“It’s hard to know who you can trust.”
Those are the words of a 26-year-old gay student at a U.S medical school who participated in a Stanford University School of Medicine study examining the experiences of sexual and gender minority medical students. In particular, the survey focused on the barriers these students face when coming out to their colleagues and professors.
[Above: Above: Alvin Poussaint, MD, a professor of psychiatry and an administrator at Harvard Medical School, celebrates National Coming Out Day.]
The results of the study are alarming. Sixty percent of students who reported a gender minority identity said they were not “out” at their medical school. Lack of support and fear of discrimination were large factors in these students’ decisions to keep their sexual identity private. The numbers aren’t any better for students who reported a sexual minority identity; 53.9 percent of students who identified as bisexual and 92 percent of those who identified as questioning reported that they were not “out” at school.
The harsh reality is that it’s not just hard for LGBTQ individuals to know whom to trust in medical school, it’s also difficult for them to know whom to trust in any medical setting. In a survey conducted by the National Center for Transgender Equality and the National Gay and Lesbian Task Force, 19 percent of respondents reported being refused healthcare services because of their transgender or gender-nonconforming status, 28 percent reported experiencing harassment in a medical setting, and 2 percent reported experiencing violence in a doctor’s office.
Jessica Halem, the LGBT program director in Harvard Medical School’s Office for Diversity Inclusion and Community Partnership, says there’s no question that LGBTQ people aren’t getting the medical care they need and deserve. “There are huge disparities faced by LGBTQ people when it comes to medicine and their health,” she says. “And it’s up to the healthcare community to fix itself.”
That fix starts with making sure LGBTQ students feel welcome and included in medical schools, from recruitment through graduation, says Halem. She thinks medical schools can accomplish this objective if they look at it as a three-step process: diversity, inclusion, and advocacy.
According to Halem, the lowest acceptable bar is diversity. Faculty and students must abide by federal, state, and university rules forbidding discrimination, but that’s hardly enough, she says. It’s essential that medical schools move from that baseline on to step two, inclusion — which, Halem says, is when students feel truly welcomed. She believes LGBTQ individuals shouldn’t be forced to choose between studying medicine and exploring their identities. Straight and cisgender students don’t ever have to make that choice; they see their identities and histories reflected everywhere.
By making sure content that reflects LGBTQ experiences is integrated across the curriculum, medical schools can give these students that same sense of acknowledgement and appreciation that straight and cisgender students receive — and set them up to give back to the medical world in a big way.
“When I think about young trans and gender-nonconforming individuals, I see a group of people that is being misunderstood and mistreated by medicine at every turn, but I also see people who are really taking medicine into their own hands in extremely exciting ways,” says Halem. “They’re learning things at a young age, taking on knowledge about hormones and their bodies; I don’t think their straight counterparts have ever had to think about their bodies in that same way.”
One barrier to making sure LGBTQ students feel included is a lack of mentors, says Tiffany Delaney, director of the Office of Diversity and Inclusion at the Robert Larner College of Medicine at the University of Vermont. “During medical school, students often lack a breadth of LGBTQ physician mentors who can help guide them around issues of professional development.”
Halem has noticed a similar pattern, and she’s on a mission to change it. She would like medical students at Harvard to have more than just one or two LGBTQ faculty members to advise them. “I want [mentors] to be in different specialties, different career phases, married, have kids on the job, [be] doing research — LGBTQ faculty who are doing LGBTQ research and want to bring LGBTQ students along with them.”
But making sure students have LGBTQ mentors still isn’t enough, says Halem. Straight and cisgender faculty and students also need to be working to create an inclusive environment. “I work with faculty one on one in their courses to figure out how sex and gender, and particularly sexuality, … come into play in their specific class and how I can help them organically integrate [into that] this new way of seeing the world, this new language, and this new understanding of how people live their lives.”
Working directly with students is important as well, says Delaney. Her team collaborates with student services and a number of student interest groups, including the college’s Gender and Sexuality Alliance (GSA), to increase understanding of the LGBTQ community.
Last spring, GSA students assisted with the college’s #pushforpronouns campaign, which encouraged members of the medical community to make sure their email signatures and name tags included their pronouns. The goal was to create a more respectful environment.
Efforts like these are what Halem is referring to when she talks about moving from inclusion to advocacy. And, as important as student-led initiatives are, she wants to see activism by medical school faculty as well. She finds it encouraging when teaching hospital departments reach out to her asking how they can help, and she believes it’s incredibly important that the information these professionals are seeking come directly from a human being rather than from a webinar or a pamphlet.
In Halem’s experience, 99 percent of the people she works with end up having an “ah-ha” moment when they understand the importance of making LGBTQ students and patients feel welcome. “You can’t put webinars up and think that everyone gets it now. This is still a very human-to-human interaction,” she says. “[We] really need to tell the story about sex and gender in our lives and the struggle that people go through.”
Halem says she’s seen a lot of progress at Harvard Medical School, but it still has some areas to work on. Her main concern is finding a better way for students to provide feedback when they encounter a situation that makes them feel uncomfortable, be it in the classroom, hospital, or hallway.
“I think some schools are using a heavy bias-incident model,” says Halem. “I’m looking for a learning-opportunity call line — how do we create an environment in a graduate school where faculty are constantly learning?”
The bottom line, Delaney says, is “having a welcoming community that not only supports our LGBTQ medical students on their path to becoming caring and competent physicians, but also reminds us that it is patients who are at the center of the practice of medicine — and we must ensure inclusive and welcoming treatment for all.”●
Alice Pettway is a contributing writer for INSIGHT Into Diversity.