What Image Comes to Your Mind When You Think of a “Doctor”?

By: Ann Cavallo, Ph.D., Assistant Vice Provost, University of Texas at Arlington

Implicit bias is something we have all experienced or even inadvertently perpetuated. In teaching, the implicit bias, automatic thoughts, views, or judgments we may have about students can deprive them of opportunities and learning experiences. Implicit bias develops over a lifetime and is described as attitudes or stereotypes that affect our judgements or assessments of others (NEA Center for Social Justice, 2021).

At the University of Texas at Arlington (UTA), a Hispanic-Serving Institution, Asian American Native American Pacific Islander-Serving Institution, diverse R1 university, we work to educate our STEM teachers to develop professional dispositions that recognize implicit bias and are intentional and deliberate in implementing inclusive teaching and culturally responsive/sustaining pedagogy in their interactions with students.  About 90% of STEM teacher graduates from our UTA teacher certification programs, the largest being the undergraduate UTeach Arlington program, are from diverse, economically disadvantaged school districts in the Dallas-Fort Worth (DFW) metroplex, where they return to teach. Most of these districts have a majority of Hispanic/Latino or Black/African American students. Since 2008, UTA has received four NSF Robert Noyce Scholarship grants to support the recruitment, preparation, and induction of STEM teachers, with 192 preservice teacher scholarships awarded to date. The demographics of our Noyce Scholar graduates are 27% Hispanic/Latino, 11% Black/African American, 50% White, 11% Asian, and 1% Native American, paralleling the university demographics (UTA Fast Facts). However, these demographics do not match the diversity of our DFW high-need schools.  (See appendix for more information about UTeach Arlington.)

Creating Equitable and Inclusive Classrooms

Activities for Addressing Implicit Bias
The goal for our teacher certification program is to provide transformational learning experiences for preservice teachers (PSTs) that help them address their own potential implicit bias, view the world from the perspectives of others, and create classroom environments that uphold and foster equity and inclusion. I designed a series of activities beginning with the Knowing and Learning in Science and Mathematics course. The lessons learned are carried through the subsequent Classroom Interactions and Multiple Teaching Practices in Science and Mathematics (PBL) courses (each with field experiences), and full time Student Teaching with seminar. In addition to revisiting inclusion and equity in these courses, we assess the PSTs’ application of strategies learned in their written inquiry-based lessons and project-based curriculum unit plans and observe implementation in their classroom teaching experiences.

The activities for PSTs are designed to:

• raise awareness of the existence and prevalence of implicit, unconscious bias in themselves, classroom teaching, and society
• identify and describe implicit bias and stereotype threat in their lived experiences, educational experiences, and society
• gain knowledge and skill in implementing strategies to mitigate implicit bias for promoting an equitable, inclusive, and culturally responsive and sustaining classroom learning environment.

Raising Awareness: The Heart Surgeon Activity
To initiate PSTs’ professional development on implicit bias and inclusive teaching, I created The Heart Surgeon activity. To increase its potential impact, the PSTs are not told what The Heart Surgeon is about, only that it is a story. Lights are dimmed, and they are invited to quietly read each line as the PowerPoint slides are advanced and to imagine/visualize the scenes presented. Click here to view the slides for The Heart Surgeon presentation.

The students then discuss what they pictured in their minds while reading. The story was created to draw readers into experiencing implicit bias; many admit it did. The PSTs are surprised they “fell into” implicit bias in the story, imagining an older, white male as the heart surgeon rather than an expectant mother and visualizing an older male instead of a baby as the patient. We discuss that the first step in promoting an inclusive, equitable teaching environment is awareness – to recognize implicit bias or assumptions we ourselves may hold and unconsciously convey in our teaching and interactions with students. Such implicit bias can negatively impact students’ self-efficacy and achievement, can marginalize students, and create a sense that they “don’t belong” or cannot be successful in STEM.

Discussion of current studies illustrates how implicit bias experienced in reading The Heart Surgeon story prevails in society. Vogel (2019) states that “Today a physician is as likely to be female as male, yet most people still picture a doctor as a man. Only 5% of people presume a doctor will be female…”.  In a study with 48 college students who were prompted to draw a nurse, 74 percent drew women and only 4 percent drew men; whereas when prompted to draw a doctor, 40 percent distinctly drew men compared to 28 percent who drew women doctors (Stephens et al., 2016). Pappas (2016) reported that people were less apt to hire a woman for a (fictitious) job solving math problems the stronger their beliefs were that males are better than females in mathematics. These studies clearly underscore the importance of deliberate and consistent efforts to create lasting awareness and positive change in implicit bias prevalent in society and in school classrooms.

