Sexual and Gender Minority Identity Disclosure from Undergraduate to Graduate Medical Education: Perceptions of Professional “Outness” Among Medical Students

Abstract

Increasingly, medical schools and residency programs seek to recruit trainees from diverse backgrounds, including sexual and gender minority (SGM) people. However, many trainees do not disclose their SGM identity during medical training due to fear of discrimination, which remains a challenge for institutional diversity and inclusion efforts. Despite this, relatively few studies have rigorously quantified trainees’ SGM identity self-disclosure across different stages of medical training. In 2018 and 2019, the Medical Student Pride Alliance (MSPA) distributed a 33-item online questionnaire interrogating practices and attitudes about SGM identity disclosure to medical students at allopathic and osteopathic medical schools in the United States. Here, we analyze these data to compare 1) the degree to which medical students disclose SGM identity in various professional contexts during undergraduate and graduate medical training and 2) students’ attitudes regarding SGM identity disclosure across those contexts. Overall, 1,162 medical students from 125 medical schools responded to the survey. Of these respondents, 629 (54%) were SGM-identified. Among SGM-identified respondents, students were most likely to report SGM identity self-disclosure to peers (91%) and least likely to report SGM identity self-disclosure on applications to residency or post-doctoral work (29%). Cisgender women were less likely to report SGM identity self-disclosure than other genders, and students performing research were more likely to report SGM identity self-disclosure among mentors. Overall, most (>90%) survey respondents supported trainees’ ability to disclose their sexual orientation or gender identity during medical training. This exploratory study provides preliminary evidence that SGM-identifying medical students often do not disclose their sexual orientation or gender identity in evaluative professional contexts. Future work should assess this phenomenon in a larger national sample and propose targeted policies to support SGM inclusion throughout medical training in general and on applications to graduate medical education specifically.