Specialty Choice Among Sexual and Gender Minorities in Medicine: The Role of Specialty Prestige, Perceived Inclusion, and Medical School Climate

Preparedness of Filipino Neurologists on the Provision of Medical Care Toward Patients of the Lesbian, Gay, Bisexual, Transgender, Queer Plus Community

The study aimed to describe the preparedness of active members of the Philippine Neurological Association (PNA) in providing medical care to LGBTQ+ patients. We electronically sent out a 21-item self-administered online survey adapted from the 2019 American Academy of Neurology LGBTQ+ Survey Task Force to 511 active members of PNA that included questions about demographic information, knowledge, attitude, and clinical practices. Descriptive statistics were used to analyze variables. Text responses were transcribed and summarized. Seventy-nine (15.5%) of 511 PNA members participated. Most participants were aware of local (53%) and national (56%) barriers that preclude patients in the LGBTQ+ sector from accessing quality health care. The majority (90%) of participants agreed that LGBTQ+ patients experience disproportionate levels of physical and psychological problems. Forty-two percent (42%) of respondents believed that sexual and gender issues have no bearing on neurological management, although a majority (53%) reported individualizing their management considering these issues. The majority were cognizant of the challenges that LGBTQ+ patients face in the health care system. However, awareness has not translated into modifications in neurological management. The openness of the participants to educational opportunities concerning health care related to LGBTQ+ can be leveraged to address this gap.

Mapping the Impact of Anti-LGBT Legislation on Graduate Surgical Education

BACKGROUND

LGBTQ medical students and surgery residents face myriad structural barriers. The American Civil Liberties Union (ACLU) reports 492 pieces of state-level legislation targeting Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) people in the past year. These bills including bans on medical care, "don't say gay" bills, exclusion from anti-discrimination protections, and more. These bills may limit where medical students pursue surgical training STUDY DESIGN: The Movement Advancement Project and the ACLU legislative databases were consulted to determine whether states (plus Puerto Rico and the District of Columbia) currently had or were actively considering anti-LGBTQ legislation. This information was then mapped against data from the 2023 National Residency Match Program. US News rankings of top surgical training programs were utilized as well.

RESULTS

There were 2803 general surgical training spots, of which 1597 (57%) were located in states which currently have anti-LGBTQ legislation in place. 245 (9%) of training spots are in states which do not have such legislation but are currently considering anti-LGBTQ legislation. Of the top 20 residency programs, 11 (55%) were in states with anti-LGBTQ legislation. In affiliated specialties, 50 (54%), 118 (57%), and 24 (49%) surgical training positions for integrated vascular, plastic, and thoracic surgery, respectively, are in states that currently have anti-LGBTQ legislation in place. In total, 63% of fellowship opportunities were in states with Anti-LGBTQ legislation in place CONCLUSION: A majority of graduate surgical education occurs in states with anti-LGBTQ legislation, potentially limiting residency options for people who value protection of LGBTQ rights.

Representation of online LGBTQ+ support in general surgery residency programs

BACKGROUND

Lesbian, Gay, Bisexual, Transgender, Queer, and more(LGBTQ+) trainees are underrepresented in medicine, and their experiences in surgery have not been well studied. We sought to examine the practices of general surgery residency programs by region regarding representation of LGBTQ+ ​support online.

METHODS

Retrospective, two-person review of 100 general surgery residency programs stratified by Electronic Residency Application Service(ERAS) region comparing data on Diversity, Equity, and Inclusion(DEI) and LGBTQ+ ​-specific webpages.

RESULTS

The Middle Atlantic and South Atlantic regions had 20% of programs each, with fewer programs found in other regions. Of the 100 institutions, 92% had DEI webpages, and 43% had LGBTQ+ ​-specific webpages. There was a significant difference in the likelihood of a program being an Human Rights Campaign(HRC) LGBTQ+ ​leader when compared by region(p ​< ​0.01).

CONCLUSIONS

Few general surgery residency programs share LGBTQ+-specific DEI content online with no regional difference observed. Recommendations such as updating websites to highlight LGBTQ+ ​inclusion should aid recruitment of a diverse, surgical residency as well as create a welcoming environment for prospective residents.

"Encouraged to be Your True Self": An Interpretative Phenomenological Study of Medical Students' Experiences of Role Models in Shaping Sexual Minority Identity in Medical School

Phenomenon: Sexual and gender minority (SGM) identifying individuals experience worse health outcomes compared to non-SGM identifying counterparts. Representation of SGM individuals within medical schools may improve the delivery of more equitable healthcare through reducing biases and normalizing SGM presence within healthcare spaces. Approach: Our initial aim was to explore the extent to which role models may influence personal SGM identities within medical schools in the United Kingdom, using an interpretative phenomenological approach. This methodology allowed us to develop meaning from, and give voice to participants' relationship with their bespoke experiences, respecting differing narratives within the broad 'SGM' umbrella, rather than attempting to establish commonalities. Semi-structured interviews were conducted with five medical students and three medical school faculty within three medical schools, who identified as SGM. Due to a lack of gender minority identifying participants, we unfortunately could not adequately speak to their experiences, and therefore narrowed our eventual focus to sexual minority (SM) individuals. Findings: The developed themes followed a cyclical process of: (1) role model identification; (2) role model selection, influenced by matched wider identities including generation, hierarchy and power; (3) trait assimilation, particularly where identity deficits were perceived; and (4) identity projection, where students used role models to both emulate comfortable SM identity projection, and become advocatory role models themselves. Throughout, participants described role models as multifaceted in their direction (vertical and horizontal), influence (positive and negative) and locus of effect (as individuals, and as part of a collective). Unexpectedly, identity, power, and hierarchy-matching meant peer-to-peer role modeling was often experienced more positively than vertical faculty-to-student role modeling. However, as expected, heteronormativity exerted an inhibitory effect on this process. Insights: We built upon existing social cognitive paradigms to develop a 'double-funnel' model to represent how social contexts can map onto individual SM identities and vice versa, mediated by role models. The triangulation of these three aspects in relation to medical education presents novel understandings to the field. Greater explicit institutional support of student-led SM societies, and facilitation of the presence and discussion of SM symbols and personal identities within professional spaces, may go a long way in redefining 'normativity' in medical schools.

Gender and Racial Disparities in Pediatric Orthopaedic Surgery Fellows: A Decade-Long Analysis

BACKGROUND

Despite increasing diversity among medical students, pediatric orthopaedic surgery remains underrepresented regarding gender and ethnic diversity. Previous studies highlight notable underrepresentation of women and minorities in orthopaedic subspecialty fellowships.

METHODS

This study analyzed data from 2013 to 2023 on pediatric orthopaedic surgery fellows, collected through the Accreditation Council for Graduate Medical Education and Graduate Medical Education Consensus. Self-identified race and gender data were used to assess trends over the decade.