Implicit Bias in Lived Experiences
An activity that follows The Heart Surgeon story is journal writing and/or anonymous electronic polling (e.g., Poll Everywhere). PSTs are asked to name and provide one example of implicit bias they have experienced or observed in education/school, and one example they experienced or observed in everyday society/life. Examples of the educational experience include situations where they were not acknowledged by the teacher when they had the correct response, whereas others were praised for the same, or when another was credited for their response or work, or situations where they participated in groups with unfair distribution of the work. In society, they may describe situations where they were stopped and questioned by an authority who was suspicious of their activities, or where they observed differential treatment that appeared to be based on race, gender, gender identity, or other personal qualities. We discuss how such situations made them feel or imagine how it made the person they observed feel, and what might have been the impact. Particularly, what would be the impact on, for example, their confidence or self-efficacy if this type of situation regularly occurred?

In another activity, I show the figure above and ask how labels, mainly those listed on the right side, might trigger implicit bias. For example, when we think of  “mechanic” what image comes to mind? What about “teacher,” “scientist,” “nurse”?  The message to teachers is that if we engage in implicit bias in teaching – knowingly or unconsciously – it communicates to students they may not belong in certain professions, or they may not be able to succeed in fields of study and professions if they do not fit the image or stereotype. We then discuss how to change the dialogue surrounding these terms by directly addressing their associated implicit bias, and using non-stereotypical examples of scientists, mathematicians, pilots, nurses, or mechanics. We consider the concept of intersectionality, or many different qualities that describe us (e.g., being a Latina mother, sister, and engineer). To focus on implicit bias in teaching, students must find and share short summaries of research on implicit bias, stereotype threat, or other indications of bias or inequities found in classroom teaching.  We discuss a study by Baker (1996), which states that “Teachers call on boys more often than girls, ask boys more higher-order questions, give boys more extensive feedback, and use longer wait-time with boys than girls.” Has teaching changed over the last 25 years to be more inclusive?

Implicit bias is based on long-standing societal stereotypes that are difficult to change, potentially clouding judgments of teachers and permeating through classroom interactions. In a study with 140 students in high school biology classrooms (Cavallo, 1994), teachers were asked to rate each of their students as a rote learner (surface learning, learns by memorizing) or a meaningful learner (deep structured learning, learns by connecting concepts and making sense of concepts). The four teachers (both male and female) rated significantly more females as rote learners and more males as meaningful learners among their students (Cavallo, 1994). On a standardized multiple-choice biology test, males significantly outperformed the females; however, on open-ended “mental model” essays transcribed and scored without identifying information, there were no differences in performance between the males and females in biology understanding (Cavallo, 1994). Female students had learned the biology concepts as meaningfully as males; however, this knowledge was not “tapped” by the multiple-choice question format. Moreover, teachers had viewed the females as rote learners, whereas they showed more deep structured understandings that only became evident when given the opportunity to express what they knew in writing. In a 2012 study on gender bias by Moss-Racusin, Dovidio, Brescoll, Graham, and Handelsman, female students were judged by 127 male and female faculty from various universities as less competent in science than male students, even though the gendered names on the materials reviewed were randomly assigned. The authors summarize that though there may be increases in women in science fields, “some women may persist in academic science despite the damaging effects of unintended gender bias…” (Moss-Racusin, et al., 2012, p. 16478). These studies show that implicit bias is ever-present in education, not only with respect to gender, but to many aspects of diversity.

Stereotype Threat
Studies illustrate how implicit bias may fuel an individual’s perception of themselves as fitting or belonging in a place or circumstance, or stereotype threat, described as a “socially premised psychological threat that arises when one is in a situation or doing something for which a negative stereotype about one’s group applies” (Steele & Aronson, 1995). The foundation for discussion of stereotype threat can be found in a video by Dr. Claude Steele, which also underscores its implications in learning and achievement (Steele, 1997; Spencer et al., 1999). According to the American Psychological Association (2006), although differences in achievement may not be completely due to stereotype threat, it is important enough to be well understood by educators in STEM fields.

