A couple of years ago a medical student who was considering gender transition contacted me to inquire about training as a surgeon. This gender-variant individual of color was attending a medical school somewhere in the Mid-West and had suffered appalling experiences of discrimination. After much soul-searching, they decided that no surgery training program would be safe enough, so they are now training in psychiatry. A few months ago a gay man emailed me from the Mid-West (is there a trend here?) to ask me what I thought of including his experience with conversion therapy in his medical school application.
Medical schools are supposed to be beacons of scientific inquiry populated by smart, educated, compassionate individuals working tirelessly to prevent, cure, or alleviate disease and suffering, and be inspired by social justice and ethical values to treat everyone equally. Really. Recent studies provide a sobering context to the experiences of the transgender medical student and the gay medical school applicant. In one of them, the authors found substantially elevated rates of depressive and anxiety symptoms and decreased levels of self-rated health among LGBT students in allopathic medical schools. The disparity between heterosexual and sexual minority students in psychological distress was explained statistically largely by experiences of discrimination and loneliness reported by LGBT students. Similar results were reported by a study in osteopathic medical schools. In addition, only one in ten students obtained a passing score in a test of knowledge of issues related to the health of LGBT patients.
The implicit association test is like an X-ray picture of the mind. It shows how biased our thinking can be, even if that bias is unconscious and we think of ourselves as free of prejudice. (Taking the test, which I recommend, can be a humbling experience). Using the test, a study showed that over eighty (eight, zero) percent of medical students exhibited at least some unconscious bias against gay and lesbian individuals. No wonder another study showed that almost thirty percent of sexual orientation minority students and sixty percent of gender minority students conceal their identity in medical school.
It takes a village to raise a child, the proverb says, and I’d say that it takes a village to educate a physician. Medical schools don’t exist in a sociocultural vacuum. Until the larger society becomes more accepting, inclusive and welcoming of LGBT individuals, medical schools and training hospitals will continue to graduate wounded, closeted healers. And that shames us all.
Andrés F. Sciolla, MD
Dr. Sciolla is an Associate Professor at the Department of Psychiatry and Behavioral Sciences, University of California, Davis, Co-Director of the Doctoring 2 course at the School of Medicine and Medical Director of a community mental health clinic, the Northgate Point Regional Support Team in Sacramento, California. He graduated from the University Of Chile School Of Medicine and is a board-certified psychiatrist.