RESULTS

The analysis included 380 fellows, of whom 62.4% were male and 37.1% were female. Racial distribution showed 62.9% White, 9.2% Asian, 4.5% Hispanic/Latino/Spanish, 4.5% Black/African American, 0% American Indian/Alaskan Native, 0% Native Hawaiian/Pacific Islander, 0.53% multiple race/ethnicity, and 8.4% other. Notably, 37.1% of fellows were non-White.

CONCLUSION

The study reveals persistent gender and racial disparities in pediatric orthopaedic surgery fellowships. Targeted recruitment and support for underrepresented groups, along with systemic changes to address barriers, are crucial for fostering a diverse and inclusive workforce. Enhanced diversity is essential for providing culturally competent care to the diverse patient population.

The need for critical and intersectional approaches to equity efforts in postgraduate medical education: A critical narrative review

BACKGROUND

Racialised trainees in Canada and the USA continue to disproportionately experience discrimination and harassment in learning environments despite equity, diversity, and inclusion (EDI) reform efforts. Using critical approaches to understand what problems have been conceptualised and operationalised as EDI issues within postgraduate medical education (PGME) is important to inform ongoing learning environment reform in resident training.

METHODS

We conducted a critical narrative review of EDI literature from 2009-2022 using critical race theory (CRT) and the concept of intersectionality to analyse how issues of discrimination in PGME have been studied. Our search yielded 2244 articles that were narrowed down to 349 articles for relevance to Canadian and American PGME contexts. We attended to reflexivity and our positionality in analysing the database and identifying themes related to EDI reform.

RESULTS

Interest convergence was noted in how EDI reform was rationalised primarily by increased productivity. Problems of learner representation, gender inequities and curricular problems were conceptualised as EDI issues. The role that racism played in EDI-related problems was largely invisible, as were explicit conceptualisations of race and gender as social constructs. Overall, there was a lack of critical or intersectional approaches in the literature reviewed. Misalignment was noted where studies would frame a problem through a critical lens, but then study the problem without attention to power.

DISCUSSION

Interest convergence and epistemic injustice can account for the absence of critical approaches due to the alignment of existing EDI work with institutional interests and priorities. Interest convergence conceptually limits existing EDI reform efforts in PGME. CRT and intersectionality connect racialised learner experiences to systemic phenomena like racism and other forms of discrimination to challenge dominant assumptions. Because they attend to power, critical approaches are key to understanding why inequities have persisted to advance equity in learning environments for racialised and intersectionally marginalised learners.

Examining Scientific Inquiry of Queerness in Medical Education: A Queer Reading

Phenomenon. The language of medicine (i.e., biomedical discourse) represents queerness as pathological, yet it is this same discourse medical education researchers use to resist that narrative. To be truly inclusive, we must examine and disrupt the biomedical discourse we use. The purpose of this study is to disrupt oppressive biomedical discourses by examining the language and structures medical educators use in their publications about queerness in relation to physicians and physician trainees. Approach. We searched PubMed, Web of Science, CINAHL, PsycINFO, and ERIC in October 2021 and again in June 2023 using a combination of controlled vocabulary (select terms designated by a database to enhance and reduce ambiguity in search) and keywords to identify articles related to sexuality, gender, identity, diversity and medical professionals. Searches were limited to articles published from 2013 to the present to align with the passage of The Respect for Marriage Act. Articles were included if they focused on the experiences and paths of physicians and physician trainees identifying with or embodying queerness, were authored by individuals based in the United States, and presented empirical studies. We excluded articles only discussing attitudes of cisgender heterosexual individuals about queerness. Two authors independently screened all articles for inclusion. We then used narrative techniques to "re-story" included articles into summaries, which we analyzed with four guiding questions, using queer theory as a sensitizing concept. Finally, we sought recurrent patterns in these summaries. Findings. We identified 2206 articles of which 23 were included. We found that biomedical discourse often: characterized individuals associated with queerness as a single homogenous group rather than as individuals with a breadth of identities and experiences; implied queer vulnerability without naming-and making responsible-the causes or agents of this vulnerability; and relied minimally on actual intervention, instead speculating on potential changes without attempting to enact them. Reflections. Authors each reflect on these findings from their positionalities, discussing: disrupting essentializing categories like "LGBT"; addressing harm through allyship around queerness; editorial responsibility to disrupt structures supporting oppressive biomedical discourse; the importance of program evaluation and interventions; and shifting the focus of medical education research toward queerness using QuantCrit theory.

Prevalence of Depression and Generalized Anxiety Among LGBTQ+ Medical Students in Thailand

This study evaluated the prevalence and associated factors of depression and generalized anxiety among LGBTQ+ in five medical schools in Thailand. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess major depressive disorder (MDD) and generalized anxiety disorder (GAD), respectively, and multivariable logistic regression was employed to identify associated factors. Of 1,322 students, 412 (31.16%) identified as LGBTQ+. The prevalence for MDD and GAD among LGBTQ+ students were 32.77% and 17.23%, respectively. Significant associated factors for both MDD and GAD were a history of psychiatric illness (AOR for MDD = 2.32, p = .020; AOR for GAD = 3.67, p < .001), educational problems (AOR for MDD = 6.62, p < .001; AOR for GAD = 5.12, p < .001), and dissatisfaction with gender identity or sexual orientation (AOR for MDD = 1.92, p = .019; AOR for GAD = 2.47, p = .005). Additional factors associated with MDD were preclinical years (AOR = 2.30, p = .023), financial struggles (AOR = 2.05, p = .021), and inadequate peer support (AOR = 2.57, p = .044). In conclusion, nearly one-third and one-fifth of Thai LGBTQ+ medical students suffer from MDD and GAD, respectively. Our findings suggest that Thai medical schools should promote LGBTQ+ inclusivity to enhance students' identity satisfaction. Peer support groups should be encouraged, especially for preclinical LGBTQ+ students who face educational and financial challenges.

Understanding Implicit Bias and Its Impact in Veterinary Medicine

Implicit biases are those we are unwilling to admit, yet they influence our behavior in ways that impact our experience in the workplace. Literature demonstrates that implicit bias influences career choice and limits success within a chosen career. Discrimination in the veterinary workplace is pervasive and has a negative impact that is responsible for financial loss. It can also influence client communication, patient-care, and be inadvertently perpetuated by well-meaning community clinics. Strategies can be employed to acknowledge implicit bias and to foster behavioral change, which results in a healthier workplace and improved client and patient-care.

'I'm looking as white and as straight as possible at all times': a qualitative study exploring the intersectional experiences of BAME LGBTQ+ medical students in the UK

OBJECTIVES

The positive formation of professional identity is considered crucial in how medical students begin to feel and act as clinicians. Although, awareness of how Professional Identity Formation (PIF) may be affected among minoritised groups is increasing, understanding from an intersectional lens remains limited. The aim of this study was to explore the experiences of Black, Asian, Minoritised Ethnic (BAME) and Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ+) medical students in the undergraduate Bachelor of Medicine, Bachelor of Science programme.

