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

Abstract

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.

Keywords:

• Medical education
• homophobia
• sexism
• transphobia
• inclusivity

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

LGBTQ+ – An umbrella term for members of the gender and/or sexual orientation minority community. This includes, but is not limited to, lesbian, gay, bisexual, transgender, gender diverse, non-binary, queer & questioning, asexual, intersex, and two-spirit.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Alana Sorgini

Alana Sorgini, MD, is a graduate of the Schulich School of Medicine, Western University, beginning residency training in obstetrics and gynaecology at the University of Ottawa.

Alexandra C. Istl

Alexandra Istl, MD, MPH, FRCSC, is an assistant professor and surgical oncologist at the Medical College of Wisconsin.

Mallory L. Downie

Mallory Downie, MD, PhD, FRCPC, is an assistant professor and paediatric nephrologist at McGill University.

Amrit Kirpalani

Amrit Kirpalani, MD, MEHP, FRCPC, is an assistant professor and member of the Academy of Educators at the Schulich School of Medicine and Dentistry, Western University. He is also a paediatric nephrologist at Children’s Hospital, London Health Sciences Centre.