Towards inclusive excellence: Reducing stereotype threat and other barriers in the graduate level introductory basic science course

Toward inclusive excellence: Reducing stereotype threat and other barriers in the graduate level introductory basic science course

Nancy C. Tkacs, PhD, RNAssociate Professor of NursingAssistant Dean for Diversity and Cultural AffairsUniversity 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 coursesIn 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 diversityNational lack of improvement in key health indicators, including healthcare access and care of chronic disease, requires study by diverse multidisciplinary and interprofessional teamsHaving more diverse healthcare providers is thought to reduce health disparitiesIncreasing 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 disparitiesInextricably linked phenomena in at-risk populations:

Health disparitiesGaps in educational attainmentIncome inequalityExample: National Healthcare Disparities Report 2010 Diabetes care efficiency

Care = HbA1c +eye exam + foot examAHRQ Health Care Disparities Report Figure 2.5 Composite measure: adults age 40 and over with diagnosed diabetes who received three recommended services for diabetes in the calendar year (hemoglobin A1c test, dilated eye examination, and foot examination). Reference value (achievable benchmark) is based on the average percent achieved in the top 4 performing states.6Diabetes care efficiency (contd)

7Introductory basic science courses in the health professions curriculumGraduate 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 PathophysiologyA 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 degreeStudents may feel threatened/intimidated based on their prior science course experiences, their age, and other characteristics, including race and ethnicity Stereotype threatThe 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 69:797-811.Consequences of stereotype threatStereotype 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.

www.ReducingStereotypeThreat.org:Strategies Reframing the taskModify task descriptions to be gender- and race-neutralExplicitly state that the task (such as a test) is sex-fair or race-fairHow 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 testContextual cues reminding female undergraduates of their status as college students (a group that is expected to do well in math) eliminates gender-based stereotype threatHow 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 dont belong?Deemphasizing threatened social identitiesEncouraging self-affirmation

The power of affirmation thats 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 HelpSelf-affirmation classroom exercisesRecall of key values and writing them down with a brief descriptionEncourage students to recall their own characteristics, skills, values, or roles that they view as important.Emphasizing high standards with assurances about capability for meeting themThis bears repeating:During the introduction to the courseDuring lectures and review sessionsWhen meeting with students for office hoursAfter a poor test performanceWhat 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 mathBlack 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 difficultyGiving explanations why anxiety is occurring without validating the stereotypeTransitions 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 testEmphasizing an incremental view of intelligenceHow 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 attributeEncouragement 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 studentsAnonymous evaluationsQuality circlesCheck in during face-to-face meetingsPeer evaluations of our classroom presence and teaching styleSummaryWhy 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 generationWhat to remember: Students who are at risk may struggle in early basic science coursesWhat 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