title: Sexual and gender minority identity disclosure during undergraduate medical education: "in the closet" in medical school.
abstract: OBJECTIVE
  To assess identity disclosure among sexual and gender minority (SGM) students pursuing undergraduate medical training in the United States and Canada.
  
  
  METHODS
  From 2009 to 2010, a survey was made available to all medical students enrolled in the 176 MD- and DO-granting medical schools in the United States and Canada. Respondents were asked about their sexual and gender identity, whether they were "out" (i.e., had publicly disclosed their identity), and, if they were not, their reasons for concealing their identity. The authors used a mixed-methods approach and analyzed quantitative and qualitative survey data.
  
  
  RESULTS
  Of 5,812 completed responses (of 101,473 eligible respondents; response rate 5.7%), 920 (15.8%) students from 152 (of 176; 86.4%) institutions identified as SGMs. Of the 912 sexual minorities, 269 (29.5%) concealed their sexual identity in medical school. Factors associated with sexual identity concealment included sexual minority identity other than lesbian or gay, male gender, East Asian race, and medical school enrollment in the South or Central regions of North America. The most common reasons for concealing one's sexual identity were "nobody's business" (165/269; 61.3%), fear of discrimination in medical school (117/269; 43.5%), and social or cultural norms (110/269; 40.9%). Of the 35 gender minorities, 21 (60.0%) concealed their gender identity, citing fear of discrimination in medical school (9/21; 42.9%) and lack of support (9/21; 42.9%).
  
  
  CONCLUSIONS
  SGM students continue to conceal their identity during undergraduate medical training. Medical institutions should adopt targeted policies and programs to better support these individuals.
authors.affiliation: M. Mansh is investigator, Lesbian, Gay, Bisexual, and Transgender Medical Education Research Group, and fourth-year medical student, Stanford University School of Medicine, Stanford, California. W. White is investigator, Lesbian, Gay, Bisexual, and Transgender Medical Education Research Group, and fourth-year medical student, Stanford University School of Medicine, Stanford, California. L. Gee-Tong is investigator, Lesbian, Gay, Bisexual, and Transgender Medical Education Research Group, Stanford University School of Medicine, Stanford, California. M.R. Lunn is founder and investigator, Lesbian, Gay, Bisexual, and Transgender Medical Education Research Group, Stanford University School of Medicine, Stanford, California, and clinical research fellow, Division of Nephrology, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. J. Obedin-Maliver is founder and investigator, Lesbian, Gay, Bisexual, and Transgender Medical Education Research Group, Stanford University School of Medicine, Stanford, California; clinical research fellow, Department of Medicine, San Francisco Veterans Affairs Medical Center; and clinical instructor, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, California. L. Stewart is founder and investigator, Lesbian, Gay, Bisexual, and Transgender Medical Education Research Group, Stanford University School of Medicine, Stanford, California, and chief medical resident, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. E. Goldsmith is founder and investigator, Lesbian, Gay, Bisexual, and Transgender Medical Education Research Group, Stanford University School of Medicine, Stanford, California, and resident and PhD candidate, Department of Medicine and School of Public Health, University of Minnesota Medical School, Minneapolis, Minnesota. S
authors.forename: Matthew
authors.initials: M
authors.lastname: Mansh
authors.forename: William
authors.initials: W
authors.lastname: White
authors.forename: Lea
authors.initials: L
authors.lastname: Gee-Tong
authors.forename: Mitchell R
authors.initials: MR
authors.lastname: Lunn
authors.forename: Juno
authors.initials: J
authors.lastname: Obedin-Maliver
authors.forename: Leslie
authors.initials: L
authors.lastname: Stewart
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Goldsmith
authors.forename: Stephanie
authors.initials: S
authors.lastname: Brenman
authors.forename: Eric
authors.initials: E
authors.lastname: Tran
authors.forename: Maggie
authors.initials: M
authors.lastname: Wells
authors.forename: David
authors.initials: D
authors.lastname: Fetterman
authors.forename: Gabriel
authors.initials: G
authors.lastname: Garcia
mesh_terms: D000328:Adult; D002170:Canada; D004504:Education, Medical, Undergraduate / Q000941:ethics*; D005260:Female; D006801:Humans; D008297:Male; D008913:Minority Groups; D012189:Retrospective Studies; D012577:Schools, Medical / Q000706:statistics & numerical data*; D063507:Sexism / Q000941:ethics / Q000517:prevention & control*; D012725:Sexual Behavior / Q000941:ethics*; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D014342:Truth Disclosure / Q000941:ethics*; D014481:United States