Medical students' perception of lesbian, gay, bisexual, and transgender (LGBT) discrimination in their learning environment and their self-reported comfort level for caring for LGBT patients: a survey study

Abstract

Background: Historically, medical students who are lesbian, gay, bisexual or transgendered (LGBT) report higher rates of social stress, depression, and anxiety, while LGBT patients have reported discrimination and poorer access to healthcare.

Objective: The objectives of this study were: (1) to assess if medical students have perceived discrimination in their learning environment and; (2) to determine self-reported comfort level for caring for LGBT patients.

Design: Medical students at the University of Ottawa (N = 671) were contacted via email and invited to complete a confidential web-based survey.

Results: Response rate was 15.4% (103/671). This included 66 cis-gender heterosexuals (64.1%) and 37 LGBT students (35.9%). Anti-LGBT discrimination had been witnessed by 14.6% and heterosexism by 31.1% of respondents. Anti-LGBT discrimination most often originated from fellow medical students. Respondents who self-identified as LGBT were more likely to have perceived heterosexism (favoring opposite-sex relationships) (OR = 8.2, p < 0.001) or anti-LGBT discrimination (OR = 6.6, p = 0.002). While half of LGBT students shared their status with all classmates (51.4%), they were more likely to conceal this from staff physicians (OR = 27.2, p = 0.002). Almost half of medical students (41.7%) reported anti-LGBT jokes, rumors, and/or bullying by fellow medical students and/or other members of the healthcare team. Still, most respondents indicated that they felt comfortable with and capable of providing medical care to LGBT patients (≥83.5%), and were interested in further education around LGBT health issues (84.5%).

Conclusion: Anti-LGBT discrimination and heterosexism are noted by medical students, indicating a suboptimal learning environment for LGBT students. Nonetheless, students report a high level of comfort and confidence providing health care to LGBT patients.

Keywords: LGBT (lesbian; Undergraduate medical education; bisexual; cultural competence; gay; healthcare disparities; or transgender) persons; social discrimination.

Figure 1.

Disclosure of sexual orientation and/or gender identity. LGBT identifying students were asked to whom of their colleagues and other members of the healthcare team they have disclosed their status. Allied health members: Nurses, physiotherapists, occupational therapists, etc. UGME: Undergraduate Medical Education office.

Figure 2.

Medical students’ opinion on LGBT discrimination. Box and whiskers based on Tukey’s method. Box delineates interquartile range (IQR), with the vertical line inside the box showing the median. Whiskers extend from the lowest value or the 25th percentile minus 1.5 IQR, whichever is lower, to the highest value or the 75th percentile plus 1.5 IQR, whichever is higher. Data points that are outside of the whiskers’ range are plotted independently. Data are presented separately for LGBT-identifying and cis-gender heterosexual students. Comparison between the two groups is performed using Wilcoxon-Mann-Whitney’s test. All significant differences are noted on the graph. * p < 0.05, ** p < 0.01, *** p < 0.001. CaRMS: Canadian Residency Matching Service. LGBT: Lesbian, Gay, Bisexual and Transgender individuals.