Sexual and Gender Minority Identity Disclosure During Undergraduate Medical Education: “In the Closet”
in Medical School
Matthew Mansh, William White, MA, Lea Gee-Tong, Mitchell R. Lunn, MD, Juno Obedin-Maliver, MD, MPH, Leslie Stewart, MD, Elizabeth Goldsmith, MD, MS, Stephanie Brenman, MD, Eric Tran, MFA, Maggie Wells, David Fetterman, PhD, and Gabriel Garcia, MD
To assess identity disclosure among sexual and gender minorities (SGMs) pursuing undergraduate medical training in the United States and Canada.
From 2009 to 2010, a survey was made available to all medical students enrolled in the 176 MD- and DO-granting medical schools in the United States and Canada. Respondents were asked about their sexual and gender identity, whether they were “out” (i.e., had publicly disclosed their identity), and, if they were not, their reasons for concealing their identity. The authors used a mixed-methods approach and analyzed quantitative and qualitative survey data.
Of 5,812 completed responses (of 101,473 eligible respondents, response rate: 5.7%), 920 (15.8%) students from 152 (of 176, 86.4%) institutions identified as SGMs. Of the 912 sexual minorities, 269 (29.5%) concealed their sexual identity in medical school. Factors associated with sexual identity concealment included sexual minority identity other than lesbian or gay, male gender, East Asian race, and medical school enrollment in the South or Central regions of North America. The most common reasons for concealing one’s sexual identity were nobody’s business (165/269, 61.3%), fear of discrimination in medical school (117/269, 43.5%), and social or cultural norms (110/269, 40.9%). Of the 35 gender minorities, 21 (60.0%) concealed their gender identity, citing fear of discrimination in medical school (9/21, 42.9%) and lack of support (9/21, 42.9%).
SGMs continue to conceal their identity during undergraduate medical training. Medical institutions should adopt targeted policies and programs to better support these individuals during training.