DESIGN

Based on the methodology of phenomenography, all medical students identifying as BAME and LGBTQ+ were eligible for participation. Semistructured interviews were conducted with data collection continuing until theoretical saturation was reached. The coding framework was developed independently by the principal researcher and supervisor before being compared to create a shared analytical framework.

SETTING

University College London Medical School (UCLMS) between October 2022 and February 2023.

PARTICIPANTS

Six UCLMS students were recruited, one of whom was in the 'early' years (years 1-3) with the remainder in the 'later' years (years 4-6) RESULTS: Six main themes emerged from the data, which were categorised into three main areas: challenges to intersectionality, benefits to intersectionality and protective factors. Challenges to intersectionality included three themes, 'The BAME identity interacting with the LGBTQ+identity', 'BAME background influencing LGBTQ+identity exploration' and 'no true safe spaces for BAME and LGBTQ+ students to be themselves'. Benefits to intersectionality included 'greater insight into the self' and protective factors included two themes of 'peer support networks' and 'visibility within the university and clinical environments.'

CONCLUSION

By exploring PIF among medical students from an intersectional lens, this study highlights the increased emotional burden faced by those who identify as BAME and LGBTQ+, as they attempt to reconcile both these identities with becoming a future doctor, affecting their sense of belonging socially and within the profession. Despite being based at a single medical school, it highlights the importance of creating a truly inclusive environment through positive role modelling and increased visibility among the BAME, LGBTQ+ community in the undergraduate programme.

What Is the Representation of Sexual and Gender Minority Identities Among Orthopaedic Professionals in the United States?

BACKGROUND

There is substantial corroborating evidence that orthopaedic surgery has historically been the least diverse of all medical and surgical specialties in terms of race, ethnicity, and sex. Growing recognition of this deficit and the benefits of a diverse healthcare workforce has motivated policy changes to improve diversity. To measure progress with these efforts, it is important to understand the existing representation of sexual and gender minorities among orthopaedic professionals.

QUESTIONS/PURPOSES

(1) What proportion of American Academy of Orthopaedic Surgeons (AAOS) members reported their identity as a sexual or gender minority? (2) What demographic factors are associated with the self-reporting of one's sexual orientation and gender identity?

METHODS

The AAOS published the updated membership questionnaire in January 2022 to collect information from new and existing society members regarding age and race or ethnicity and newly added categories of gender identity, sexual orientation, and pronouns. The questionnaire was updated with input from a committee of orthopaedic surgeons and researchers to ensure face validity. The AAOS provided a deidentified dataset that included the variables of interest: membership type, gender identity, sexual orientation, pronouns, age, race, and ethnicity. Of 35,427 active AAOS members, 47% (16,652) updated their membership questionnaire. To answer our first study question, we calculated the prevalence of participants who self-reported as lesbian, gay, bisexual, transgender, queer, or another sexual or gender minority identity (LGBTQ+) and other demographic characteristics of the 16,652 respondents. Categorical demographic data are described using frequencies and proportions. Median and IQR were used to describe the central tendency and variability. To answer our second study question, we conducted a stratified analysis to compare demographic characteristics between those who self-reported LGBTQ+ identity and those who did not. Visual methods (quantile-quantile plots) and statistical tests (Kolmogorov-Smirnov and Shapiro Wilk) confirmed that the age of AAOS member was not normally distributed. Therefore, a Kruskal Wallis test was used to determine the statistical associations between age and self-reported LGBTQ+ status. Chi-square tests were used to determine bivariate statistical associations between categorical demographic characteristics and self-reported LGBTQ+ status. A multivariable logistic regression model was developed to identify the independent demographic characteristics associated with respondents who self-reported LGBTQ+ identity. Further stratified analyses were not conducted to protect the anonymity of AAOS members. An alpha level of 5% was established a priori to define statistical significance.

RESULTS

Overall, 3% (109 of 3679) and fewer than 1% (3 of 16,182) of the AAOS members (surgeons, clinicians, allied healthcare providers, and researchers) who updated their membership profiles reported identifying as a sexual (lesbian, gay, bisexual, queer) or gender minority (nonbinary or transgender), respectively. No individual self-identified as transgender. Five percent (33 of 603) of women and 3% (80 of 3042) of men self-identified as a sexual minority (such as lesbian, gay, bisexual, or queer). AAOS members who self-identified as LGBTQ+ were younger (OR 0.99 [95% confidence interval (CI) 0.98 to 0.99]; p < 0.001), less likely to self-identify as women (OR 0.86 [95% CI 0.767 to 0.954]; p < 0.001), less likely to be underrepresented in medicine (OR 0.49 [95% CI 0.405 to 0.599]; p < 0.001), and less likely to be an emeritus or honorary member (OR 0.75 [95% CI 0.641 to 0.883]; p < 0.003).

CONCLUSION

The proportion of self-reported LGBTQ+ AAOS members is lower than the 7% of the general US population. The greater proportion of younger AAOS members reporting this information suggests progress in the pursuit of a more-diverse field.

CLINICAL RELEVANCE

The study findings support standardized collection of sexual orientation and gender identity data to better identify and address diversity gaps. As orthopaedic surgery continues to transform to reflect the diversity of musculoskeletal patients, all orthopaedic professionals (surgeons, clinicians, allied healthcare providers, and researchers), regardless of their identities, are essential in the mission to provide equitable and informed orthopaedic care. Sexual and gender minority individuals may serve as important mentors to the next generations of orthopaedic professionals; individuals from nonminority groups should serve as important allies in achieving this goal.

Effect of anatomical studies prior to medical school on medical school anatomy study success and residency choice

INTRODUCTION

There is little research on how medical school matriculants' experiences prior to medical school effects their choice of specialty or performance in medical school. This research attempts to fill that gap in research in regards to surgical and radiological fields.

METHODS

An anonymous survey was sent to fourth year medical students asking them their background in anatomy studies prior to medical school and their anatomy grades in medical school and interest in surgical and radiological fields. Students were also asked whether they identified with under-represented demographic groups in those specialties.

RESULTS

Prior anatomy experience did not significantly affect performance in anatomy courses or Step 1 and Step 2 scores. However, students who applied to surgical specialties had higher performance in anatomical courses and higher Step 1 scores compared to those who did not apply to surgical specialties. There was interestingly no difference in under-represented and not under-represented student application to these fields.

DISCUSSION

For shareholders interested in increasing medical student performance, or interest in specific specialties, more information needs to be gathered.

Association of county-level provider density and social vulnerability with colorectal cancer-related mortality

BACKGROUND

Health care providers play a crucial role in increasing overall awareness, screening, and treatment of cancer, leading to reduced cancer mortality. We sought to characterize the impact of provider density on colorectal cancer population-level mortality.

METHODS

County-level provider data, obtained from the Area Health Resource File between 2016 and 2018, were used to calculate provider density per county. These data were merged with county-level colorectal cancer mortality 2016-2020 data from the Centers for Disease Control and Prevention. Multivariable regression was performed to define the association between provider density and colorectal cancer mortality.

