Pride and Practice: A Look Into LGBTQ+ Inclusivity and Academic Medicine

LGBTQ+ in Medicine

This Pride Month, Germane Solutions wants to highlight LGBTQ+ considerations in Academic Medicine and best practices towards becoming more LGBTQ+ inclusive within hospitals, programs, and the greater- Graduate Medical Education (GME) community,

LGBTQ+ trainees, physicians, and patients are becoming more prevalent; and likewise, the challenges they experience within healthcare settings are more visible. While diversity and inclusion have become exponentially more prevalent within medicine (with both enhanced standards from the ACGME and Joint Commission), diversity in sexual orientation is often the least implemented (“DEI Data” p. 5).

GME programs are crucial in shaping the cultural competence of future healthcare providers and serve as tools to expose physicians to the most updated facets of care for demographics. Of 2022’s graduating medical students, more than 10% identified as a sexual minority (Parsons).

Regarding the care of LGBTQ+ patients, nearly one in five who identify as LGBTQ+ avoid seeking medical care; and one in six have experienced discrimination in a healthcare setting (Powell): for example, trans people are more likely to be told by healthcare professionals that they have a depressive disorder. Additionally, trans people experience proportionally more poor health days, having gender-affirming care curtailed, and bias around said care (Yurcaba). As LGBTQ+ communities are becoming more prevalent in medicine, Germane Solutions believes it is imperative to utilize GME programs to guide and foster the next generations of physicians.

Below are areas where LGBTQ+ inclusivity can be improved or applied and a brief section with applicable questions to consider for your institution.

Improving LGBTQ+ Inclusivity

Recruitment and Holistic Reviews

Recruitment revolves around reactions to applicants and has the potential to be rife with bias—intentional or not. Several GME- and recruitment-related applications have tools available to mitigate bias, such as the Electronic Residency Application Service (ERAS) and its filtering mechanisms, where certain applicant data points can be filtered. While these tools are certainly beneficial ways to mitigate bias, the faculty and reviewers should be properly educated and aware of their responsibility when reviewing applicants. More importantly, bias mitigation should be considered throughout the recruitment process. Oftentimes, recruitment processes can seem templated and/or focused on tangible items, such as test scores, which can be non-substantive or omit critical information. Conversely, a holistic review, composed of experiences, attributes, and academic accomplishments, can be done without a heavy consideration of scores and impersonal factors and can focus on the personable attributes of the candidate. This type of reviewing allows institutions to better identify individuals who fit into the environment of their programs and the mission they espouse, which can support future mentorship initiatives. Development sessions with relevant faculty before and after recruitment cycles can be valuable opportunities to improve in this regard.

Lastly, with recruitment, interviewing is a vital component where mitigating bias and equally reviewing applicants is paramount. Recruitment Selection Committees, or the program leadership involved with recruitment, should develop universal questions in order to assess all applicants equally. Additionally, these questions should be reviewed with utmost scrutiny to mitigate potential biases. Prior to interviews, all faculty involved should participate in faculty development regarding mitigating bias and the importance of a diverse and inclusive healthcare workforce.

Mentorship Programs

Mentorship programs are activities that allow trainees to work closely with other like-minded individuals. Specifically for the LGBTQ+, mentors and mentees can share experiences/advice, bond over shared interests (such as (LGBTQ+ community-building, queer and trans health, and improving inclusivity in residency training), and develop learning pathways within the program. Ultimately, mentorship programs can be established to build connections throughout the program and can connect trainees with faculty of similar perspectives and values.

Committee Involvement in Diversity, Equity, and Inclusion

GME Committees, particularly the Graduate Medical Education Committee (GMEC) or the Program Evaluation Committee (PEC), provide critical oversight and reflection for the institution and program; and likewise, committees can spearhead inclusive initiatives. GMEC provides oversight to all programs sponsored by a sponsoring institution. Within these duties, GMEC reviews GME policies, recruitment processes, and health benefits—all of which can be reviewed with LGBTQ+ inclusivity in mind. Likewise, the PEC is required to annually review the aggregate resident and faculty diversity within the workplace. Lastly, GME programs and/or institutions can develop Diversity (sub)committees that work to discuss and advance initiatives. In smaller programs, dedicated time within GMEC could be sufficient as well.

Other Initiatives to Consider

The following initiatives can both improve measures of care and improve metrics of LGBTQ+ inclusivity:

• Culturally Affirming Practices & Systems: This includes something as simple as inclusive medical history forms or improvements to patient-facing mechanisms; additionally (albeit more complex), hospital systems could support certification programs in LGBTQ+ healthcare, which would recognize and incentivize healthcare providers to specialize in this field. Effective communication and psychological safety are vital to ensuring the LGBTQ+ community feels at ease when sharing personal health information, which is crucial for accurate diagnosis and treatment—as well as data collection: LGBTQ+ individuals may feel uncomfortable with providing information about themselves, which can limit data points on these demographics. Roughly 1/5 of LGBTQ+ individuals do not seek out medical care and/or experience discrimination, which can be mitigated and improved through affirming, compassionate care in all aspects of healthcare.
  

• Regular Educational & Training Sessions: These sessions could include faculty development or didactic sessions with residents and fellows. With faculty, these sessions could be timed around applicable periods, such as with recruitment. Didactics, similarly, could be taken in several directions, such as individual community health, data collection, specific LGBTQ+ content, etc. Residents or fellows strongly interested in this area of medicine can create quality improvement projects that can be used to educate peers and other healthcare professionals.
  

• Knowledge of Community Healthcare Services Physicians within a hospital setting should be knowledgeable of where LGBTQ+ individuals can receive care within their community. Pursuits in this realm of LGBTQ+ inclusivity can include the following:
  

  • LGBTQ+ Health Promotions/Highlighting Community Resources

  • Patient Education Efforts

  • Developing Partnerships

  • LGBTQ+ Advocacy

Questions to Consider

Below are questions your program or hospital can consider to pursue improvements in LGBTQ+ Inclusivity and Diversity.

• How well do your current training and healthcare policies accommodate the needs of LGBTQ+ individuals, and what gaps have you identified that need addressing?

• What are the key barriers in your institution to implementing inclusive healthcare policies, and how can we assist in overcoming these to create a more inclusive environment?

• How can integrating LGBTQ+ health education into your training programs improve patient outcomes and reduce health disparities within your facility?

• In what ways can your institution engage more deeply with local LGBTQ+ communities to better understand and serve their health needs?

• How can your institution implement ongoing feedback mechanisms from both LGBTQ+ trainees and patients to continually adapt and improve inclusivity and care standards?

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Works Cited

“DEI Data Insights Leadership and Governance in Hospitals and Health Systems.” AHA Institute for Diversity and Inclusions and American Hospital Association. February 2024. ifdhe_dei-benchmark-survey-leadership-governance-3.pdf (aha.org).

Parsons, Matthew Q., BA. “Multilevel LGBTQ+ Surgical Mentorship: Fostering Interest and Inclusivity in Medical School.” Association for Academic Surgery. September 8, 2023. Multilevel LGBTQ+ Surgical Mentorship: Fostering Interest and Inclusivity in Medical School - Association for Academic Surgery (AAS) (aasurg.org).

Powell, Alvin. “The Problems with LGBTQ Health Care.” The Harvard Gazette. March 23, 2018. Health care providers need better understanding of LGBTQ patients, Harvard forum says — Harvard Gazette.

Yurcaba, By Jo. “Nearly Half of Trans People Have Been Mistreated by Medical Providers, Report Finds.” NBC News. August 18, 2021. Nearly half of trans people have been mistreated by medical providers, report finds (nbcnews.com).