Gendered Expectations: Strategies for Navigating Structural Challenges in Support of Transgender and Nonbinary Trainees in Academic Medicine

Abstract

Members of the lesbian, gay, bisexual, transgender, and queer community experience marginalization, bias, and discrimination, including in the world of academic medicine. People who are transgender and nonbinary (TGNB) experience further marginalization compared with individuals who are lesbian, gay, bisexual, and queer. According to a recent survey, more than half of medical students who are TGNB chose not to disclose their gender identities during training due to fears of discrimination, feeling a lack of support, and concerns about future career options. Academic medicine has historically pathologized TGNB individuals, perpetuating discrimination structurally and reinforcing discriminatory behaviors of peers and faculty. In this Perspective, the authors provide a comprehensive overview of the challenges that administrators and educators face in creating a learning environment that is inclusive of TGNB trainees. They outline opportunities for change and provide strategies to address administrative and educational challenges, including those related to institutional climate, policies, data collection, physical spaces, health care, curriculum, mentoring, and the evaluation of TGNB trainees. Finally, the authors issue a call to action for medical educators and administrators to create environments in which trainees who are TGNB can fulfill their educational mission: to learn the practice of medicine.

Gender Distribution & Rank of Authorship in Surgical Literature

“…Non-binary and transgendered medical professionals often do not disclose their gender due to fears of discrimination and concerns regarding repercussions for their future careers. 50 A recent study found that the majority of mission statements, constitution, or bylaws published by surgical societies do not explicitly promote membership for the LGBTQ+ communities, or prohibit denial of membership based on an individual’s sexual identity/orientation. 43 Additionally, over 40% of surgical societies failed to mention a diversity and inclusion task force/committee.…”

Strategies to Counteract Impact of Harmful Bias in Selection of Medical Residents

“…15,16 Medical students who identify as SGM were more likely to perceive people in specialties lacking diversity to be less accepting of SGM identities. 17 They also felt, if they were to choose a less diverse specialty, that they would be more likely to perceive their own SGM identity as a hindrance to their career and more likely to witness or personally experience discrimination. 15,17 Students with disabilities also favored primary care careers due to perceived differences like those of other underrepresented groups in medicine.…”

“…17 They also felt, if they were to choose a less diverse specialty, that they would be more likely to perceive their own SGM identity as a hindrance to their career and more likely to witness or personally experience discrimination. 15,17 Students with disabilities also favored primary care careers due to perceived differences like those of other underrepresented groups in medicine. 18 When evaluating the motivations of these impacted students, we must also consider concepts such as race-conscious professionalism, where Black students attempt to "navigate the competing demands of professionalism, racial obligations, and personal integrity. "…”

Beyond the Procedure Log: Using Individualized Learning Plans to Set Learner-Specific Milestones for Procedural Skills Acquisition

“…In other words, our collective responsibility to improve current practices in procedural training and address inequities that exist in procedural allocation must extend beyond ILP-based interventions 55 . For procedural training in particular, the combination of structured mentoring programs, 10,50 dedicated procedural rotations, 10 and well-developed ILPs may represent a partial solution to gender-based inequities that exist in ad hoc procedural training.…”