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Stanford Medcast Episode 65: Women in Critical Care Mini-Series - Stereotype Threats

Learning Objectives
1. Describe the concepts of stereotype threat and self-affirmation
2. Discuss intervention strategies to reduce stereotype threat in their communities
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Audio Transcript

Intro: Hello, you are listening to Stanford Medcast, Stanford CME's podcast where we bring you insights from the world's leading physicians and scientists. This podcast is available on Apple Podcasts, Amazon Music, Spotify, Google Podcast, and Stitcher. If you're new here, consider subscribing to listen to more free episodes coming your way.

Kirsten Steffner, MD: On behalf of the Society of Critical Care Anesthesiologists and women in critical care, welcome back to our podcast, miniseries. I'm your host, Dr Kirsten Steffner, a critical care physician and cardiac anesthesiologist at Stanford University. Our ultimate goal for this podcast series is to provide professional development content that puts a new lens on how we define success and supports the multiple roles that we play in our day-to-day lives, not only as critical care doctors, but also as mothers, partners, sisters, colleagues, mentors, and so much more. Today we have the unbelievable honor of speaking with Professor Claude Steele. Claude Steele is an American social psychologist and a professor of psychology at Stanford University. He also has served in several other major academic leadership positions such as the executive vice chancellor and provost at UC, Berkeley, the dean for the School of Education at Stanford University, and as a 21st provost of Columbia University.

Professor Steele's best known for his work on stereotype threat. Stereotype threat describes the phenomena when an individual's awareness of a widely known negative stereotype and a concern that he or she will confirm that stereotype actually interferes with the individual's cognitive processing and performance. Most notably, professor Steele described the effect of stereotype threat on minority student academic performance in higher education and women in mathematics. We cover some incredibly important topics in this interview. I really hope you enjoy this episode. Professor Steele, thank you so much for being here and welcome.

Claude Steele, PhD: Thank you. I'm really happy to be here. It's an important mission you're on. I'm flattered and happy to be part of it.

Steffner: Our audience for this podcast series is primarily physicians and healthcare workers, some of whom might not be familiar with the psychology literature. Let's start with a definition of stereotype threat.

Steele: Sure. Stereotype threat, it's a pretty common phenomenon. It's simply being in a situation for which there is a negative stereotype about one of your identities, your age, race, religion, region of the country, dialect. There's a negative stereotype about one of those identities that's relevant to what you're doing and when that situation happens, you know you could be seen or treated in terms of that negative stereotype. It's tied to your identity. It's a possibility and you're in a situation where that stereotype is relevant to what you're doing. You know you could be judged or treated in terms of it. And if what you're doing is very important to you or to your future, the possibility of being seen in terms of such a negative stereotype is upsetting and it can interfere with your functioning right there in the immediate situation where you feel that pressure or you feel that threat of judgment coming from possibly being stereotyped.

And if there's a walk of life where you feel that threat on a regular basis, it can deter you from that walk of life. So stereotype threat winds up having a pretty significant impact on how we perform in certain circumstances where the stereotype is relevant. So whenever we're in a situation where one could apply, we know we could be seen that way. We don't know that we are being seen that way, but we know we could be. And so that puts us in a vigilant mode of functioning. I've been using the term churn lately to describe that mode where we are churning, how am I going to manage this and what does this mean about my future and my happiness? So stereotype threat can have these pretty profound effects in our lives.

Steffner: I really like that term churn, whenever you use it and when I've listened to you speak about it in interviews, it makes me think of when my computer starts to overheat and the fan starts to go on and you're wondering what is running in the background that's causing my computer to overheat? And so I think about this wasted energy that's being expended in the background that you could be directing towards your actual goal and how this distraction or this inefficient way of moving through the world and how you're not really using all your resources in the right ways.

Steele: As you might appreciate real physiological consequences of being in churn in important professional situations. It probably is a source of elevated blood pressure and certain patterns of brain activation and galvanic skin response, sweating as a symptom of tension and pressure, and so it can be pretty persistent. That's the general framework of stereotype threat.

Steffner: So the key components of stereotype threat are one, there needs to be an awareness of the bias and it has to be something that you really care about and are consciously trying to disprove.

