Toward inclusive excellence: Reducing stereotype threat and other barriers in the graduate level introductory basic science course Nancy C. Tkacs, PhD, RN Associate Professor of Nursing Assistant Dean for Diversity and Cultural Affairs University of Pennsylvania School of Nursing

Why is it important to be aware of stereotype threat and other barriers? Consideration of barriers to high performance of at-risk students (racial and ethnic minorities, first-generation students, students with highest financial aid needs) is imperative when shaping introductory level courses In college, poor performance in the first year can lead students to change majors away from STEM fields and may even lead to attrition

Institute of Medicine, 2004

The importance of increasing healthcare workforce diversity National lack of improvement in key health indicators, including healthcare access and care of chronic disease, requires study by diverse multidisciplinary and interprofessional teams Having more diverse healthcare providers is thought to reduce health disparities Increasing access to careers in health care, particularly in the healthcare professions (physicians, nurses and nurse practitioners, pharmacists, etc), can reduce income inequality

An unholy trinity of disparities Health EconomicEducation Inextricably linked phenomena in at- risk populations: Health disparities Gaps in educational attainment Income inequality

Example: National Healthcare Disparities Report 2010 – Diabetes care efficiency Care = HbA1c + eye exam + foot exam

Diabetes care efficiency (cont’d)

Introductory basic science courses in the health professions curriculum Graduate school in the health professions often begins with a series of basic science courses (biochemistry, physiology, neuroscience, microbiology, etc.) In Penn School of Nursing, students in adult APRN programs (nurse anesthesia, nurse midwifery, nurse practitioner) begin with Advanced Physiology and Pathophysiology A “weed-out” course??! A single course with an extremely heterogeneous group of students based on prior science coursework, age, race and ethnicity, socioeconomic status, and number of years since previous degree Students may feel threatened/intimidated based on their prior science course experiences, their age, and other characteristics, including race and ethnicity

Stereotype threat The concept of stereotype threat posits that environmental cues remind an individual of negative stereotypes associated with their group status. These reminders then trigger anxiety, negative reactions, and can lead to lower performance on a variety of tests. Steele, C.M. & Aronson, J. (1995) Journal of Personality and Social Psychology 69:

Consequences of stereotype threat Stereotype threat has been implicated in gaps in test performance between racial and ethnic minority students versus majority students. Similar gaps are seen in the performance of women and minorities vs white males in STEM fields.

Strategies – Reframing the task Modify task descriptions to be gender- and race- neutral Explicitly state that the task (such as a test) is sex-fair or race-fair How can we introduce our tests in a way that reduces anxiety? Faculty set the tone! What is the history – have course tests been perceived as “tough but fair”?

Standardized test scores improve when questions about ethnicity and gender are moved to the END of the test “Contextual cues reminding female undergraduates of their status as college students (a group that is expected to do well in math) eliminates gender- based stereotype threat” How can schools and individual faculty members promote an inclusive culture such that ALL students feel a part of the whole, rather than feeling that they don’t belong? Deemphasizing threatened social identities

Encouraging self-affirmation

The power of affirmation “… that’s when I get to wondering, what would happen if I told her she something good, ever day?” “I hold her tight, whisper, ‘You a smart girl. You a kind girl, Mae Mobley. You hear me?’ And I keep saying it till she repeat it back to me.” Aibileen, in “The Help”

Self-affirmation classroom exercises Recall of key values and writing them down with a brief description Encourage students to recall their own characteristics, skills, values, or roles that they view as important.

Emphasizing high standards with assurances about capability for meeting them This bears repeating: – During the introduction to the course – During lectures and review sessions – When meeting with students for office hours – After a poor test performance What about before the course starts? – What message is the office of student services giving? – What about program directors or those leading orientation?

Providing role models “… women performed more poorly than men when a math test was administered by a man but equivalently when the test was administered by a woman with high competence in math” “…Black individuals were less aware of stereotype threat and less affected by it in terms of test performance when the administrator was also Black.”

Providing external attributions for difficulty Giving explanations why anxiety is occurring without validating the stereotype Transitions can be very difficult, but the challenge decreases as with increased time to adjust (can we authentically tell students that “it gets better”?) Telling students about stereotype threat – the anxiety they may feel has no bearing on their ability to do well on the test

Emphasizing an incremental view of intelligence How do we think of “intelligence” or “ability”? How much is responsive to effort and studying? Performance improved under conditions presenting intelligence as a muscle that grows stronger with practice (an incremental view), rather than as a fixed attribute Encouragement to increase effort, rewarding motivation, and de-emphasizing “talent” or “genius” produced better results

How do we assess the classroom climate for diversity? Checking in with students – Anonymous evaluations – Quality circles – Check in during face-to-face meetings Peer evaluations of our classroom presence and teaching style

Summary Why we think about this: Because helping ALL students succeed in health care programs will increase diversity in the health professions, thus improving care, reducing disparities, and producing role models for the next generation What to remember: Students who are at risk may struggle in early basic science courses What to strive for: Faculty who recognize barriers to success and actively work to overcome them can be part of the solution, rather than perpetuating the problem