Sexual and gender minorities SGMs in medicine experience unique stressors in training. However, little is known about SGM specialty choice. This study examined predictors of SGM specialty choice, associations between specialty prestige and perceived SGM inclusion, and self-reported influences on specialty choice. We operationalized specialty choice at the individual level
Sexual health medical specialty test respondents' specialty of Sexual health medical specialty test at the specialty level, as a percentage of SGM respondents in each specialty.
SGM most frequently rated personality fit, specialty content, role models, and work—life balance as strong influences on specialty choice. Specialty prestige and perceived inclusivity predict SGM specialty choice. SGM diversity initiatives in prestigious specialties may be particularly effective by addressing SGM inclusion directly. Further research is "Sexual health medical specialty test" to inform effective mentorship for SGM medical students.
Supporting and promoting SGM diversity across the spectrum of medical specialties, therefore, represents a critical avenue to improve the care delivered to SGM populations and addresses the role of providers in the health disparities experienced by SGM. S exual and gender minority SGM individuals, including those who identify as lesbian, gay, bisexual, transgender, or queer, are subject to stigma-related stress, also known as minority stress. Chronic exposure to stigma yields anxious anticipation of future rejection, internalized heterosexism, and stress associated with identity concealment.
Sexual minority SM medical students are more likely than non-SGM students to report stress, isolation, verbal insults, and harassment or threats 5 and they are approximately twice as likely to experience depression and related mental health comorbidities.
Although it is clear that SGM stress extends into the residency application process, 9—11 little is known about the relationship between SGM identity and specialty choice. Furthermore, no research to date has examined the association between specialty prestige and SGM specialty choice. Anecdotal evidence and limited empirical data suggest that SGM in medicine perceive certain specialties as less inclusive, to the extent that SGM applicants may conceal their minority identity during the residency application process to protect their chances of matching in a given specialty.
Medical school climate for SM students has previously been associated with SM medical student comfort and with identity disclosure, 6 but it has not previously been studied in relation to specialty choice. Additional predictors of specialty choice, such as income expectations or family plans, have also not been compared between SGM and non-SGM. Written informed consent was obtained before survey access. The survey complete survey available as Supplementary Appendix A ; Supplementary Data are available online at www.
The survey was initiated by individuals. Respondents were able to skip any survey item. After application of the exclusion criteria, the percentage of missing data per item ranged from 0. SGM, sexual and gender minority. We used this sample to examine the relationship between specialty prestige and perceived anti-SGM bias. States were categorized into census regions. We calculated the proportion of SGM respondents in each specialty that contained at least 10 respondents, which excluded the following specialties, as they did not satisfy this threshold: SGM respondents ranked the 26 specialty options 17 by using four 5-point Likert items evaluating perceived SGM inclusion and support see Supplementary Appendix A for all items.
Perceived SGM inclusion for each specialty was calculated as the mean of SGM respondents' responses to these four items. Specialty competitiveness and median income were measured by using publicly available data.
Prestige was dichotomized at the median of 0. SGM respondents completed 18 previously used items describing medical school SGM support 6 ; the mean of the items served as the medical school climate index. Medical school climate scores were dichotomized at the median of 0. In specialty-level models, linear regression was used to evaluate associations between 1 specialty prestige and proportion of SGM respondents in each specialty; 2 perceived SGM inclusion and proportion of SGM respondents; and 3 specialty prestige and perceived SGM inclusion.
In person-level models, we first evaluated associations between SGM identity and other demographics by using chi-square tests of independence and independent-samples t -tests.
We also used chi-square tests of independence and independent-samples t -tests to compare respondents included and excluded from the study based on the inclusion criteria. We conducted a post hoc analysis with a Bonferroni correction to identify the direction of difference for demographic data. Using the same covariates, logistic regression was used to evaluate associations between SGM identity and predictors of specialty choice, and between frequency of exposure as a medical student to SGM faculty and specialty prestige.
We also qualitatively describe Sexual health medical specialty test frequency with which each predictor of specialty choice was identified as strongly influential by SGM and by non-SGM respondents.
Two-sided tests of significance were employed in all analyses. A P -value of 0. Age and graduation year did not differ Table 1. SGM and non-SGM did not differ in the likelihood of rating the following factors as strongly influential on specialty choice: An alternative statistical model incorporating level of training did not show an interaction between level of training and SGM status for any factor influencing specialty choice, such that level of training did not affect the findings reported earlier results not shown.
As shown in Table
Sexual health medical specialty testthe following factors in order were the most often rated as strong influences on specialty choice by SGM: The following factors in order were the most often rated as strong influences by non-SGM: Overall, SGM and non-SGM, thus, report a similar qualitative ranking of the factors strongly influencing specialty choice, as inferred by the frequency with which those factors are reported as strongly influential in each group.
This study reveals that prestigious specialties, as measured by an objective index, are perceived by SGM to be less inclusive of SGM. This study also indicates that the proportion of SGM within a specialty is positively related to the perceived SGM inclusivity of that specialty, and inversely related to specialty prestige.
SGM were significantly more likely than non-SGM to rate their sexual orientation or gender identity as a strong influence on Sexual health medical specialty test choice. Contrary to hypotheses, the associations between medical school climate and specialty prestige among SGM, and between exposure to SGM faculty as a medical student and specialty prestige among SGM, were not significant.