Steele: That last point is an important point. I'm a little older these days and old enough to, as I've described it in some situations, if I'm trying to turn on my television and figure out all streaming versus live and all these complicated because I have to join and not join and just my son-in-law who's very good at all those things is sitting there. I could feel under the pressure of being judged by a stereotype about older people is not so technologically sophisticated and dependent. That would irritate me a little bit, but that's not really that important. I can live with that little pressure. But if I'm a woman trying to survive in a STEM program, an advanced STEM program, it's very important to my career ambitions and interest in life. That pressure and its persistence can make the experience of being in that situation very heavy.

Steffner: Investment in the outcome that makes you more vulnerable to the churn and to the weight of it.

Steele: One way people can protect themselves against this pressure is to stop caring about the performance in the domain. And that kind of idea has been used to explain how, for example, some minority students don't live up to their promise in school because they feel that pressure. They may feel that their abilities are under suspicion on a constant basis. They prove that in the third grade that they're pretty good at arithmetic, but then by the fourth grade they've got to prove it all over again to a new teacher and a new world. It gets to be a Sisyphean effort to disprove the stereotype. Goes on and on and on. And one way of protecting oneself against that experience is to disidentify with the domain. I'm not going to hold myself accountable to being a good student. I'm going to be a good athlete or I'm preparing for the priesthood or I'm going to be a good musician. It can press where you allocate yourself and your commitments in that way.

Steffner: By disidentifying, you're saying that in order to not be affected or to not feel threatened by the stereotypes that are attached to you or your group, you have to care less. You've written about other interventions or mediators at the level of the individual, particularly about the concept of trust. Can you talk a little bit more about how building trustworthy connections can mediate or lessen stereotype threat or its effect on an individual?

Steele: The things like building trust are strategies for overcoming it and in particular that idea comes up when you think about the problem of diversity and how do you make diversity work. That's where I've used the concept of stereotype to explain first what's difficult about diversity and then maybe a new approach to realizing successful diversity. And what's difficult about diversity is that when we have a history like we have, when we come together, we could be under the threat of being stereotyped by each other in pretty nasty ways. I talk about a parent teacher conference involving a African-American kid and his parents and a white teacher and the African-American parents, they're coming to this conference and this is their chance to get the teacher and the school to not see their kid through the negative stereotypes about African-Americans that they know exist. They don't know that he's being seen that way, but they know he could be and it's so important.

This is their moment to tell, don't see him that way, invest in developing his intellectual abilities and so on. And so they come in ready to fight the ghosts of those stereotypes, the ghosts of history. And so is the teacher because she says, I really invest a lot in my students and I especially try to be sensitive to the needs of minority students, but I know if I say anything slightly critical in this conversation, I could be seen as a racist and that would just be terrible. I'd hate to be seen that way. So that's the stereotype of her identity that's relevant in that situation. If she's just dealing with a white parent, that threat wouldn't be there, but she's dealing with a black parent.

That threat is there and that threat is not coming from anybody's prejudice in this situation. It's coming from the role that history has assigned us and the stereotypes it is created to justify that assignment to roles. And that's in part what is difficult about diversity, is that it's difficult for us to grant trust to each other. Both of those parties churn. We're so in a colorblind frame that we don't see this tension, we feel this tension and we want to get out of situations like that, but we don't see that it's coming from this history.

Steffner: The way out of that tension is for the teacher and those parents to actually build a relationship and to earn each other's trust. What does that trust look like in the context of negating stereotype threat?

Steele: Yeah, the trust is that I just have to believe that you're not going to see me that way. And if you do some things that enable me to think that, oh, I'm going to feel relieved and we're going to have a very different relationship. So in our research it seems to be the case. You have to give trust and if I give trust to you, you tend to trust me. Another way to put it is you have to be able to see full humanity and full potential in difference. That's the trick. It's harder to see full humanity and full potential in people who are different from us and who have been traditionally stigmatized. That's what we just as humans so quickly go into dehumanizing stereotypes around difference. That's the trouble because Jeff Cohen and Lee Ross and I some years we were asking the question, how does a white professor give critical feedback to a black student and have that feedback be trusted?

