The hidden cost of gender stereotypes in flexible bronchoscopy: A randomized controlled trial on female anesthesiology residents

Abstract

Background: Stereotype threat is a psychological phenomenon in which individuals fear being judged based on negative stereotypes about their group, potentially impairing cognitive and motor performance. In surgical and procedural fields, gender stereotypes may negatively affect female trainees. This study examines the impact of gender stereotype threat on female anesthesiology residents' performance during a simulated flexible bronchoscopy intubation task. Methods: A randomized controlled trial with a parallel-group design was conducted at Hacettepe University Hospital. Fifty anesthesiology residents (29 women, 21 men) were randomly assigned to a stereotype threat group (exposed to gender-based cues) or a control group. Performance was evaluated using the ORSIM bronchoscopy simulator. Outcomes included total simulation score, task completion time, maximum bronchoscope speed, and collision avoidance percentage. Two-way analysis of variance was used to analyze the effects of gender and stereotype threat. Results: Female participants in the stereotype threat group had significantly lower simulation scores (mean difference = 12.17, P =.017) and collision avoidance percentages (mean difference = 15.8%, P =.021) compared to male participants. Bronchoscope speed was higher in the stereotype threat group, especially among women, indicating potential compensatory behavior linked to increased error risk. No significant difference was observed in task completion time. Conclusion: Gender stereotype threat adversely affects simulation-based performance in female anesthesiology residents. These results highlight the need to address gender-based bias and foster psychologically safe environments in medical training. © 2025 Elsevier B.V., All rights reserved.