Despite similar numbers of women and men in internal medicine (IM) residency, women face unique challenges. Stereotype threat is hypothesized to contribute to underrepresentation of women in academic leadership, and exploring how it manifests in residency may provide insight into forces that perpetuate gender disparities.


To quantify the prevalence of stereotype threat in IM residency and explore experiences contributing to that stereotype threat.


We used a mixed methods study design. First, we surveyed IM residents using the Stereotype Vulnerability Scale (SVS) to screen for stereotype threat. Second, we conducted focus groups with women who scored high on the SVS to understand experiences that led to stereotype threat.


The survey was sent to all IM residents at University of California, San Francisco (UCSF), in September–November 2019. Focus groups were conducted at UCSF in Spring 2020.


The survey included an adapted version of the SVS. For focus groups, we developed a focus group guide informed by literature on stereotype threat. We used a thematic approach to data analysis. The mixed methods design enabled us to draw metainferences by integrating the two data sources.

Key Results

Survey response rate was 61% (110/181). Women were significantly more likely than men to have a score indicating stereotype threat vulnerability (77% vs 0%, p < 0.001). Four themes from focus groups characterized women’s experiences of gender bias and stereotype threat: gender norm tension, microaggressions and sexual harassment, authority questioned, and support and allyship.


Gender-based stereotype threat is highly prevalent among women IM residents. This phenomenon poses a threat to confidence and ability to execute patient care responsibilities, detracting from well-being and professional development. These findings indicate that, despite robust representation of women in IM training, further attention is needed to address gendered experiences and contributors to women’s vulnerability to stereotype threat.


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Author Descriptions

Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

Annabel K. Frank MD, Rebecca A. Berman MD & Karen E. Hauer MD, PhD

School of Medicine, University of California, San Francisco, San Francisco, CA, USA

Jackie J. Lin MD & Patricia O’Sullivan EdD

Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA

Sophia Bellin Warren MD

Department of Medicine, University of Washington, Seattle, WA, USA

Justin L. Bullock MD

Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

Lauren E. Malishchak MD & Maria A. Yialamas MD