We had Stanford students write essays about their favorite teacher, white and black. We told them if the essay was good, we'd publish it maybe in this new magazine, put your best foot forward, come back in two days and we'll give you feedback. And when they come back and they get the feedback, we measure how much they trust the feedback. And what we vary is how we give the feedback, is one way or another that's more effective. And what was expected but unsettling is that whereas when you give the feedback straightforwardly, here's the feedback on your essay or you say something nice about the person first and then you give the critical feedback like we faculty often do, white students trusted it. They're not under any stereotypes, suspicions about their abilities in this society, but black students didn't trust that feedback. It's a surprising finding because these are obviously highly talented and privileged students at an elite university.

You'd think, my goodness, there's any circumstance where they would trust the feedback, it would be here. They don't. They don't know whether it's coming from their essay or whether it's coming from the feedback givers opinions of their group's abilities and not knowing it's hard for them to trust it and not trusting it, it's hard for them to benefit from. And this isn't just something that happens once in their life and then they with a little grit they pursue past. No, they're living in that box all the time. They've got this credibility issue. Can I trust these people? It's a tension between remembering and forgetting. Do I remember how my group has been treated and seen in this society and use that to interpret what's happening to me in this situation, interpret this feedback or do I just forget that, assume that I can trust it?

Steffner: And even when proceeded by a complimenter before the feedback, if that feedback is too generic, then it doesn't make that feedback any more trustworthy. But I think I heard you talk about this. If the feedback is delivered with this sense of I trust you and your potential, I see your potential as a human independent of the other labels that you may identify with or may be placed onto you, that is the form of affirmation that builds trust and allows those students to receive that feedback more productively. Is that correct?

Steele: Exactly. The third condition in the experiment did yield trust in the black students. And the form that that feedback took was the feedback giver said, look, we're using really high standards here. Signal number one that I'm not looking down on your ability. I'm not seeing you stereotypically. We're using high standards because we might publish these essays. Then the second thing he says is, and I've looked at your essay and I think you have the potential to meet these standards. That's all. With that, that just whoop black students in that condition of the experiment, trusted the feedback more than participants in any other condition of the experiment, and they were three times more likely to take their essays home to use the feedback to improve them. I'm encouraged by that because it's a simple, intuitively compelling and usable way to build trust and it's a good illustration of giving trust. That person saw the humanity and potential.

Steffner: Really knowing that this person is not judging you, that they are evaluating your work independent of preconceived notions, allows the student to free up any of that excess energy that might be wasted on what they think people think about them and allows them to be more productive and to take that feedback more on face value.

Steele: Yeah, I mean it puts them in a completely different frame of mind. It kills churn, this trust and you see, whoa, this person really seems to believe in my potential. That is so empowering.

Steffner: So it's the sense that a person or a mentor or a network of people really truly believe in your potential and liberates you from that excess background, worry and churn. Could you also describe the concept of self-affirmation and how that plays into how an individual might be able to mitigate the churn and the effect of stereotype threat?

Steele: The basic idea is that affirming the self, reminding us of our moral and adaptive adequacy, you're a good person and you're able to deal with the situations. Affirming that makes a particular threat that I have to face, like the possibility of being stereotyped, it makes it less important. My whole sense of myself is not hinging on whether that person's stereotypes me or not. I have that independent of the circumstances that I have to deal with. A lot of amazing intervention research now has shown that brief affirmations, the effects can last from years because they start a positive recursive process of achievement.

All of a sudden you allow me to affirm myself by describing what's most important to me and you're my teacher. Let's say you know who I am and I know who I am. And so now every little transaction is not laden with the threat of confirming a stereotype because my sense of worth has been affirmed independent of all that, and then I start to do a little better. I'm even less likely to be stereotyped and treated that way and diminished. So it starts a recursive process that has a very long-lasting effect.

Steffner: In that example, were these affirmations given to these students in very specific context. You're a great basketball player and you're such a kind brother, and so that mitigates how they do on a math test or in what way was that experiment conducted?

Steele: They would allow students at the beginning of the seventh grade to write to the teacher the things about them that really are important. Well, you should know that I really love my church choir and my Aunt Mildred is fantastic and she takes me here and there and that's all they're doing is telling you about the things that reflect their values. So now they have some assurance that you're less likely to just reduce them to a negative stereotype about their race. They're not just a low income black kid struggling to read.

Steffner: There's so much more to them than that singular,

Steele: Yeah.

Steffner: Characteristic or they're not identified by a single factor or a much more multidimensional person.