Stereotype threat, where students feel they are an outsider or do not belong in STEM, can impact self-efficacy in these fields, which may result in lower performance. In our study with 290 college physics students, self-efficacy, or confidence in one’s ability to succeed in physics, significantly predicted actual achievement (Cavallo et al., 2004). Another with 138 high school physics students, self-efficacy also predicted students’ decisions to enroll as a STEM major in college, particularly among females (Cavallo et al., 2014). Fourth grade Hispanic ELL students had significantly lower self-efficacy in their ability to successfully learn science as compared to other groups, primarily White and Asian students (Cavallo & Gomez, 2010). The literature reports connections among self-efficacy, stereotype threat, and achievement worth further exploration and continued research (Sunny et al., 2016). Educators are urged to pursue research on how building positive self-efficacy and a sense of belonging may support students’ learning and successful achievement in STEM.

Classroom Teaching Observation Strategies to Promote Inclusion and Belonging
One strategy that mitigates implicit bias is conducting effective classroom teaching observations with observers as “data collectors.” The observers or data collectors (faculty supervisors and/or peers) are instructed to draw the classroom being observed. During the class meeting, observers carefully note activities such as teacher positioning, teacher eye contact, teacher questions, student questions, and teacher responses. With practice, observers can indicate other interactions, such as off-task conversations, distracted behavior, level of teacher questioning, and feedback given to students on responses. Observers may also keep running notes with timestamps as the classroom activities occur Running notes may record the wording of teacher questions, wait time, if the teacher answered questions themselves, the time(s) a student asked to leave the room, transitions in class activities, how transitions were managed, and more.

A sample peer observation classroom diagram with observed data is shown below. The observer shares the diagram with the observed teacher at a post-observation meeting. The teacher begins by discussing what they think of their positioning, eye contact, students called on, and other observational data collected. Then the observer shares the running observation notes.

In reviewing the classroom observation data, teachers reflect on their teaching through the lens of equity and inclusive teaching. The observer can initiate such reflection with questions such as, “What can this classroom observation diagram tell us about inclusive teaching?” Using the sample classroom diagram shown above, discussion would focus on how some students (e.g., those on the left side) were not included in classroom interactions due to the teacher’s positioning and open-ended question style. This teaching pattern resulted in a small target group of students engaged in learning activities and questioning during class, most likely the quickest, loudest students who were sitting closest to the teacher’s position.

We encourage PSTs who exhibit such teaching patterns to first recognize the pattern based on data collected, then focus on using techniques that engage all students in learning. Here are a few recommendations that are easy to implement and effective:

• Call students by name to respond (e.g., shuffling index cards with names),
• Implement group work or think-pair-share techniques for questions and problems,
• Give students time to write responses to questions before sharing,
• Walk around the room while students work,
• Sit eye-to-eye with them, rather than stand over them, so they feel more comfortable sharing,
• Ask students to come to the board as a pair or team to solve problems, and
• Ask students (anonymously if preferred) to write the “muddiest point”, i.e., something they are still confused about, on an index card or electronic polling app at various stopping points during class or before they leave for the day, which the teacher will re-address.

Classroom Interactions and Curriculum Planning Strategies to Promote Inclusion and Belonging
Our teachers have the extraordinary responsibility to build foundational skills and knowledge among the next generation of STEM professionals in an unpredictable, changing world. It is essential they know the enormity of this responsibility, and with it, the importance of a supportive, equitable learning environment so students thrive and remain on the path toward STEM careers. To guide PSTs in using strategies to support inclusion and equity in classroom interactions and curriculum/lesson planning, we share the following list of recommended strategies.

To ascertain outcomes of our efforts to promote inclusion and equity, the PSTs demonstrate understanding by integrating listed strategies in the inquiry-based and project-based learning curricula/unit they develop in courses and teach in their early field experiences. Using inclusive teaching strategies is also in the grading rubric for their curriculum/unit plan and formal classroom observation documents in student teaching, included as part of their Capstone portfolio.

Closing

Inclusive teaching means awareness and assurance of learning equity for all students. As educators, we are committed to learning and growing our understandings of what this truly means to best prepare our future teachers. This definition applies to everyone, including students with physical, emotional, and/or mental disabilities, LGBTQ+ students, students of diverse racial, ethnic, and economic backgrounds, and students with any quality that makes us human and unique. I share with teachers how Destiny Ortega, a member of the UTA women’s wheelchair basketball team and my student intern, helped me shift my thinking and gain new understandings of her experiences and those of her classmates with disabilities. I learned more from her than she did from me. Destiny, now a UTA graduate, gave a presentation to faculty on “10 Things Students with Disabilities Would Like Faculty to Know.” This advice drawn from her experiences and other students with disabilities who she surveyed and related work is applicable and used in preservice teacher education to help broaden perspectives and promote equity and inclusion in the classroom.

