Medical students who are gay, lesbian or bisexual have less favorable perceptions of their learning environment than those who are straight—and could be linked to higher rates of burnout, according to a study published in JAMA Network Open.

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For the study, researchers analyzed data from a 2016–2017 Association of American Medical Colleges’ survey of more than 25,000 medical student respondents. Among that group, 2.2% identified as bisexual and 3.3% as gay or lesbian.

“Both bisexual students and gay or lesbian students reported less favorable perceptions of their learning environments than heterosexual students,” says the study, summarizing how the medical students scored their medical schools on a zero–20 “emotional climate” scale in which a higher score meant a more positive perception.

Meanwhile, the study says, “bisexual and gay or lesbian students were more likely to be in the top quartile for burnout scores.” That association, the authors wrote, “was attenuated when accounting for student perceptions of the learning environment ... with poorer perceptions of the medical school learning environment associated with higher burnout symptoms.”

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The researchers—from Yale School of Medicine and the Warren Alpert Medical School of Brown University—wrote that “students reporting decreasingly favorable learning environments were progressively more likely to score in the top quartile of burnout symptoms.”

The findings are important and should prompt medical schools to take action, said James Ding, MD, the outgoing medical student member of the AMA Advisory Committee on LGBTQ Issues.

“The study points to the fact that how med students experience their training directly can impact their ability to burnout, so medical schools can use that information to prioritize well-being and make sure they are being responsive to LGBTQ students wants and needs,” said Dr. Ding, an AMA member. “Schools should be amenable to changes and open to ways to mitigate bias on the wards and to developing policies that protect LGBTQ students and trans students specifically.”

Learn more about AMA policy on LGBTQ+ issues.

Potential interventions

Gay, lesbian and bisexual students are more likely to experience burnout, the study says. Adjusting for learning environment, the study’s authors indicated that the potential for gay, lesbian and bisexual students to experience top-level burnout was increased by about 40%.

The study’s authors recommended investigating and understanding student experiences in real time —prior to graduation—and fostering mentor relationships with LGBTQ+ faculty.

For Dr. Ding, as he moves from student to resident—staying at the University of Pennsylvania to pursue his residency training in urology—he can reflect on a generally positive experience as an LGBTQ+ medical student.

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“I was, overall, satisfied and didn’t experience burnout,” he said. “Our school administration has been receptive to incorporating LGBTQ+ medicine into our curriculum, and our student affinity group [called Penn Med Pride] is continuing to work with them to expand how LGBTQ health is formally integrated into our curriculum. We developed a new transgender student protections policy during the four years I was there, that I was able to be a co-author on.”

From his work with the AMA, Dr. Ding knows his experience is not universal.

“A lot of students can face pushback from their administration, or are not heard. And once you go on clerkships—because so much more focus is on your clinical grades and how you are perceived—I think there’s potential for having to deal with burnout and exhaustion from having to deal with either overt or unconscious bias on the wards.”

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