AAMC Reporter: July 2007

Gay Discrimination Still Exists in Medical Schools

Your lifestyle is unnatural.

You should not be eligible to become a U.S. citizen.

Your opinion counts for less, because you are less than one person.

You should not become a doctor, nor should a doctor be permitted to treat you.

Some may assume that these remarks—each targeted toward gay, lesbian, bisexual, and transgender (GLBT) individuals—are nowadays confined to the shadier corners of society. That assumption may partially explain the surprise among members of academic medicine who learned recently that these and other anti-GLBT sentiments still exist on the nation's medical school campuses.

Separate surveys conducted during the 2005-2006 academic year by the AAMC's Group on Student Affairs (GSA) and Organization of Student Representatives (OSR) found that, while cases of discrimination and mistreatment are certainly few and far between, their existence is undeniable.

Approximately 15 percent of GSA survey respondents reported being aware of the mistreatment of GLBT students at their schools during the preceding academic year; 7 percent described the social, personal, and learning environments at their institution as "hostile" toward GLBT students.

On the OSR survey, up to 17 percent of self-reported GLBT student respondents reported hostile environments. Additionally, 34 percent of GSA and 53 percent of OSR survey respondents indicated that they were unaware of the existence of nondiscrimination statements at their schools and at school-based clinical training sites, despite the fact that every medical school has such a statement.

"This was a real wake-up call," said Samuel K. Parrish, M.D., associate dean for student affairs at Drexel University College of Medicine, and a member of the GSA national committee on student affairs. "We thought a lot of improvement had been made on this issue."

After encouraging results from a 1998 AAMC GLBT survey, organizers thought the 2005-2006 surveys would highlight issues such as domestic partner benefits.

"What we ended up finding, especially in our OSR survey feedback, was very sobering," Parrish said. "It really changed our focus.... It brought us back to recognizing that a respectful learning environment and a safe education was not present across the board."

"In some cases, it's downright hostile," Parrish said.

In isolated instances, the environment is hostile enough that some students felt their sexual or gender orientation factored in to performance evaluations. GLBT students named hospital clinical faculty, residents and interns, and nurses as the top sources of discrimination. A total of 3.2 percent of all respondents reported that they had been denied rewards or training opportunities based on sexual orientation either "once," "occasionally," or "frequently." And 4.2 percent reported lower evaluations or grades because of sexual orientation.

"A very small minority of students and faculty are intolerant, but we feel that one person is too many," said GSA national committee on student affairs chair Maureen J. Garrity, Ph.D., associate dean for student affairs at the University of Colorado School of Medicine. "There should be no tolerance for this kind of intolerance."

Medical students said the implications of GLBT discrimination transcend the classroom, and may set precedents for physician bias when dealing with future patients.

"Discrimination in any sense, if exhibited by faculty or staff, percolates down to anyone they work with, including the students," said James Littlejohn, OSR chair and a medical student at Texas A&M Health Science Center College of Medicine. "So this is teaching us that it is okay to discriminate against people."

Regardless of one's own opinion on GLBT issues, prejudging specific population segments can interfere with physician objectivity and, by extension, a physician's ability to treat patients, according to Garrity.

"We hold our doctors to very high standards in this society, and we expect them to put their personal feelings aside," Garrity said.

This phenomenon, however, may not be exclusive to medical schools in the world of higher education. A 2006 study conducted by the Law School Admission Council found that 7.2 percent of first-year law students and 23.6 percent of GLBT first-year law students witnessed some form of GLBT-based discrimination, while 2 percent of all first-year law students and 23.5 percent of first-year GLBT law students experienced such discrimination firsthand. Overall, however, the survey, titled "The Climate in Law Schools for GLBT Persons: Results from a Survey of Law Students," indicated that law students, like medical students, generally view their schools as being open and friendly toward GLBT populations. On a scale of 1 to 5 (with 5 being the most favorable rating), GLBT law students gave their schools an average rating of 3.6.

Spokespersons for the Association of American Colleges and Universities and the Association to Advance Collegiate Schools of Business said they do not collect information at the national level on their constituent groups' GLBT environments.

Ronni L. Sanlo, director of the University of California, Los Angeles' Lesbian, Bisexual, Gay, and Transgender Campus Resource Center and a former chair of the National Consortium of Directors of Lesbian, Gay, Bisexual, and Transgender Resources in Higher Education, said anti-GLBT sentiments may be increasing in higher education, although a general paucity of national data renders such judgments purely speculative, and makes it nearly impossible to pinpoint a cause.

"I think there is more harassment on a college campus these days," Sanlo said. "We're seeing a number of different things in this population. There is a huge sense of isolation among [GLBT] students. The vast majority are very closeted...and feeling like they don't want people to know who they are. So they are attempting to fit in in very negative ways."

The effort to "fit in" among GLBT students can lead to risky behaviors including drug abuse, promiscuity, and even sex work, Sanlo said.

It may not be a problem inherent only to medical schools, but AAMC student committee members said medical schools should hold themselves to the highest standards.

"I thought medical education had matured and progressed beyond all of this," Parrish said. "I thought we led the way."

The AAMC and its member institutions are now considering what comes next. For starters, the AAMC is formulating a set of GLBT "good practices" for medical schools, which is tentatively expected by November. The AAMC has already recommended changes in professional and curricular policies.

In general, according to Parrish, a good first step is reinforcing policies and statements that are already on the books.

"Medical schools should reaffirm that discrimination is not tolerated, and restate their commitment to respond to discrimination effectively and immediately," he said.

GLBT student and faculty mentoring programs can provide much-needed support structures. At the University of California, Davis, School of Medicine, Jesse P. Joad, M.D., the school's associate dean for faculty development and diversity, decided several years ago to create an informal social network for GLBT students and faculty. As a lesbian, Joad said she recognized the challenges to being a member of the GLBT population in any environment. Now, Joad e-mails an invitation to all students and faculty at the beginning of each academic year, and her trimonthly GLBT potlucks are drawing crowds.

"The biggest problem is not knowing who else is [GLBT]," she said. "So I tried to pull people together as much as possible, and I thought it would be good to have a social meeting. People know they have a place to go, and it's been extremely successful."

Mindy Young-Spint, a regular potluck attendee who recently began her general surgery residency at University of California, Davis Medical Center, said one challenge is knowing how and when to speak out.

"In many places, there is difficulty in creating a dialogue," she said. "In talking to undergrads, a lot of people are worried about coming out on their essays or applications. How much do you really want the school to know?"

Discrimination may be relatively uncommon, and free speech is always a consideration, but ensuring safety and optimum objectivity should be a high priority for academic medicine moving forward, said OSR's Littlejohn.

"Most schools say they don't have a problem with this, but if I had my druthers, I'd like to see every school create standards," he said. "Because even if it's not a problem now, it could be down the road."

—By Scott Harris

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