1. For students in a wheelchair: Please sit down when you speak with me so you are at eye level rather than hovering over me.
2. You do not need to speak louder for those of us who are hard-of-hearing, but you may need to face us or turn the camera on if teaching online so we can lip read, and please caption your recordings.
3. For students in a wheelchair: What is your plan if there is an emergency (fire, active shooter) and I am on an upper floor of the building? Who will carry me downstairs or help me hide? Who will carry my wheelchair?

In closing, I invite you to watch a short and inspiring video of Josie, one of Destiny’s UTA basketball teammates. It might help activate one more mental shift in implicit bias toward viewing inclusion and equity as empowering and a way to celebrate each individual’s special qualities, talents, and character to the fullest extent.

Remember the title of the blog?  Now what image comes to mind when you think of a “doctor”? Let’s work together to make this and other images we encounter inclusive and the learning experiences we provide for students fair and equitable in every classroom.

Note: 

Although The Heart Surgeon story does not describe actual events, it can be related to the true account of the first blue baby heart surgery at The Johns Hopkins University circa 1944.  The team was led by Dr. Alfred Blalock, a highly accomplished head of surgery.  He was joined by Dr. Helen Taussig, one of a few women physicians at the time, who had suggested the idea for an operation that might help children with “blue baby” to surgeon Blalock, and surgical technician Vivien Thomas, an African American man who had experimented extensively with the procedure, developing the smallest of instruments.  Taussig had lost her hearing as a young woman and relied on lip reading and hearing aids.  Blalock, Taussig, and Thomas later repeated the blue baby surgery successfully on two more patients.   The true account of this remarkable history is fascinating and inspiring. Two films based on this historic surgery are highly recommended: Partners of the Heart and Something the Lord Made.

Acknowledgements

This work is a partnership of the UTA College of Education, College of Science, and College of Engineering. Portions of this material is based upon work supported by the National Science Foundation Grant Nos. 0833343, 1035483, 1439914, 1758507, 1745263, and 1950152. The opinions, findings, and conclusions or recommendations expressed are those of the author and do not necessarily reflect the views of the National Science Foundation.

Portions of the classroom planning and strategies list were compiled from suggestions adapted from resources from the Center for Teaching & Learning at the University of Washington.

Appendix

NSF Noyce Program at University of Texas at Arlington (UTA):  Sustaining Education and Support on Equity and Inclusion for Teacher Graduates

We graduated our first Noyce Scholars from our programs in 2010.  Over 85% of our STEM teacher graduates are still teaching in significantly diverse, high-need school districts. Our research on retention in high-need school classrooms focusing on these and subsequent graduates revealed that of 59 survey respondents, 55 attributed their retention to strong preparation and early field experiences on teaching diverse student populations in high-need schools (Cavallo, Hale, & Gonzales, 2020). The teacher graduates along with their school administrators will benefit most from our partnership in providing sustained support so they remain teaching STEM in these high-need schools where they are so desperately needed.

Our programs provide continuing support for all teacher graduates during induction into teaching and beyond through various events, including an alumni group, email lists, and social media groups. The Noyce Scholars, in particular, attend four Scholar Learning Seminars per semester for continued professional development, which includes participation of Scholars currently in the program and those graduated and teaching, the PI Leadership Team, and our Noyce Scholar Leader (a retired science and mathematics teacher). During their induction into teaching, the Noyce Scholar Leader visits Noyce graduates in their school classrooms and holds Zoom and/or Teams meetings with them for continued guidance. The Noyce teacher graduates also have a school-based Mentor Teacher to provide advice and help through induction, and who works in collaboration with our Noyce Scholar Leader. As another layer of support, a network of experienced Noyce teachers lead a Near Peer Mentor program with Scholars who are in the certification program or recent graduates in their first years of teaching.

Finally, as PI of the NSF-funded Texas Western Regional Noyce Alliance (WRNA) subaward (lead institution San Francisco State University), our Noyce leadership team works with Noyce Scholars from universities across Texas, hosting networking/professional development meetings surrounding our state-sponsored science and mathematics teacher conferences. At our fall 2022 Texas WRNA meeting attended by 26 Noyce Scholars, we addressed implicit bias, equity, and inclusion in school classrooms where teachers shared their perspectives and experiences. The teachers voiced their commitment to ensure safe and equitable learning environments for all students. We maintain dialogue with Noyce Scholars and share experiences and resources on this and many teaching topics through our UTA Noyce Scholars and Texas Western Regional Noyce Alliance Facebook groups.