Steele: Yeah. And that again, frees them from churn and being freed from churn enables them to succeed better at school and succeeding better at school makes it even less likely that the people in their environment are going to see them that way and they start to do better in a whole different way. And so the importance or nicety of the affirmation in that situation is that they get to tell their teacher that. It's one thing for their parents to know. It's very powerful for their teacher to know these things about them.

Steffner: I see. They have some agency in defining who they are and,

Steele: Who they are. Otherwise, they're just sitting in a class of 35 kids, one of let's say 10, 12 black kids and they know full well how they're seen. They're having to carry that weight and that churn, as you've noted in this conversation, is taking away from the resources they need to do well in school. So it starts to be a negative recursive process. Then they do worse in school and then doing worse in school, they worry even more about being judged this way and then pretty soon they just give up on school. Let me go somewhere else and find a life for myself.

Steffner: Just negative reinforcement that circles back to itself.

Steele: Yeah.

Steffner: So how has your work informed your own style of leadership and your approach to mentorship?

Steele: I think the common adhesive that will make diverse situations work is trust. And I think it is a game that is played on the ground and we have good intuitions about it. It's showing up and it's listening and then maybe listening again, and it's really trying to serve the other person, give them real help. As soon as I'm treated that way, I don't care whether the person is a different race than me, a different religion than me, a different age than me. I understand that I'm working with somebody I can trust and that's the bottom line. Now I can listen to them. I can open up to what they're teaching me. The world transforms at that moment, that relationship transforms. As in the third condition in that experiment, we're using high standards. I think you can meet them. That's how I see it in mentorship too, is that that's what students need from me as a professor, are the ingredients, the elements of trust.

Respond to the email, talk to the person, try to listen to what they're experiencing in the training situation and try to address that. Try to give them real concrete, here's how you do this. That's ultimately, for example, how my own advisor helped me is that come here, here's what science is and science is this. And I was in graduate school, but I'm not sure I really knew exactly what it was at the time. And he kind of cleared up some ambiguity and he said, this is what's important. Learn this and learn that, and then you do this. And he gave me real help. So he came from a very different background. He came from the south and here I am coming from south side of Chicago as a kid and I had every reason to distrust him and I was in churn. Can I trust him?

As time went on though, I could see no, he's got my back. He worked me hard. He demanded a lot. That was part of it. So he was a very different person. In the modern ethos, we think too much that you have to have the same identity, the same age, the same race, the same gender, and nah, you have to work with somebody who's trustworthy and who's going to listen to you so that they do hear your particular experience and try to deal with that, not just help you in the way they want to help you.

Steffner: And your mentor came to you with high demands, not because he was highlighting your deficits or highlighting the ways in which you were reinforcing a stereotype, but he was making high demands because he saw potential in you.

Steele: Yeah, he was willing to go out on a limb and treat me that way. Like, I'm going to listen to you, I'm going to bet on your potential. I think you can rise to these standards. So when he started to behave to me, in fact that condition and that experiment came from my experience with him. We used to call it, his name was Tom Ostrom. We used to call it the Ostrom condition. Because that was his mode of mentoring. So it was a really good example of it and it was really transformative.

Steffner: It seems like the antidote to stereotype threat is expanding our perspectives on an individual beyond just one unique identifying feature, but seeing them as a full person, trusting that other people see you as a full person and that you are multidimensional and not identified by one thing or one label or one achievement. Is that accurate?

Steele: Yeah, I think that is a real part of it, is you see the full humanity in difference. And for us to have a successfully diverse society, that's what we have to go toward and especially given our history where we haven't. It's not just history. It's an ongoing thing. The life of George Floyd, we see the tragic end of it. We see the poor man trying to pass a counterfeit $20 bill. But if you look at the whole life, you see the things that are tied to his identity. He's born black, he's going to be in a low income community. There's an unemployment rate there three times what it is in the general society, that people are having multiple jobs just to keep food on the table. They can't withstand economic shocks like a car breaking down. They don't have time to prepare a young George Floyd for school. They get to school, he's going to go to the worst funded schools with the least trained teachers and the harshest disciplinary practices. If he gets in trouble outside of school, we know how the criminal justice system is going to relate to him.

His family's going to have the worst access to good healthcare, to good food. So these are things that poor George didn't choose, but they're tied to his identity in the way based on how our society is organized around race and income levels and gender, that it's organized this way, who's on top, who's not. So he's having to contend with things. And if our schools think, well, the thing for me to do when George shows up here is give him a lot of tests and which he's going to score low on and give him even more discouragement from identifying that he could trust this institution, that this institution immediately problematizes him.

