A Vicious Cycle of Bias: Residents’ Perceptions of Leadership in Health Care

Abstract

Purpose Despite growing interest in shared leadership models, autocratic physician leadership remains the norm in health care. Stereotype and bias limit leadership by members of other professions. Furthermore, traditional views of effective clinical leadership emphasize agentic behaviors associated with male gender. To shift the prototypical concept of a leader from a male physician to a more inclusive prototype, a better understanding of prototype formation is needed. This study examines leader prototypes and their development among resident physicians through the lens of leadership categorization theory. Method One researcher conducted semistructured interviews with anesthesia and internal medicine residents at a single institution, asking participants to describe their ideal team leader and comment on the video-recorded performance of either a male or female nurse practitioner (NP) leading a simulated resuscitation. Interview questions explored participants’ perceptions of NPs as team leaders and how these perceptions developed. The researchers conducted deductive analysis to examine leadership prototypes and prototype formation, and inductive analysis to derive additional themes. Results The majority of residents described a male physician as the ideal resuscitation team leader. Exposure to male physician leaders, and lack of exposure to NP leaders, contributed to this prototype formation. Residents described a vicious cycle in which bias against female and NP leaders diminished acceptance of their leadership by team members, resulting in decreased confidence and performance, further aggravating bias. Conclusions These results provide suggestions for interventions that can help shift the leadership prototype in health care and promote shared leadership models. These include increasing exposure to different professionals of either gender in leadership roles and increased representation in educational materials, education about effective leadership strategies to create awareness of the benefits of shared leadership, and reflection during team training to increase awareness of bias and the backlash effect faced by individuals whose behaviors counter established stereotypes.

An interview study about how nurses and physicians talk about the same concepts differently

“…Such a hidden curriculum can influence learning and later behaviour among course participants. An example of this was shown in a study by Ju and van Schaik [ 25 ] on leadership prototype formation (the understanding of what it means to be a leader). Ju and van Schaik [ 25 ] argued that prototype formation is influenced by the teaching materials and role models that health professionals are exposed to during their education and clinical practice.…”

“…An example of this was shown in a study by Ju and van Schaik [ 25 ] on leadership prototype formation (the understanding of what it means to be a leader). Ju and van Schaik [ 25 ] argued that prototype formation is influenced by the teaching materials and role models that health professionals are exposed to during their education and clinical practice. Even something as simple as the sex of nurses and physicians in educational videos could have an impact on prototype formation and later behaviour [ 25 ].…”

“…Ju and van Schaik [ 25 ] argued that prototype formation is influenced by the teaching materials and role models that health professionals are exposed to during their education and clinical practice. Even something as simple as the sex of nurses and physicians in educational videos could have an impact on prototype formation and later behaviour [ 25 ]. We argue that the observed differences in understanding of leadership and decision-making would similarly influence course participants’ concept formation (or ‘prototype formation’ to use the terminology of Ju & van Schaik [ 25 ]), which would cause course participants taught by a nurse educator to form a slightly different understanding of, for example, leadership than a course participant taught by a physician educator.…”

“…Following that reasoning, we argue that healthcare professionals’ internal understanding of the terms behind social and cognitive capabilities could be coupled with the way they enact particular social and cognitive capabilities. Such internal understandings of words or terms might be referred to as concepts [ 22 , 23 ], mental models [ 24 ], prototypes [ 25 ], and schemata [ 26 ]. Here, we call such internal understandings concepts .…”

Disruption and Dissonance: Exploring Constructive Tensions Within Research in Medical Education

“…From stereotypes relating to gender bias and leadership and mechanisms to evaluate communication skills for Spanish-speaking populations. 22,23 A poignant piece by Wyatt et al who highlight how Black trainees and physicians experience racial trauma and retraumatization, compounding their grief and suffering during times where racial tension shapes broader sociopolitical narratives. 24 Another important piece highlights how Euro-centric discourse shapes practice that marginalizes and magnifies power asymmetry related to internationally educated health professionals.…”