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Association of American Medical Colleges Tomorrow's Doctors, Tomorrow's Cures®

Changing Times for LGBT Population Affect Medical Schools and Teaching Hospitals

—By Allison Prescott, special to the Reporter

When the AAMC released survey data in 2007 showing that one-fifth of respondents knew of mistreatment toward lesbian, gay, bisexual, and transgendered (LGBT) medical students, medical school officials were surprised.

Four years later, LGBT experts and advocates are working to change policies at medical schools, in the health care system, and in society at large. And while challenges remain, the future for LGBT medical students, physicians, and patients looks brighter.

LGBT issues have received extra attention lately as gay marriage, the repeal of the military’s “don’t ask, don’t tell” policy, and related matters gain national prominence. In the world of health care, Shane Snowdon, Ph.D., director of the University of California, San Francisco (UCSF) LGBT Resource Center, said longstanding perceptions of inequitable treatment at the clinic and hospital is another issue growing ripe for discussion.

“As our society as a whole becomes more aware of LGBT issues, that awareness is definitely reaching into health care,” Snowdon said. “There is no question that LGBT individuals have delayed and avoided health care for many decades. I think that is something that the health care system was unaware of for a long time.”

But changes are afoot. The Joint Commission, for example, now requires hospitals to include “sexual orientation” and “gender identity” in their non-discrimination statements. The U.S. Department of Health and Human Services is expected to propose regulations allowing same-sex partners to be listed as patient family members and emergency contacts. This particular issue, Snowdon said, could mean more LGBT patients will seek care. But the issue could be advanced even more in the halls of the nation’s medical schools.

“An LGBT patient may worry about whether their loved one should be identified as such, or whether they will be treated in a biased way,” Snowdon said. “That’s going to have to be addressed over time in how we train physicians, residents, and other house staff, so the surprise factor surrounding LGBT status goes down, and care becomes more equitable.”

Medical training on LGBT issues is only one side of the coin for medical schools and teaching hospitals. Reports like the AAMC survey find that challenges for LGBT medical students begin during the application process, when they may face uncertainty about whether or not to be “out” on applications, Snowdon said.

Once accepted, medical students may encounter even greater challenges, including “underprepared faculty and staff, negative comments in and out of the classroom, and limited LGBT content in the curriculum,” Snowdon added. Nevertheless, Mitchell Lunn, M.D., a graduate of Stanford University School of Medicine who co-founded the school’s LGBT Medical Education Research Group and is now a resident at Brigham and Women’s Hospital in Boston, said his experience was “pretty good.” By and large, officials said medical schools provided a welcoming environment for LGBT students, even if pockets of discrimination or insensitivity persist. They also are quick to stress that LGBT discrimination in health care and medical education is not disproportionate to that found in the general populace.

Samuel Parrish, M.D., said he has seen several incidents of mistreatment during his 10 years as associate dean for student affairs and admissions at Drexel University College of Medicine. Parrish described most incidents of bias and discrimination at medical schools as “offhanded, homophobic comments in clinical settings.”

Lunn suspects most of these comments are not malicious, but are “fueled by a lack of knowledge and sensitivity. Many are old jokes, and some people don’t realize that they’re unacceptable.” Still, Snowdon said certain institutions continue to struggle with homophobia and related problems.

“I have traveled to medical schools around the country for 11 years, and know hundreds of LGBT medical students,” Snowdown said. “From this experience, I would say there are still serious issues for LGBT students. At some schools, students deliberately stay closeted because of their con-cerns.”

The practice of staying closeted can bring its own problems.

“There are studies in psychology that show that when you are hiding and concealing a fundamental aspect of your identity, it takes a toll,” Snowdon said. “It can affect academic performance both directly and indirectly.”

The 2007 AAMC survey found that many medical students are unaware of how to report incidents, or are nervous about doing so.

“Students know how quickly word travels,” Lunn said, “and when it comes time for evaluations and residency applications, they don’t want the offending faculty member to single them out, possibly hindering their chances of admission.”

With this in mind, some medical schools have changed their reporting systems to make them safer. Drexel allows a student to anonymously submit a complaint and be quickly transferred, if necessary, to a new clinical training site. Offending clinicians can receive sensitivity training and education or, in extreme cases, be banned from working with students. Stanford provides students with the option to delay faculty notification, in case they feel more comfortable waiting until after evaluations are complete.

Jonathan Appelbaum, M.D., director of internal medicine education at Florida State University College of Medicine and a member of the AAMC’s Group on Diversity and Inclusion (GDI), said education itself is key to fostering an LGBT-friendly environment.

“There is a huge lack of knowledge about LGBT people and health issues in the medical community,” Appelbaum said.

UCSF School of Medicine has incorporated LGBT issues, from health disparities to building a sexual history, into its curriculum. For example, two LGBT case studies simulate real-world situations, while three hours of didactic instruction dedicated to LGBT health gives students a comprehensive understanding of LGBT health care.

“Having LGBT instruction in the curriculum improves the social and educational climate through direct education,” Lunn said. “This yields greater understanding and awareness. When the climate improves, [I would think that] schools would see fewer incidents of discrimination and bias.”

Medical schools also are working to better support LGBT students. At UCSF, an “out list” publicly lists openly LGBT students and faculty to help facilitate collegiality and networking. Open LGBT faculty members “send the message that they can advance academically and rise to high-ranking positions at an academic institution,” Parrish said.

The AAMC also is working to bring these issues to the fore. In November, the association’s Group on Student Affairs started an LGBT subcommittee that will make recommendations on the resources medical schools should have available for LGBT students in order to foster a welcoming and equitable environment. In addition, the GDI has established working groups to advance LBGT priorities in the elimination of health disparities and achieving health care equity.

“The situation is better now than it was even five or 10 years ago,” Appelbaum said. “Many medical students don’t even see it as much of an issue because a diverse learning environment seems only natural to them.”