Steffner: It speaks to the fact that stereotypes and then also the experience of stereotype threat exists or comes to form in the context of someone's environment of culture and societal norms and is not like an characteristic that's rigid. It doesn't inherently belong to a person. It exists in the context of your environment.

Steele: That is so true. That is so well put. I'm glad you put an underline under that because stereotype threat, a lot of people say, well, what do you mean by that? You mean that they internalize the stereotype and then when they're in a situation where it's relevant, they self fulfill the stereotype and it's the opposite of that. It's taking this person's perspective and looking out at the world and you can see the person worried and churn about how the world's going to respond to them. It's what's happening inside them. It's not some belief that we really are not as intelligent or we really are more emotional. Or it's that you could be seen that way and treated that way in important situations and you kind of have to be prepared to navigate that all the time. So you have to kind of stay in churn in these situations.

Steffner: In terms of the research, where do you think there's more work to be done and what makes you feel the most hopeful?

Steele: What excites me personally in recent years is this personal discovery of how important trust is in these intergroup relations. And as a psychologist, you ask about optimism, changing prejudice itself, eliminating it is really hard, if not impossible. Building trust is a lot more manageable if you know that that's what you should be doing. So I feel optimistic that this work is broadening the road forward with regard to how to have a successfully integrated society.

Steffner: Well, it's hard not to feel hopeful and optimistic when you talk about it like that. Thank you for all the work that you're doing. It's so important and so impactful.

Steele: Well, thank you. I really appreciate hearing that and the encouragement I'll take from that. I appreciate it and thanks very much. It's been a real pleasure.

Steffner: Thank you so much. Not surprisingly, this conversation touched on enormously important issues that affect the very fabric of our society. On a small scale, it was so interesting and helpful for me to think about all the ways in which we are functioning under the pressures of stereotype threat and how that churn running in the background of our daily interactions may be contributing to physician burnout, but on a much larger scale, this conversation really opened my eyes to the idea of trust, not only as a solution to the effects of stereotype threat, but also trust as the key to making diversity, equity, and inclusion actually work. Moving forward, it's our responsibility to think about the ways in which we can create an environment of trust at work.

How can we help negate the effect of stereotype threat for others? How can we make our patients, trainees, colleagues, and coworkers trust that we see them for their strengths and their potential and not for the stereotypes associated with the groups with which they identify? I felt incredibly hopeful after this conversation by the sentiment that even though it's really challenging to completely erase prejudice and bias, building trust is much more manageable. I hope you walk away from this episode feeling optimistic and empowered as well. Thanks so much for listening.

Outro: Thanks for tuning in. This episode was brought to you by Stanford CME. To claim CME for listening to this episode, click on the claim CME link below or visit medcast.stanford.edu. Check back for new episodes by subscribing to Stanford Medcast wherever you listen to podcasts.

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Stanford Medicine adheres to the Standards for Integrity and Independence in Accredited Continuing Education.

The content of this activity is not related to products or the business lines of an ACCME-defined ineligible company. Hence, there are no relevant financial relationships with an ACCME-defined ineligible company for anyone who was in control of the content of this activity.

Ruth Adewuya, MD, CHCP

Managing Director, Center for Continuing Medical Education

Stanford University School of Medicine

Course Director

Claude Steele, PhD


Amanda K Schilling, DO


Tucson Medical Center


Kirsten Rhee Steffner, MD

Stanford University


 Stereotype Threat.  SWD at NIH. Diversity.nih.gov. June 30 , 2017. https://diversity.nih.gov/sociocultural-factors/stereotype-threat#:~:text=Definition
Steele  CM, Aronson  J.  Stereotype threat and the test performance of academically successful African Americans.  In: Jencks  C, Phillips  M, eds.  The Black–White test score gap. Brookings Institution Press; 1998: 401-427.Google Scholar
Spencer  SJ, Steele  CM, Quinn  DM. (1999).  Stereotype Threat and Women's Math Performance.  Journal of Experimental Social Psychology. Jan1999:(35):4–28. doi:10.1006.jesp.1999.1373Google Scholar

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Stanford Medicine designates this Enduring Material for a maximum of 0.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


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