Sexual and gender minority identity in undergraduate medical education: Impact on experience and career trajectory

Abstract

Introduction The wellbeing of sexual and gender minority (SGM) medical students and the impact of their experiences on career trajectory remain poorly understood. The present study aimed to characterize the incidence of mistreatment in SGM trainees as well as general perspectives on the acceptance of SGM individuals across medical and surgical specialties. Methods This was a cross sectional survey study of all actively enrolled medical students within the six University of California campuses conducted in March 2021. An online, survey tool captured incidence of bullying, discrimination, and suicidal ideation as well as perceived acceptance of SGM identities across specialties measured by slider scale. Differences between SGM and non-SGM respondents were assessed with two-tailed and chi-square tests. Qualitative responses were evaluated utilizing a multi-stage, cutting-and-sorting technique. Results Of approximately 3,205 students eligible for participation, 383 submitted completed surveys, representing a response rate of 12.0%. Of these respondents, 26.9% (n = 103) identified as a sexual or gender minority. Overall, SGM trainees reported higher slider scale scores when asked about being bullied by other students (20.0 vs. 13.9, P = 0.012) and contemplating suicide (14.8 vs. 8.8, P = 0.005). Compared to all other specialties, general surgery and surgical subspecialties had the lowest mean slider scale score (52.8) in perceived acceptance of SGM identities (All P < 0.001). In qualitative responses, students frequently cited lack of diversity as contributing to this perception. Additionally, 67.0% of SGM students had concerns that disclosure of identity would affect their future career with 18.5% planning to not disclose during the residency application process. Conclusions Overall, SGM respondents reported higher incidences of bullying and suicidal ideation as well as increased self-censorship stemming from concerns regarding career advancement, most prominently in surgery. To address such barriers, institutions must actively promote diversity in sexual preference and gender identity regardless of specialty.

Burnout and Perception of Medical School Learning Environments Among Gay, Lesbian, and Bisexual Medical Students

“… 37 A recent study showed that 67% of medical students minoritized on the basis of sexual orientation or gender identity (sexual and gender minority [SGM] students) had concerns that the disclosure of their identity would negatively affect their future career, and nearly 40% of these students had been explicitly advised to avoid disclosing their identity. 36 Therefore, elucidating the elements of the medical school environment that are most attributable to burnout can help to inform interventions that will be effective and appropriate. Mistreatment has been established to be experienced at increased rates among SGM students and associated with burnout.…”

“…Mistreatment has been established to be experienced at increased rates among SGM students and associated with burnout. 14 , 15 , 36 Addressing mistreatment of medical students is a vital component of addressing burnout in this student population.…”

Sexual and gender minority undergraduates’ relationships and strategies for managing fit in STEM

“…STEM undergraduate programs and environments are typically founded upon hetero- and cis-normative standards and can be unwelcoming of other gender identities and sexualities [ 5 – 8 ]. Specifically, SGM students often deal with discrimination and exclusion due to others’ perceptions, biases, and stereotyping of their minoritized sexual and gender identities [ 5 , 9 , 10 ]. This treatment is frequently in the form of microaggressions—covert, indirect, restrained, and ambiguous demonstrations of discrimination and prejudice against minoritized groups [ 6 , 11 , 12 ], such as cis-normative language use by faculty [ 13 ], including their resistance to trans or non-binary students’ pronouns [ 14 , 15 ].…”

Doing the Work—or Not: The Promise and Limitations of Diversity, Equity, and Inclusion in US Medical Schools and Academic Medical Centers

“…The placement of responsibility on a select few-rather than the entirety of institutional, departmental, and programmatic leadership-is neither sustainable nor equitable. This clear manifestation of minority tax, alongside the daily abuse and discrimination experienced by minoritized people in academia, leads to burnout and exit (22)(23)(24)(25)(26)(27)(28)(29)(30). In turn, an institution's entire DEI programming may stall or completely halt with the loss of only a handful of individuals.…”