RESULTS

Among 2,863 counties included in the analytic cohort, 1,132 (39.5%) and 1,731 (60.5%) counties were categorized as urban and rural, respectively. The colorectal cancer-related crude mortality rate was higher in counties with low provider density versus counties with moderate or high provider density (low = 22.9, moderate = 21.6, high = 19.3 per 100,000 individuals; P < .001). On multivariable analysis, the odds of colorectal cancer mortality were lower in counties with moderate and high provider density versus counties with low provider density (moderate odds ratio 0.97, 95% confidence interval 0.94-0.99; high odds ratio 0.88, 95% confidence interval 0.86-0.91). High provider density remained associated with a lower likelihood of colorectal cancer mortality independent of social vulnerability index (low social vulnerability index and high provider density: odds ratio 0.85, 95% confidence interval 0.81-0.89; high social vulnerability index and high provider density: odds ratio 0.93, 95% confidence interval 0.89-0.98).

CONCLUSION

Regardless of social vulnerability index, high county-level provider density was associated with lower colorectal cancer-related mortality. Efforts to increase access to health care providers may improve health care equity, as well as long-term cancer outcomes.

Sexual Orientation and Racial Bias in Relation to Medical Specialty

Physician explicit and implicit biases involving race and sexual orientation (SO) affect patient and provider experiences in healthcare settings. An anonymous survey was disseminated nationally to graduating medical students, residents, and practicing physicians to evaluate SO and racial biases across medical specialties. SO explicit and implicit bias were measured with the Attitudes toward Lesbians and Gay Men Scale, short form (ATLG-S) and Gay-Straight Implicit Association Test (IAT). Racial explicit and implicit bias were measured with the Quick Discrimination Index (QDI) and the Black-White IAT. Medical specialty was associated with racial explicit bias and specialty prestige with Black-White IAT score. Medical specialty and specialty prestige were not associated with SO bias. Female sex, sexual and gender minority (SGM) identity, and decreased religiosity were associated with reduced SO and racial bias. Provider race was associated with racial implicit and explicit bias.

The sexual and gender minority (LGBTQ+) medical trainee: the journey through medical education

In this literature overview, we share with the reader challenges faced by LGBTQ + individuals pursuing medical education, from undergraduate to postgraduate training. The LGBTQ + acronym has evolved to encompass the diverse spectrum of sexual orientation and gender identities. Recently, the term "Sexual and Gender Minority" (SGM) has emerged as an umbrella term to provide consistency in research advancing SGM health. The unique obstacles LGBTQ + trainees encounter are highlighted throughout this article, including external factors influencing career decisions, a lack of LGBTQ + healthcare curricula, discriminatory social interactions, limited mentorship opportunities, and a higher mental health burden. These challenges have the capacity to affect educational experiences, personal well-being, and professional growth. Additionally, we examine the impact of inclusive institutional climates on LGBTQ + trainees' selection of medical schools and residency programs, as they may prioritize inclusiveness and diversity when making their choice. In postgraduate training, LGBTQ + trainees continue to face challenges, exemplified by disparities in placement rates and discriminatory experiences based on sexual orientation and gender identity. We describe the gap in current research and its long-term impact of these challenges on career paths. Hostile environments persist in certain specialties, and the lack of LGBTQ + mentorship and support can hinder academic pursuits. We shed light on the unique and pervasive challenges faced by LGBTQ + trainees throughout their medical education journey, while emphasizing the need for inclusive policies, support systems, and research to address these challenges. With increasing research and studies, we hope to create a medical workforce and community that better represents the diverse communities it serves.

Pride & prejudice: A scoping review of LGBTQ + medical trainee experiences

PURPOSE

LGBTQ + medical trainees experience significant discrimination. These individuals are stigmatized within a hetero- and cis-normative system, resulting in poorer outcomes in mental health and increased stress regarding career trajectory compared with their hetero- and cis-identifying counterparts. However, literature on the barriers experienced during medical training in this marginalized group is limited to small heterogeneous studies. This scoping review collates and explores prominent themes in existing literature on the personal and professional outcomes of LGBTQ + medical trainees.

METHODS

We searched five library databases (SCOPUS, Ovid-Medline, ERIC, PsycINFO and EMBASE) for studies that investigated LGBTQ + medical trainees' academic, personal, or professional outcomes. Screening and full text review were performed in duplicate, and all authors participated in thematic analysis to determine emerging themes, which were iteratively reviewed to consensus.

RESULTS

From 1809 records, 45 met inclusion criteria (κ = 0.57). Major themes that emerged in the literature included the prevalence of discrimination and mistreatment faced by LGBTQ + medical trainees from colleagues and superiors, concerns regarding disclosure of sexual and/or gender minority identity, and overall negative impacts on mental health including higher rates of depression, substance use, and suicidal ideation. There was a noted lack of inclusivity in medical education and having an LGBTQ + identity had a large impact on career trajectory. Community with peers and mentors was an important determinant of success and belonging. There was a noteworthy lack of research on intersectionality or positive interventions that improved outcomes for this population.

CONCLUSION

This scoping review highlighted important barriers facing LGBTQ + medical trainees, identifying substantial gaps in the existing literature. Research on supportive interventions and predictors of training success is lacking and will be important to foster an inclusive education system. These findings provide critical insights for education leaders and researchers to help create and evaluate inclusive and empowering environments for trainees.

"As a psychiatry resident I am invited to explore my identity. But when I accept that invitation, I still encounter a wall." A qualitative study on inclusion experienced by psychiatry residents with a migration background, sexual minority identity and/or working-class background

Diversity in terms of class, sexual identity and migration background among medical students in high income countries has increased greatly in recent decades. Some research into the experiences of these new groups of doctors has been performed. However, no previous research into the experiences of psychiatry residents specifically, is known. This qualitative study investigates how psychiatry residents, from these minoritized groups, experience their training regarding inclusion. Inclusion is defined as the degree to which one's needs for connection and for being valued in one's uniqueness, is satisfied. In-depth interviews with 16 psychiatry residents were conducted. These interviews were transcribed and coded using MaxQDA software. Initial themes that were constructed, were explored further in subsequent interviews and linked to literature. Finally, the developed themes were ordered in a model conceptualizing inclusion. Participants reported high belongingness within psychiatry training. Their experienced value in uniqueness, however, was generally quite low. Participants reported to experience little interest in and sensitivity for their perspectives and lived experiences from their co-workers. When faced with stigmatization and discrimination, participants reported lack of support from their colleagues. Assimilation was found to be the most frequently used coping strategy in dealing with diversity. Participants seemed to conform to the 'neutral' norm and experienced barriers in expressing themselves. Through this mechanism of assimilation, the added value that participants might bring with their unique knowledge and lived experiences was not used, both in patient care and in creating an inclusive climate within the organization. Moreover, assimilation is associated with psychological strain.

