Just Read: Sexual and Gender Minority Identity Disclosure: “In the Closet” in Medical School

Medical schools should have zero tolerance for mistreatment or discrimination against SGM* students on the basis of their identity.

*The term SGM is inclusive of all nonheterosexual and noncisgender individuals, including, but not limited to, those who identify as lesbian, gay, bisexual, transgender (LGBT), queer, or questioning

Except when it’s tolerated, even in this decade.

When I published the story of my colleague, Social Innovator: Louise “Lu” Casa, MSN, CRNP, CTTS on identity, partnership, teamwork, who came out at the beginning of her career, in 1983 (!), I cited data from 1994 about acceptance of sexual minority students (gender minorities weren’t even on the radar then). Lu noticed these articles and sent them my way.

The first is a survey of US and Canadian MD and DO students in 2009-2010 (well before the fall of “Don’t Ask, Don’t Tell” and marriage inequality in most US States) performed by researchers (medical students!) at Stanford School of Medicine (@MattMansh).

Even though the response rate is low (5.7%) it is “the largest study collecting information on sexual identity, gender identity, and identity disclosure among medical students in the United States and Canada. Respondents came from the majority of eligible medical schools, all class years, and represented a diverse set of sexual and gender identities.”

Because the goal is zero events, a description of the experience of even a subset students is going to be useful. Because the percentage of students identifying as SGM (Sexual and Gender Minority) is high (15.7%, compare to 6.9% for the general population), I assume there’s some selection bias/oversampling, which again is useful in this case.

I almost can’t believe the numbers aren’t better:

The majority (67.5%) of sexual minority respondents were “out” about their sexual identity in medical school. However, this percentage represents only a moderate increase from a previous estimate (44%) from roughly two decades ago.

The numbers are lower for gender minority students with 34.3 % reporting being out.

And:

In interacting with residents and attendings, it is clear through general conversation and offhand comments that LGBT is unfamiliar and, at best, a joke. (26-year-old, third-year, gay, white, male, U.S. MD student)

On my surgery rotation, we saw a male- to-female transgender patient who had “do-it-yourself ” silicone breast implants which had become infected. He [sic] was treated like a freak by the residents and attendings behind closed doors, joking at his [sic] expense. (25-year-old, third-year, lesbian, white, female, U.S. MD student)

These types of environments are damaging to the profession and to our patients, and as the paper mentions, amplified in the student role, where there’s less power to challenge norms.

As recounted in my own educational experience (see: Doctors know : It Gets Better ), and more recently on stage with a patient, when I was in training all I could do is observe and remember for a future time, which I did, and that time is now 🙂 .

We shouldn’t make more people wait to be agents of change. Fortunately we don’t have to, because our generation can change is changing everything.

The importance is underscored, because since the it gets better post, the anti-LGBT comments from professional colleagues have come back, this time directed against people who are transgender, and their allies (including me). Sometimes our profession doesn’t learn from past failures.

Having a role in ending sexual and gender minority bias, without fear, is (a) as wonderful as I thought it was going to be, (b) physicians and our health professional colleagues are uniquely capable of leading the change, AND our patients and society want more leaders to experience it with me, sooner in their careers. It’s what they expect + why we came to medicine.

Don’t be afraid, be who you are. In order to be fulfilled you have to be yourself – Louse “Lu” Casa, MSN, CRNP, CTTS

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