Perception of Residency Program Diversity Is Associated With Vulnerability to Race and Gender Stereotype Threat Among Minority and Female Orthopaedic Trainees.

Introduction: Stereotype threat (ST) is a psychological phenomenon in which perceived fear of confirming negative stereotypes about one's identity group leads to impaired performance. Gender and racial ST has been described in various academic settings. However, it is prevalence in orthopaedic surgery, where women and minorities are underrepresented, has not been examined. This study analyzes the prevalence of ST among orthopaedic surgery residents and fellows. Methods: US orthopaedic trainees completed a voluntary anonymous survey, which included demographics, perceived program diversity based on percentage of racial-ethnic and gender-diverse faculty and trainees, and a validated, modified version of the Stereotype Vulnerability Scale (SVS). Higher scores indicate greater ST vulnerability. ST prevalence was analyzed with descriptive statistics, and associations between program diversity, resident demographics, and ST vulnerability were compared using nonparametric tests. Results: Of 1,127 orthopaedic trainees at 40 programs, 322 responded (response rate 28.6%). Twenty-five percent identified as female, and 26% identified as an underrepresented minority in medicine (i.e., Asian, Black, or Hispanic). Asian (12 points), Black (12.5 points), and Hispanic (13.5 points) trainees had significantly higher SVS scores than White trainees (9 points) (p = 0.0003; p < 0.0001; p = 0.0028, respectively). Black trainees at perceived racially nondiverse residencies had the highest mean SVS scores (16.4 ± 1.03 points), while White trainees at perceived racially nondiverse residencies had the lowest SVS scores (9.3 ± 0.3 points), p = 0.011. Women had significantly higher gender stereotype vulnerability than men (p < 0.0001) in both gender-diverse (17.9 ± 0.2 vs. 9.0 ± 0.3 points) and gender nondiverse residencies (16.4 ± 0.4 vs. 9.6 ± 0.2 points). Conclusion: Minority and female orthopaedic trainees had higher ST vulnerability, especially in programs perceived as lacking racial or gender diversity. While perceived program diversity may offer some protection for minority and women trainees, women trainees still met the threshold for high vulnerability regardless of program gender diversity. Future strategies to mitigate ST should be explored in orthopaedic training.