Introduction
There is a growing community of individuals nationally and within medicine who identify as Lesbian, Gay, Bisexual, Transgender, Queer, or any other sexual or gender diverse identity (LGBTQ+). However, queer and trans representation in the field of surgery does not yet reflect this growth. As a queer fourth-year medical student applying into general surgery this year, I am curious to understand why we are seeing noticeably lower LGBTQ+ representation among surgical trainees and how we can improve inclusivity in surgical training. In this reflection piece, I detail the growing proportion of medical students who identify as LGBTQ+, discuss some of the challenges that queer and trans surgical trainees face, and describe how multilevel LGBTQ+ mentorship can foster inclusivity and interest in surgery beginning with junior medical students on their first surgical rotations.
A Growing Community
One in nine (11.6%) graduating medical students in 2022 identified as a sexual minority (lesbian, gay, bisexual, pansexual, etc.) and 1% of all medical graduates identified as having a gender identify that is different from the sex they were assigned at birth (i.e., transgender or gender diverse). These numbers have been steadily increasing with each subsequent graduating medical class.2 In Gallup’s 2022 demographic survey, one in five (19.7%) members of Generation Z (birth years 1997-2004) identified as LGBTQ+. This is almost a two times higher rate than Millennials (11.2%) and almost six times higher than Generation X (3.3%).3
In a 2019 anonymous survey sent to all US general surgery resident physicians following the completion of their annual in-site training exam (85% response rate), only one in 20 (4.8%) general surgery residents identified as LGBTQ+ (305 of 6076 respondents). This survey also revealed that LGBTQ+ general surgery resident physicians reported significant higher reported rates of mistreatment, discrimination, and sexual harassment in the surgical workplace compared to their straight and cisgender peers.1 This survey also found that LGBTQ+ general surgery resident physicians were twice as likely to consider dropping out of their program than their non-LGBTQ+ colleagues.
I believe one major entry point into improving LGBTQ+ representation, visibility, and inclusivity among surgical training programs is at the level of junior medical students and their early formative experiences in surgery. Multilevel mentorship for LGBTQ+ junior medical students presents a unique opportunity for senior medical students, residents, and attending surgeons to foster interest in surgery and provide resources to navigate surgical training as a queer or trans person.
Near Peer Mentors
Senior medical students (Near Peers) who have completed their foundational and advanced surgical rotations can provide invaluable insights to junior medical students, as they have an unparalleled understanding of the recent experience being a medical student on surgical services. In the context of queer mentorship, Near Peers can connect their mentees to LGBTQ+ student organizations, direct the junior medical students to resources offered by their medical school, and give advice on navigating challenges that may come up in medical school, on surgical rotations, or in residency applications. Near Peers represent the lowest power differential between themselves and the junior medical students and can consequently step into more informal and low stakes advising roles with ease.
Resident Mentors
Resident mentors can also augment the experiences of senior medical students. Surgical residents are uniquely positioned to offer insights on how to discuss LGBTQ+ identities on residency applications and in interviews, provide reflections on the inclusivity of their residency programs, and provide LGBTQ+ contacts at other residency programs.
This past year, I worked with Massachusetts General Hospital to pilot a Queer in Surgery Mentorship Program that connected LGBTQ+ surgical residents with queer or trans medical students applying into general surgery. My own resident mentor was able to review my program list and share his experiences from the interview trail about the inclusivity of the programs. We were able to bond over our shared interests in LGBTQ+ community-building, queer and trans health, and improving inclusivity in surgical training. Finally, my resident mentor was the first out gay man in surgical training that I have met and seeing him thrive in residency helped me envision my own path towards an affirming and fulfilling experience as a future surgical resident.
Attending Mentors
The impact of LGBTQ+ visibility in surgical faculty cannot be understated. When LGBTQ+ general surgery residents were surveyed about factors influencing their residency match list, 80% reported rating surgical programs in which they knew of an LGBTQ+ faculty member more favorably.1 Attending surgeons can offer advising on professional development, surgical specialty selection, and research opportunities among many others. Attending surgeons have years of experience navigating both surgical training and the surgical workplace. These experiences can be invaluable perspectives for medical students as they consider their specialty choice and career path.
Conclusion
There is a growing community of LGBTQ+ folks, both nationally and within medical education. With this burgeoning community, there is a need to enhance visibility and inclusivity for surgical trainees starting with junior medical students. Multilevel queer mentorship represents one of the pillars of establishing an affirming and supportive culture within surgery. Near Peers offer unique perspectives as informal and low-pressure mentors who can provide insights about navigating medical school and surgical rotations as a queer or trans person. Resident mentors can help foster interest in surgery by mentoring medical students as they apply to residency. Attending surgeons can connect LGBTQ+ medical students to research opportunities, aid in professional development and specialty selection, and have years of experiences completing surgical training to drawn upon in giving advice when challenges arise. This multilevel commitment to inclusive training is essential for the future generations of diverse surgeons.
References
1. Heiderscheit EA, Schlick CJR, Ellis RJ, et al. Experiences of LGBTQ+ Residents in US General Surgery Training Programs. JAMA Surg. 2022;157(1):23. doi:10.1001/jamasurg.2021.5246
2. Graduation Questionnaire (GQ). AAMC. Accessed June 4, 2023. https://www.aamc.org/data-reports/students-residents/report/graduation-questionnaire-gq
3. Inc G. U.S. LGBT Identification Steady at 7.2%. Gallup.com. Published February 22, 2023. Accessed June 25, 2023. https://news.gallup.com/poll/470708/lgbt-identification-steady.aspx
Matthew Q. Parsons, BA