The IR Trainee Workforce 10 Years after Becoming a Primary Medical Specialty

The recognition of interventional radiology (IR) as a primary medical specialty and the subsequent development of IR residency programs initiated a new wave of development in the field. The shift from recruiting from the pool of diagnostic radiology residents to the pool of medical students offered a new opportunity to evolve the composition of the IR workforce. After a decade of specialty status, the composition of IR's workforce and pipeline shows progress in its reflection of national demographical changes. Increasing diversification of practitioners in IR is an aggressive growth strategy, which is necessary to serve a diversifying population. Increasing the diversity of the IR workforce offers the potential to promote access to and utilization of IR and improve the quality of care. Cultivating a more diverse workforce utilizes untapped potential critical to the continued growth of IR.

Our Efforts to Create a Welcoming Surgical Residency for LGBTQ Trainees

OBJECTIVE

To provide a more welcoming environment for LGBTQ residents.

DESIGN

This paper is based upon the authors experience creating a training program welcoming to LGBTQ residents.

SETTING

University General Surgery Training Program.

PARTICIPANTS

Surgical Residents and Surgical Faculty.

RESULTS

Over a 9 year period, our residency has made intentional efforts to welcome LGBTQ applicants and support LGBTQ residents. We now have a residency in which over 25% of our residents identify as LGBTQ.

CONCLUSIONS

We see opportunities for other residencies to signal to applicants and trainees that they are welcome and celebrated for who they are.

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

Human biases impact medical care in ways that perpetuate health disparities. Research has demonstrated that biases negatively affect patient outcomes and stifle diversity across the physician workforce, further compounding health disparities by worsening patient-physician concordance. Taken as one, the application, interview, recruitment, and selection processes employed by residency programs has been one of the critical junctures where bias has exacerbated inequities among future physicians. In this article, the authors define diversity and bias, review the history of bias in residency programs' processes for selecting residents, explore the impact of this history on workforce demographics, and discuss ways to optimize and work toward equity in the practices used by residency programs to select residents.

Strategies for recruiting underrepresented in medicine and sexual and gender minority students to emergency medicine

Background

Despite having well-described benefits, diversifying the physician workforce has been an ongoing challenge. Within emergency medicine (EM), multiple professional organizations have identified expanding diversity and inclusion as top priorities. The following is a description of an interactive session held at the SAEM annual meeting addressing recruitment strategies for underrepresented in medicine (URiM) and sexual and gender minority (SGM) students into EM.

Methods

During the session, the authors provided an overview of the current state of diversity in EM. In the small-group portion of the session, a facilitator helped characterize the challenges programs face in recruiting URiM and SGM students. These challenges were described during three distinct phases of the recruitment process: (1) preinterview, (2) interview day, and (3) postinterview.

Results

Our facilitated small-group session allowed for discussing the challenges faced by various programs in recruiting a diverse group of trainees. Common challenges in the preinterview and interview day included messaging and visibility as well as funding and support. Postinterview challenges included communication and the ranking process. Through this exercise, we were able to collaboratively share ideas on tangible solutions that programs may use to overcome their specific challenges.

Conclusions

Given the importance of intentionality in diversifying the physician workforce, the authors describe successful strategies implemented within one residency program and those shared by session participants to overcome recruitment challenges.

The West Coast Plastic Surgery Mentorship Program: Successes, Failures, and Future Growth

BACKGROUND

Students who are underrepresented in medicine experience limited access to mentorship throughout medical school and when applying to plastic surgery residency. This study describes the creation, growth, and results of the multi-institutional West Coast Plastic Surgery Mentorship Program (WCPSMP), specifically reflecting on barriers to implementation and room for future improvement.

METHODS

Students were eligible to apply to the plastic surgery mentorship program if they were first-, second-, or third-year medical students in a US medical school interested in plastic surgery. Preference was given to students who are (1) underrepresented-in-medicine racial/ethnic minorities; (2) first generation, low income; (3) lesbian, gay, bisexual, transgender, queer; and/or (4) without a home integrated plastic surgery program. Preprogram and postprogram surveys were analyzed.

RESULTS

The 2021-2022 cycle of the WCPSMP included 30 resident mentors and 30 resident mentees, with a 1:1 mentor-to-mentee relationship. The second annual Mentor-Mentee Day was hosted on June 25, 2022, in San Diego, California, with attendance from 18 mentees. There was a 63% response rate in the presurvey and postsurvey. Most students endorsed gaining didactic skills, technical skills, and networking, but only a few gained research opportunities.

CONCLUSION

The WCPSMP is a promising venue to offer underrepresented medical students valuable resident mentorship, as well as acquire surgical knowledge and skills. Further development of the program includes implementing a curriculum for residents on how to be an effective mentor and offering more research opportunities.

Medical Student Perspectives on Sexual and Gender Minority Acceptance in Surgical Specialties and Sexual and Gender Minority Education

BACKGROUND

The topics of healthcare for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) patients and inclusion of LGBTQ+ health providers remain overlooked. Some specialties may be perceived as less inclusive to LGBTQ+ trainees. This study aimed to describe the perspectives of current medical students regarding LGBTQ+ education and the acceptance of LGBTQ+ trainees among different specialties.

MATERIALS AND METHODS

A cross-sectional voluntary and anonymous online survey was distributed through REDCap to all medical students (n = 495) at a state medical school. Medical students' sexuality and gender identity were queried. A descriptive statistical analysis was performed, and the responses were classified into two groups: LGBTQ+ and non-LGBTQ+.

RESULTS

A total of 212 responses were queried. Of the respondents who agreed that certain specialties are less welcoming to LGBTQ+ trainees (n = 69, 39%), orthopedic surgery, general surgery and neurosurgery were identified most frequently (84%, 76%, and 55%, respectively). After analyzing sexual orientation as an influence on choosing a future specialty for residency, only 1% of non-LGBTQ+ students indicated that their sexual orientation influences their specialty of choice in comparison with 30% of LGBTQ+ students (P < 0.001). Finally, more non-LGBTQ+ students indicated that they believe they are receiving appropriate education on caring for LGBTQ+ patients as compared to LGBTQ+ students (71% and 55%, respectively, P < 0.05).

CONCLUSIONS

LGBTQ+ students are still hesitant to pursue careers in General Surgery as compared to their non-LGBTQ+ peers. The perception that surgical specialties are the least welcoming to LGBTQ+ students continues to be a concern for all students. Further strategies of inclusivity and their effectiveness need to be studied.

The Current State of Workforce Diversity and Inclusion in Pediatric Critical Care

Literature suggests the pediatric critical care (PCC) workforce includes limited providers from groups underrepresented in medicine (URiM; African American/Black, Hispanic/Latinx, American Indian/Alaska Native, Native Hawaiian/Pacific Islander). Additionally, women and providers URiM hold fewer leadership positions regardless of health-care discipline or specialty. Data on sexual and gender minority representation and persons with different physical abilities within the PCC workforce are incomplete or unknown. More data are needed to understand the true landscape of the PCC workforce across disciplines. Efforts to increase representation, promote mentorship/sponsorship, and cultivate inclusivity must be prioritized to foster diversity and inclusion in PCC.

