its existence, thus providing external attribution for task anxiety. For example, Johns and colleagues found that telling female students that stereotypes about gender and math ability might cause anxiety that has nothing to do with ones actual ability eliminated the under-performance of the female students, compared to the male students, that was seen in the control group (who were not given such instructions).¹¹ In another study, women, who were both told explicitly about the effects of gender stereotypes on negotiation skills and advised to work against those negative stereotypes, performed as well as men and better than controls in a negotiation task.⁵² Other interventions that provide clear external attribution for anxiety about difficult academic tasks also reduced the impact of stereotype threat on female students math scores.⁵³ Taken together, research supports the benefit of educating female faculty in academic medicine about stereotype threat. To accelerate the process of reducing stereotype threat in academic medicine, however, we believe it is advisable to educate both male and female faculty about stereotype threat. In addition, providing structured opportunities for female faculty members to share experiences can reinforce the message that difficulties faced by women in academic medicine are related to the features in the environment that may be triggering stereotype threat and not due to a lack of competence.

The likelihood that stereotype threat will occur is reduced in the presence of contextual cues that signal an identity-safe environment (i.e., high female representation, valuing of diversity) but is increased by cues indicating identity threat (i.e., low female representation, indications of sexism).^46,50 Continued attention to reducing overt gender discrimination and sexual harassment is fundamental to creating identity-safe environments with clear policies of what conduct is acceptable and how to report violations.^45,54 For instance, in one study, providing information about the existence of auditing practices that guard against discrimination increased trust and reduced identity threat, even in settings with cues that signaled stereotype threat.⁵⁰

Specific messages about the ability of men and women to be effective leaders can also promote an identity safe environment. In one experiment, women were first exposed to either a neutral advertisement or to a sexist advertisement (that had been previously shown to elicit stereotype threat) and were then asked to indicate whether they preferred a female or a male leader. Half of the women in the “sexist advertisement” condition were also given a statement to read that men and women performed equally well as leaders (the “identity safe” group), while the other half in the same condition were not given this information (the “identity vulnerable” group). Strikingly, the identity vulnerable group, but not the identity safe group, exposed to the sexist advertisement had diminished leadership aspirations compared to the women who were exposed to the neutral advertisement.¹⁰ Likewise, workgroups of medical students who, before selecting a leader, were given an identity safe message that encouraged individuals without leadership experience to volunteer (stating that “this is a safe environment” and that it did not matter “whether youre male or female”), were significantly more likely to choose female leaders than groups that were not given this message.⁵⁵

It is also important that those in charge of evaluating the performance of female faculty members receive specific training in how to provide feedback that is free of gender bias and that does not evoke negative stereotypes. Until these changes become a regular part of performance evaluation systems, it may be necessary to monitor such feedback to reinforce the training. Evidence from two experiments suggests that performance feedback is least likely to activate stereotype threat when it communicates high performance standards with assurance that the individual is capable of meeting those standards.⁵⁶ This finding is consistent with the recommendation from the Association of American Medical Colleges Increasing Womens Leadership Project Implementation Committee that medical schools “target womens professional development needs within the context of helping all faculty maximize their faculty appointments, including helping men become more effective mentors of women.”¹² Thus, departments should consider offering specific training for faculty in how to provide feedback that is free of gender bias and that does not evoke negative stereotypes.

The assumption that specific jobs require stereotypically male or female traits dissipates when the minority gender constitutes more than 25% of the profession.^39,42 Increasing the total number of female faculty members and the number of female faculty in top leadership positions should be a key part of any long-term strategy to improve the environment for women in academic medicine. Although women now exceed 25% of junior faculty nationally,⁵⁷ their marked underrepresentation as chairs and deans continues both to reinforce the assumption that male traits are required for success in these roles and to strengthen the role that gender plays. No change will occur if women remain associate deans and assistants to the top leadership, particularly if these positions hold little authority at the institution or prevent women from building academic careers.³⁹ When women are only seen in roles subordinate to male leaders, it may actually reinforce rather than dispel gender stereotypes. Bakken and colleagues, for instance, found that their earlier findings⁵⁷ of a gender gap in research self-efficacy among female faculty members was not present when the women were faculty, rather than staff in subordinate positions.⁵⁸

To increase the successful recruitment of women to top leadership positions, AHCs should implement hiring practices that have been shown to reduce inadvertent gender bias.⁵⁹ For example, researchers at one institution found that workshops for members of search committees that discussed the impact of gender stereotypes on decision-making were associated with an increase in the number of female faculty who were recruited.⁶⁰

In the absence of gender parity among faculty leaders, devising alternative ways to increase the presence of successful female role models is necessary.⁶¹ In two studies, simply reading about successful women in male-dominated fields eliminated the effect of stereotype threat on womens performance on a math test.^51,62 Likewise, female students who were exposed to images of female scientists performed better on a science test than those who were exposed to images of male scientists.⁶³ Similarly, exposure to negative stereotypes about women in math negatively affected female college students math performance, whereas exposure to a positive, self-relevant stereotype (that college students are good at math) improved their performance.⁶⁴ In practical terms, leaders at AHCs should create forums to increase exposure to successful internal or external female role models. Institutions might also be well served by both examining the descriptors in competitions for grants, awards, and promotion, and replacing stereotypically male words, such as “distinguished senior scientist” and “risk-taker,” with more descriptive, gender neutral words (i.e., “developed a new line of research,” “published in peer-reviewed journals”).³⁴ Similarly, replacing “chairman” with “chair” or “head” might reduce the effects of gender stereotypes that favor male applicants.^65,66 The strategic placement of images of female leaders alongside the pictures of previous male leaders that line the walls of many academic buildings should be considered as well.

Positive performance in any domain builds self-efficacy,⁶⁷ which has been shown to consistently predict whether an individual will engage in a new task. Hoyt and colleagues have found that women with high leadership efficacy are less vulnerable to the negative effects of stereotype threat on performance than women with low leadership efficacy.^29-31 Leaders in academic medicine should offer opportunities for women to develop leadership efficacy and leadership skills throughout their careers.