The findings of this study suggest that SGM may be systematically under-represented across a range of specialties. Disproportionate distribution of SGM physicians may, thus, be a longstanding issue. This conclusion is supported by a previous study describing differences in the specialty of practice between SM and non-SM female physicians. Furthermore, under-representation of SGM within prestigious specialties may be a self-perpetuating phenomenon, as SGM identify SGM mentors as critical facilitators of professional success.
Equitable representation of SGM across specialties has the potential to positively impact SGM-based health disparities in the general population, which include obesity, mental health, tobacco and other substance dependence, teenage pregnancy, asthma, infectious disease, and certain cancers.
Conversely, medical trainees with less contact with SM are more likely to express anti-SM attitudes. Further research is needed on the factors contributing to perceptions of anti-SGM bias within specialties. Preliminary evidence suggests that perceptions of SGM inclusion may partially reflect extant professional environments.
A study of practicing physicians found that in order surgery, family medicine, and orthopedic physicians expressed the most homophobic attitudes, whereas psychiatry, internal medicine, and pediatric physicians Sexual health medical specialty test the least homophobic attitudes.
The concurrent development and evaluation of programs to address anti-SGM bias and to promote SGM diversity across specialties is also needed.
Although some specialty-specific organizations have published SGM health curricula guidelines 44 and some independent groups have begun to develop specialty-level curricular materials on SGM topics, 45 such efforts are disjointed and sporadic. Graduate medical education may benefit from adapting strategies to promote SGM diversity that have contributed to the recent, significant climate change around SGM issues in undergraduate medical education.
Comparable specialty-level organizations could do the same, propelling further efforts to address SGM topics within specialties. The AAMC has also taken a leading role in developing and disseminating materials to support undergraduate SGM curriculum development and to instigate improvement of institutional climate change.
In contrast, the Accreditation Council for Graduate Medical Education has yet released comparable statements or resources, and, if it did so, could play a critical role by integrating the disparate programming already underway within specialty training, and instigating the development and adoption of SGM programming in graduate medical education.
The development of a similar, easily accessible reservoir of specialty-specific educational and support materials might be an important step in facilitating SGM programming and, thus, supporting SGM diversity across medical specialties. In the present study, no association was found between SGM respondents' medical school climate and specialty prestige. In addition, the items used to evaluate climate were adapted
Sexual health medical specialty test use with medical students from a scale originally designed and validated for use with undergraduate populations.
Perceptions of specialty and residency program inclusivity have previously been shown to influence SM specialty choice and ranking of residency programs. Thus, initiatives to encourage and sustain SGM diversity, particularly within prestigious specialties, may be particularly effective when specialty- or residency program-specific mentorship programs, publications, and other methods of medical student recruitment directly address nondiscrimination and SGM inclusion.
In our study, both SGM and non-SGM rated the following factors in order the most frequently as strong influences on specialty choice: In part, this finding may reflect the importance of the quality of exposure or interaction with SGM faculty, as opposed to the frequency of exposure to SGM faculty.
This finding may also reflect the importance of other quantitative elements of interaction with SGM faculty, including the number of SGM faculty to a student is exposed and the duration of interaction. The discrepancy between the prominence of role models as a strong influence on specialty choice among SGM and the lack of association between exposure to SGM role models and specialty choice may also reflect the importance of non-SGM professional role models for SGM medical students.
By virtue of being a numeric minority in the general population and in medicine, considerably fewer SGM faculty compared with non-SGM faculty may be accessible to SGM medical students, particularly within specialties with disproportionately fewer SGM.
This study has several limitations. Sexual health medical specialty test cross-sectional design does not allow causal inference. Longitudinal studies are needed to further evaluate associations between SGM identity, perceptions of SGM inclusion, and specialty prestige to establish temporal precedence of specialty perceptions when predicting ultimate specialty choice. As military, ophthalmology, and urology residency competitiveness are not included in the publicly available data that are used to develop the specialty prestige index, these residency options were excluded from analyses involving prestige.
In addition, the small number of gender minority participants precluded SGM sub-group Sexual health medical specialty test. Lastly, despite our large, diverse sample representing more than 26 specialties, our survey method does not allow calculation of response rate. It is, therefore, possible that the survey response rate is low and that a biased subset of organizations disseminated the survey.
The incorporation of SGM-specific assessments into representative surveys of medical students and practitioners may remedy these latter two problems. Such assessments will also provide critical, representative data about potential demographic differences between SGM and non-SGM that may also influence SGM entry into high prestige specialties, such as United States Medical Licensing Examination scores or research experiences.
This study provides the first evidence that objectively defined prestigious specialties are perceived as less inclusive by SGM and that SGM are less likely to train and practice in prestigious specialties. Further research is needed to enhance mentorship and other means of promoting SGM entry into prestigious specialties. Exposure to SGM reduces anti-SGM bias among non-SGM in medicine, such that supporting SGM diversity across medical specialties may constitute a powerful means by which to improve provider competency in serving SGM in the general population, thereby helping to ameliorate the substantial health disparities experienced by SGM.
The authors wish to thank the respondents of this study and the many organizations and individuals Sexual health medical specialty test disseminated the recruitment materials.
National Center for Biotechnology InformationU. Published online Dec 1. SitkinBS 1 and John E. PachankisPhD 2. Find articles by Nicole A. Find articles by John E. Author information Copyright and License information Disclaimer. CopyrightMary Ann Liebert, Inc. This article has been cited by other articles in PMC. Associated Data Supplementary Materials Supplemental data. Introduction S exual and gender minority SGM individuals, "Sexual health medical specialty test" those who identify as lesbian, gay, bisexual, transgender, or queer, are subject to stigma-related stress, also known as minority stress.
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