LGBTQ+ Perspective in Hand Surgery: Surgeon and Patient

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) individuals and patients face high levels of discrimination both in the workplace and in the clinic setting, with more than 25% of LGBTQ+ people experiencing discrimination in the workplace due to their sexual orientation. Hand Surgery stands to continue to advance by encouraging the brightest students into the field no matter their background. LGBTQ+ patients also have specific needs within the field of Hand Surgery, where we are uniquely positioned to treat them or guide them by being well versed in the needs of the community.

Preparedness of final year medical students in caring for lesbian, gay, bisexual, and transgender patients with mental illness

Background

Lesbian, gay, bisexual, and transgender (LGBT) individuals have a higher prevalence of mental illness compared to the general population. Discriminatory behaviour from mental health care providers impedes access to culturally competent mental health care. Undergraduate psychiatry education plays an important role in adequately preparing medical doctors to care for mental illness in LGBT patients.

Aim

This study aims to assess the knowledge, attitudes and clinical preparedness of final-year medical students in caring for LGBT patients after completion of their psychiatry rotation.

Setting

Faculty of health sciences at a large public university in Gauteng.

Methods

This was a cross-sectional study using an anonymous self-administered questionnaire. The questionnaire comprised demographic data, the lesbian, gay, bisexual, and transgender development of clinical skills scale (LGBT-DOCSS) and questions relating to their subjective knowledge and preparedness in LGBT mental health care. The LGBT-DOCSS is a validated tool consisting of three subscales: basic knowledge, attitudinal awareness, and clinical preparedness.

Results

Data from 170 final-year students were used in the analyses. Participants scored within the low range for clinical preparedness and basic knowledge subscales but high in the attitudinal subscale. Gender, sexual orientation and academic background were associated with higher overall scores and higher basic knowledge and attitudinal awareness scores.

Conclusion

Final-year medical students were not adequately prepared in caring for LGBT patients with mental illness as indicated by the LGBT-DOCSS.

Contribution

This study identifies a gap in undergraduate psychiatric training in providing culturally competent mental health care for a vulnerable population.

Diversity and Career Goals of Graduating Allopathic Medical Students Pursuing Careers in Dermatology

Importance

Dermatology is one of the least diverse specialties, while patients from minority racial and ethnic groups and other underserved populations continue to face numerous dermatology-specific health and health care access disparities in the US.

Objectives

To examine the demographic characteristics and intended career goals of graduating US allopathic medical students pursuing careers in dermatology compared with those pursuing other specialties and whether these differ by sex, race and ethnicity, and/or sexual orientation.

Design, Setting, and Participants

This secondary analysis of a repeated cross-sectional study included 58 077 graduating allopathic medical students using data from the 2016 to 2019 Association of American Medical Colleges Graduation Questionnaires.

Main Outcomes and Measures

The proportion of female students, students from racial and ethnic groups underrepresented in medicine (URM), and sexual minority (SM) students pursuing dermatology vs pursuing other specialties. The proportions and multivariable-adjusted odds of intended career goals between students pursuing dermatology and those pursuing other specialties and by sex, race and ethnicity, and sexual orientation among students pursuing dermatology.

Results

A total of 58 077 graduating students were included, with 28 489 (49.0%) female students, 8447 (14.5%) URM students, and 3641 (6.3%) SM students. Female students pursuing dermatology were less likely than female students pursuing other specialties to identify as URM (96 of 829 [11.6%] vs 4760 of 27 660 [17.2%]; P < .001) or SM (16 [1.9%] vs 1564 [5.7%]; P < .001). In multivariable-adjusted analyses, students pursuing dermatology compared with other specialties had decreased odds of intending to care for underserved populations (247 of 1350 [18.3%] vs 19 142 of 56 343 [34.0%]; adjusted odd ratio [aOR], 0.40; 95% CI, 0.35-0.47; P < .001), practice in underserved areas (172 [12.7%] vs 14 570 [25.9%]; aOR, 0.40; 95% CI, 0.34-0.47; P < .001), and practice public health (230 [17.0%] vs 17 028 [30.2%]; aOR, 0.44; 95% CI, 0.38-0.51; P < .001) but increased odds of pursuing research (874 [64.7%] vs 29 121 [51.7%]; aOR, 1.76; 95% CI, 1.57-1.97; P < .001) in their careers. Among students pursuing dermatology, female, URM, and SM identities were independently associated with increased odds of caring for underserved populations (eg, URM: aOR, 4.05; 95% CI, 2.83-5.80) and practicing public health (eg, SM: aOR, 2.55; 95% CI, 1.51-4.31). URM students compared with non-URM students pursuing dermatology had increased odds of intending to practice in underserved areas (aOR, 3.93; 95% CI, 2.66-5.80), and SM students compared with heterosexual students pursuing dermatology had increased odds of intending to become medical school faculty (aOR, 1.60; 95% CI, 1.01-2.57), to pursue administrative roles (aOR, 1.60; 95% CI, 1.01-2.59), and to conduct research (aOR, 1.73; 95% CI, 1.01-2.98).

Conclusions and Relevance

The findings of this cross-sectional study suggest that diversity gaps continue to exist in the dermatology workforce pipeline. Efforts are needed to increase racial and ethnic and sexual orientation diversity and interest in careers focused on underserved care and public health among students pursuing dermatology.

Diversity bias in colorectal surgery: a global perspective

There is a specific lack of data on equity and injustices among colorectal surgeons regarding diversity. This study aimed to explore colorectal surgeon's lived experience of diversity bias with a specific focus on gender, sexual orientation or gender identity and race or religion. A bespoke questionnaire was designed and disseminated to colorectal surgeons and trainees through specialty association mailing lists and social media channels. Quantitative and qualitative data points were analysed. 306 colorectal surgeons responded globally. 58.8% (n = 180) identified as male and 40.5% (n = 124) as female. 19% were residents/registrars. 39.2% stated that they had personally experienced or witnessed gender inequality in their current workplace, 4.9% because of sexual orientation, and 7.5% due to their race or religion. Sexist jokes, pregnancy-related comments, homophobic comments, liberal use of offensive terms and disparaging comments and stereotypical jokes were commonly experienced. 44.4% (n = 135) did not believe their institution of employer guaranteed an environment of respect for diversity and only 20% were aware of society guidelines on equality and diversity. Diversity bias is prevalent in colorectal surgery. It is necessary to work towards real equality and inclusivity and embrace diversity, both to promote equity among colleagues and provide better surgical care to patients.

Attitudes Among General Surgery Program Directors and Faculty Toward Openly Nonheterosexual Applicants

OBJECTIVE

Historically, nonheterosexual physicians have experienced bias in medical training. While resident-focused studies have been conducted in general surgery, the views of program directors and faculty are less evident. In this study, we surveyed program directors and faculty in general surgery to assess their attitudes toward openly nonheterosexual residency applicants.

DESIGN

A national, cross-sectional online survey.

