Jorge Ramallo considers himself lucky to be in the class of 2013 at the Yale University School of Medicine, where there are four other self-identifying lesbian, gay, bisexual, or transgender (LGBT) students. There are just two LGBT students in the Yale class of 2014, and some medical schools in the South have one or no LGBT students per class of 200, says Ramallo, copresident of the Gay Straight Medical Alliance at Yale.
"The numbers [of gay students] fluctuate every year, but it is clear that even for one of the top institutions in the world, attracting qualified LGBTQ applicants is a big challenge," Ramallo says. LGBTQ is another term used to describe the gay community, to encompass those who are questioning their sexual identities.
A lack of positive physician role models for LGBT students is one reason why gay students are "underrepresented" at medical schools, according to Ramallo.
"Many students ... have a very negative view of the medical establishment because of past experiences with inept medical providers that did not know how to react to the fact that their patient is LGBTQ," he says.
One area medical schools could better address to help attract more LGBT applicants is health complications "plaguing" the gay community, like high rates of cancer, substance abuse, morbid obesity, anorexia, and "lack of health screening due to mistrust of the medical establishment," Ramallo says. Most schools that do address LGBT issues tend to focus exclusively on HIV and gay men, he adds.
Medical schools have recently admitted there's a problem. Nearly three quarters of 132 surveyed medical schools in the United States and Canada gave themselves grades of "fair," "poor," or "very poor" for the integration of LGBT content in their curricula, according to a recent study in the Journal of the American Medical Association.
On average, the surveyed schools devoted five curriculum hours to gay health issues, the study states. Nine schools devoted no preclinical hours, and 44 schools devoted no clinical training hours to LGBT topics.
"The JAMA study illustrates a problem within our medical education that cannot simply be 'fixed' by admitting LGBTQ students," says Erica Pettigrew, chair of the American Medical Student Association's national gender and sexuality committee. "Every medical student, regardless of identity, must be familiar with LGBTQ health issues in order to provide high quality care to patients both during medical school training and while practicing as a full-fledged physician."
According to Pettigrew, being a medical student is stressful enough without students feeling pressure to conceal their identities. "Not every medical school is a welcoming environment for LGBTQ students, and this needs to change," she says.
The committee that Pettigrew chairs maintains an online LGBT Residency and Medical School Directory, which, according to the site, compiles survey responses from AMSA members "to help you gauge how medical schools and programs rate in LGBT-friendliness." The surveys ask students to comment on issues such as overall comfort level as a LGBT resident or student at the school, how the school regards "out" LGBT applicants, and availability of LGBT-related resources at the program.
Ramallo says he's found Yale's curriculum to be "very inclusive," and the Yale Daily News recently reported that the school is actively recruiting LGBT applicants. But he says if Yale added more LGBT topics into the curriculum, it could improve even more.
"We don't want to monopolize the lectures, but just [to] make sure that important statistics are also taught within pertinent lectures," he says. "[M]any other schools around the country are taking similar steps trying to better address LGBT health issues by teaching these subjects to medical students early on."
Doug Hughes, assistant dean of diversity and multicultural affairs and director of medical education at the Boston University School of Medicine, says BU devotes 10 curriculum hours—twice the national average—to LGBT topics.
Hughes, who was part of a recent Association of American Medical Colleges panel on integrating LGBT health into medical education, says the school sent out an anonymous poll asking students about their sexual identity. Of the 140 BU medical students who responded, 10 percent identified as "exclusively homosexual," and 1 percent said that they were "predominantly homosexual," Hughes says.
Medical schools were "an unwelcoming environment to LGBT faculty and students" through the mid-2000s but have since come a long way, Hughes says. Still, even students who come out in medical school aren't necessarily comfortable being out in residencies.
"I don't think one shoe fits all," he says. "[Gay students] should do what they're comfortable with."
Hughes advises LGBT applicants to visit school websites and search for the term "LGBT" to see how comfortable the school is with diversity. "If it's not in the printed material [and] if it's not in the online material, [then] it's a question mark," he says. "If there is no LGBT club at that school, it would be very hard for the potential applicant to know what they're walking into."
He also recommends that applicants contact officers of gay student clubs to "get an inside view ... from other accepted students." But overall, he's confident that LGBT applicants will be treated well.
"My advice would be to jump right in," Hughes says. "I think the water is fine at our school and at many schools."
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