Fears of discrimination from faculty, peers and patients continue to pressure many in the lesbian, gay, bisexual and transgender community to stay “in the closet” while in medical school, according to a Stanford study published today in Academic Medicine.
Some medical students worry that "coming out" could affect their grades; others are influenced by homophobic or sexist remarks overheard from peers and faculty to keep their sexual or gender identity hidden, according to the results of an online survey sent by the study’s authors to medical students throughout the U.S. and Canada. One respondent recounted an appointment during a surgery rotation with a transgender patient who was “treated like a freak by the residents and attendings behind closed doors, joking at his expense.”
The study, authored by members of the Stanford Lesbian, Gay, Bisexual & Transgender Medical Education Research Group, was accompanied by a commentary that maintains the medical community is less accepting of sexual and gender minorities than the business or law communities. From a press release I wrote on the study:
"There is still this huge percentage of medical students who are afraid of discrimination in medical school and how it could affect the rest of their careers," said Mitchell Lunn, MD, a co-author of both papers and co-founder of Stanford's LGBT research group. "We are supposed to be a field that is accepting of people and one that takes care of people regardless of differences, and yet we can’t even do that for people who are part of our own community."
The study found that a third of sexual minority medical students choose to remain "in the closet" during medical school, 40 percent of medical students who identify as "not heterosexual" are afraid of discrimination in medical school, and two-thirds of gender minority medical students (those identifying as something other than male or female) conceal their gender identity during medical school.
The results were not surprising to first author Matthew Mansh, a fourth-year medical student at Stanford who has been openly gay since he was 17. As he told me:
There were definitely times, more so during my clinical years, when I didn’t go out of my way to let people know I was gay for reasons similar to some of the reasons the medical students in the survey gave. A lot of grading in medical school is very subjective. I have met physicians who make sexist or homophobic remarks, and it makes you not want to come out. You don’t want your personal identity to affect your grade.
A blog entry published yesterday in KevinMD doesn’t leave a lot of hope that these concerns disappear for medical students once they graduate and head toward residencies. Shane Morrison, MD, who graduated from Stanford last year, gives a heartfelt description of his fears about revealing his interests in transgender surgeries as his reason for entering the field of plastic surgery:
I still can’t articulate my feelings: a mixture of shame, anger, and worry in addition to the anxiety of my approaching interview... Though these interviews would determine my fate in the competitive and exciting field of plastic surgery, my uneasiness derived from wanting to say to the plastic surgeons interviewing me for residency, 'I want to do gender affirming surgery.' I wanted this secret to come out... Yet, I feared that talking about working with the transgender community would impact my candidacy. ... Anything that makes you look 'weird' will be held against you in the pool of the most elite candidates in medical school,' one of my mentors told me.
The good news is Morrison overcame these fears and is now a resident in plastic and reconstructive surgery at the University of Washington.
Previously: A call for more training on LGBT health issues, Medical schools neglect LGBT issues and Gay, lesbian, bisexual and transgendered health issues not being taught in medical school
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