PARTICIPANTS

Program directors and faculty in general surgery listed on the Association of Program Directors in Surgery listserv.

RESULTS

Of the 123 participants who returned the survey; 33% were faculty and 58% were program directors. The response rate was 28% for program directors and 13% for faculty. Of respondents, 68% reported having openly nonheterosexual residents in their program and 38% were aware the candidates were nonheterosexual when they ranked them. Most respondents (76%) would advise a nonheterosexual mentee to be honest about their sexuality if asked during the interview and application process for general surgery (Figure 1). Of respondents, 84% reported that knowing an applicant was nonheterosexual would not affect how they ranked them while 76% reported that their program's faculty would always feel comfortable if a nonheterosexual resident brought their partner to a residency social event.

CONCLUSIONS

To our knowledge, this is the first survey of general surgery program directors regarding their attitudes toward nonheterosexual residency applicants. While a few individuals continue to hold biased beliefs, there appears to be substantial acceptance of nonheterosexual general surgery residency candidates amongst program directors and faculty who responded to our survey.

Association of Marginalized Identities With Alpha Omega Alpha Honor Society and Gold Humanism Honor Society Membership Among Medical Students

IMPORTANCE

Disparities in medical student membership in Alpha Omega Alpha (AOA) are well documented. Less is known about Gold Humanism Honor Society (GHHS) membership and it remains unknown how the intersection of different identities is associated with membership in these honor societies.

OBJECTIVE

To examine the association between honor society membership and medical student race and ethnicity, sex, sexual orientation, socioeconomic status, and intersection of identities.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study analyzed data from Association of American Medical Colleges data collection instruments. The study included all students who graduated from Liaison Committee on Medical Education-accredited US medical schools from 2016 to 2019 and completed the Graduation Questionnaire. Data analysis was conducted from January 12 to July 12, 2022.

MAIN OUTCOMES AND MEASURES

Likelihood of AOA and GHHS membership by student race and ethnicity, sex, sexual orientation, childhood family income, and intersection of identities.

RESULTS

The sample of 50 384 individuals comprised 82 (0.2%) American Indian or Alaska Native, 10 601 (21.0%) Asian, 2464 (4.9%) Black, 3291 (6.5%) Hispanic, 25 (0.1%) Native Hawaiian or Pacific Islander, 30 610 (60.8%) White, 2476 (4.9%) multiracial students, and 834 (1.7%) students of other races or ethnicities. Sex and sexual orientation included 25 672 (51.0%) men and 3078 (6.1%) lesbian, gay, and bisexual (LGB). Childhood family income comprised 31 758 (60.0%) individuals with $75 000 per year or greater, 8160 (16.2%) with $50 000 to $74 999 per year, 6864 (13.6%) with $25 000 to $49 999 per year, and 3612 (7.2%) with less than $25 000 per year. The sample included 7303 (14.5%) AOA members only, 4925 (9.8%) GHHS members only, and 2384 (4.7%) members of both societies. In AOA, American Indian or Alaska Native (OR, 0.49; 95% CI, 0.25-0.96), Asian (OR, 0.49; 95% CI, 0.45-0.53), Black (OR, 0.25; 95% CI, 0.20-0.30), Hispanic (OR, 0.53; 95% CI, 0.47-0.59), multiracial (OR, 0.69; 95% CI, 0.62-0.77), and other race and ethnicity (OR, 0.73; 95% CI, 0.60-0.88) were underrepresented compared with White students; LGB students (OR, 0.75; 95% CI, 0.67-0.83) were underrepresented compared with heterosexual students; and childhood family income $50 000 to $74 999 (OR, 0.81; 95% CI, 0.75-0.86), $25 000 to $49 999 (OR, 0.68; 95% CI, 0.62-0.74), and less than $25 000 (OR, 0.60; 95% CI, 0.53-0.69) were underrepresented compared with greater than or equal to $75 000. In GHHS, Asian students (OR, 0.80; 95% CI, 0.73-0.87) were underrepresented compared with White students, female students (OR, 1.55; 95% CI, 1.45-1.65) were overrepresented compared with male students, LGB students (OR, 1.36; 95% CI, 1.23-1.51) were overrepresented compared with heterosexual students, and students with childhood family income $25 000 to $49 999 (OR, 0.85; 95% CI, 0.78-0.94) and less than $25 000 (OR, 0.75; 95% CI, 0.66-0.86) were underrepresented compared with those with greater than or equal to $75 000. Likelihood of AOA, but not GHHS, membership decreased as number of marginalized identities increased.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study of US medical students, membership disparities were noted in both AOA and GHHS. However, differences in GHHS existed across fewer identities, sometimes favored the marginalized group, and were not cumulative.

LGBTQ+ Affirming Care May Increase Awareness and Understanding of Undetectable = Untransmittable among Midlife and Older Gay and Bisexual Men in the US South

One of the most significant innovations in HIV prevention is the use of HIV treatment to prevent HIV transmission. This information has been disseminated as the "Undetectable = Untransmittable" (U = U) message. Despite evidence of effectiveness, U = U awareness, belief, and understanding remains limited in some communities. In this study, we examine whether having an LGBTQ affirming healthcare provider increases U = U awareness, belief, and understanding among midlife and older gay and bisexual men in the US south, an understudied and underserved population and region where new HIV infections are increasing. We used data from the Vanderbilt University Social Networks Aging and Policy Study (VUSNAPS) on sexual minority men aged 50 to 76 from four southern US states collected in 2020-2021. We found that only one in four men reported prior awareness of U = U, but awareness was higher among men who have an LGBTQ affirming provider. Among HIV negative men, those with an affirming provider were more likely to believe and understand U = U, have more accurate risk perception, and have ever tested for HIV. Improving access to LGBTQ affirming healthcare may improve U = U awareness, belief, and understanding, which could help to curb HIV transmission in the US south.

The State of the LGBTQ+ Community in Surgery

The LGBTQ+ community is a diverse community that faces unique needs and multidimensional form of discrimination. Cultural awareness and awareness of intersectionality of experiences are essential in creating an equitable environment for health care professionals and patients.

LGBTQ+ in Orthopaedics: Creating an Open and Inclusive Environment

Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) individuals may encounter added challenges in the healthcare setting. Both providers and patients may face discrimination based on their sexual orientation or gender identity, which may lead to avoidance or delay in seeking care. LGBTQ+ physicians often choose not to disclose their sexual orientation because of concerns about harassment, isolation, and depression. Orthopaedic surgery remains the least diverse medical specialty and there is inconsistent training about the needs and cultural issues that affect sexual and gender minority individuals. Furthermore, orthopaedic research specific to LGBTQ+ patients and physicians is exceedingly limited. By encouraging mentorship and improving awareness of the challenges that this community faces, the field of orthopaedic surgery can work to foster an open and inclusive environment that is conducive to the experience of all patients, trainees, and healthcare personnel.

Creating a Welcoming Surgery Residency Training Program for LGBTQ Trainees

General Surgery residencies have been perceived as unwelcoming to lesbian, gay, bisexual, transgender, and queer (LGBTQ) applicants. Historically, applicants have been reluctant to reveal their LGBTQ status when interviewing for residency positions and LGBTQ surgery residents are more likely to consider leaving their residency. Despite the increased acceptance in society and calls for diversity by governing bodies, there is a perception that the field of surgery is lagging behind. In this article, we summarize the recent literature concerning LGBTQ status in surgery residencies and the impact it has on students and trainees. We then review the recent calls to action to remedy the identified shortcomings. We then share what has been done by our surgery residency, which has been successful in recruiting LGBTQ-identifying residents and summarize recommendation for moving forward.

LGBT + medical students and disclosure of their sexual orientation: more than in and out of the closet

Medical students face many challenge in their academic path. The disclosure of their own sexual orientation may be problematic since it impacts negatively on their acceptance in the educational environmental and the course of their career. Mental health issues may also occur among medical students as consequences of their perceived homophobia as well as stigma after the coming out. Research shows that students' attitude to the sexual orientation disclosure may vary across countries and cultures as well as students' homophobic attitudes towards sexual minorities: the latter should be addressed since prejudice might affect the quality of medical care for LGBT+ (Lesbian, Gay, Bisexual, Transgender) patients. We suggest that more education and training on LGBT + health issues is needed in the medical students' core-curricula: this would improve the health care of sexual minorities and LGBT + students' acceptance in the academic milieu.

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

IMPORTANCE

The perspectives of gay, lesbian, bisexual (sexual minority [SM]) students about their medical school learning environment and how they relate to burnout is poorly understood.

OBJECTIVE

To understand SM medical students' perceptions of the medical school learning environment and how this is associated with reported burnout.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study included medical students graduating from Association of American Medical Colleges (AAMC)-accredited allopathic US medical schools in 2016 and 2017 and responding to the AAMC Graduation Questionnaire. Data analysis was conducted from June 2021 to March 2022.

EXPOSURES

Sexual orientation, based on self-identification, and categorized as bisexual, gay or lesbian, or heterosexual or straight.

MAIN OUTCOMES AND MEASURES

Primary outcomes included burnout as measured by Oldenburg Burnout Inventory for Medical Students (OLBI-MS; two 24-point scales [range, 0-48], with higher scores indicating greater burnout) and student perceptions of the medical school learning environment (0-5-point scales for emotional climate [range, 0-20] and student-faculty interactions [range, 0-15], with higher scores indicating more positive perceptions). Logistic regression was used to model the association between burnout, SM status, and learning environment while controlling for demographic characteristics.

RESULTS

A total of 25 757 respondents (12 527 [48.6%] women; 5347 [20.8%] Asian; 2255 [8.8%] underrepresented in medicine; 15 651 [60.8%] White; 10 726 [41.6%] aged ≤26 years) were included in the analysis: 568 (2.2%) self-identified as bisexual, 854 (3.3%) as gay or lesbian, and 24 335 (94.5%) as heterosexual or straight. Both bisexual students and gay or lesbian students reported less favorable perceptions of their learning environments than heterosexual students (mean [SD] emotional climate score, bisexual students: 8.56 [3.29]; gay or lesbian students: 9.22 [3.33]; heterosexual or straight students: 9.71 [3.20]; P < .001; mean [SD] faculty-student interaction score, bisexual students: 13.46 [3.69]; gay or lesbian students: 14.07 [3.45]; heterosexual or straight students: 14.32 [3.37]; P < .001). Bisexual and gay or lesbian students were more likely to be in the top quartile for burnout scores (bisexual: odds ratio [OR], 1.71; 95% CI, 1.42-2.07; P < .001; gay or lesbian: OR, 1.53; 95% CI, 1.31-1.79; P < .001). This association was attenuated when accounting for student perceptions of the learning environment (bisexual: OR, 1.37; 95% CI, 1.11-1.67; P < .001; gay or lesbian: OR, 1.42; 95% CI, 1.19-1.68; P < .001), with poorer perceptions of the medical school learning environment associated with higher burnout symptoms.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, SM students had less favorable perceptions of the medical school learning environment compared with heterosexual students. Results suggest the medical school environment may be associated with higher rates of burnout in SM students. Future research should explore interventions to improve the learning environment for SM students.

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

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.

Sexual Orientation Diversity and Specialty Choice Among Graduating Allopathic Medical Students in the United States

This survey study examines the prevalence of gay, lesbian, or bisexual individuals among graduating allopathic medical students by specialty choice in the US.

Factors influencing emergency medicine residency choice: Diversity, community, and recruitment red flags

BACKGROUND

Emergency medicine (EM) applicants consider many factors when selecting residency programs. Prior studies have demonstrated that applicants consider geography as well as modifiable/nonmodifiable program factors. Less attention, however, has been paid to underrepresented groups. Additionally, the prevalence and characteristics of "red flags," or factors that may lead an applicant to lower a program's rank or not rank it at all, remain unknown in EM. Our objective was to describe the factors that influence current EM-bound medical students' residency selection focusing on underrepresented applicants and red flags encountered during the recruitment process.

METHODS

We conducted a mixed-methods survey study of EM-bound graduates from U.S. medical schools in the 2020 application cycle. Quantitative analysis included descriptive statistics, measures of central tendency, 95% confidence intervals (CIs), nonparametric tests for ordinal data, and logistic regression. For the qualitative portion of the study, two independent reviewers performed a thematic analysis of the red flag free-text responses. Discrepancies were addressed via consensus with third-party oversight.

RESULTS

Our survey response rate was 49%, and most applicants considered both geographic and program factors. Underrepresented applicants prioritized program diversity, program commitment to the underserved, neighborhood/community, and patient population. Of all respondents, 71% reported red flags. Women had a significantly higher odds of encountering red flags (odds ratio = 1.64, 95% CI = 1.25 to 2.18). Red flags included seven key themes: violations of regulatory standards, program characteristics, interview day experience, program culture, interpersonal interactions, lack of fit, and quality of life; subthemes included lack of diversity and racism.

CONCLUSIONS

Modifiable/nonmodifiable program factors and geography continue to influence EM-bound applicants' residency choices. Underrepresented applicants place a higher value on diversity, community, and patients served. Residency programs should consider modifiable factors and self-assess for red flags to successfully recruit the next generation of EM physicians.

Current Status and Future Strategies for Mentoring Women in Neurology

The American Academy of Neurology's (AAN) 2017 Gender Disparity Report identified improving mentorship as a key intervention to fill the leadership and pay gaps for women in neurology. Here we summarize the literature on mentoring women, provide an outline of ideal components of programs geared toward closing gender gaps, and present a mentoring program for AAN members. The strategies discussed share similarities with those for closing gaps related to race, ethnicity, and religion. Developing effective mentorship and sponsorship programs is essential to ensure a sufficiently diverse pool of academic faculty and private practitioners and to establish equal representation in leadership roles in this field.