Setting and Problem
Health care professionals who identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ) contribute significantly to improving the care of LGBTQ patients yet are underrepresented in medicine and medical training.1 LGBTQ trainees often face discrimination and as such may experience significant anxiety in deciding whether to come out during the residency application process if they do not perceive institutions and training programs as inclusive.
Residency program recruitment represents a key, largely unexplored opportunity for institutions to mitigate this anxiety, demonstrate an LGBTQ-inclusive climate, and enhance the gender and sexual diversity of their training programs.2 At our residency program, LGBTQ residents had developed an informal practice of offering to meet with applicants, averaging 5 meetings per year. This practice was coordinated by the residents themselves, rather than by the residency program. We sought to intentionally signal the inclusive climate of our residency program in order to improve program diversity, while maintaining applicant trust and confidentiality.
During the 2019–2020 residency recruitment season for the department of medicine, all applicants received a pre-interview survey to gauge their interest in a number of optional interview day experiences. This included an item allowing applicants to opt-in to a confidential, one-on-one, informational interview day “chat” with a current LGBTQ-identifying resident volunteer. This 30-minute “LGBTQ Applicant-Resident Chat,” or LGBTQARC, was built into applicants' personalized interview day schedules. The opt-in survey explained the intervention's goal as offering LGBTQ applicants a safe space to explore the inclusivity of our training environment. It also confirmed that participation in the program would be confidential from recruitment leadership and have no impact on the applicant's ranking.
Integration into the existing interview day infrastructure simplified logistics and minimized administrative burden. Efforts were made to pair each applicant with 1 of 5 available volunteer residents. Due to busy resident schedules, several applicants were unable to be paired with an available LGBTQ resident on their interview day. In these cases, applicants were connected to 1 of the 5 LGBTQ resident volunteers after the interview day.
Outcomes to Date
Of 521 total interviewed applicants, 32 (6.1%) opted into the inaugural LGBTQARC intervention. Previously, only 5 applicants per year were engaged via the informal process. Overall, 8.5% of the class recruited in 2019–2020 identified as openly LGBTQ, as compared to 3.9% of the classes recruited prior to the intervention in 2017–2018 and 2018–2019.
For the 2019–2020 recruitment cycle, 7 openly LGBTQ-identifying interns matched to our program, compared to only 3.3 residents per year in the 2 years prior. All 7 interns elected to organize the LGBTQARC initiative for the 2020–2021 recruitment cycle. This signals the intervention's sustainability, as the additional recruited interns now contribute to future implementation of the program.
Our program administrator found the initiative highly feasible to implement, particularly given the ease of folding the LGBTQARC intervention into the existing interview infrastructure. The limited availability of LGBTQ residents to interview each interested applicant was a challenge given busy workloads and the small number of current LGBTQ residents. However, with an increased number of LGBTQ-identifying residents in the program, this challenge is likely to be mitigated.
Future work will focus on program evaluation via development of a survey assessing the impact on applicant decision-making and well-being. This survey will be sent to all applicants who opt into the program in future recruitment cycles.
Overall, LGBTQARC provides a safe opportunity for LGBTQ-identifying future physicians to explore the inclusivity of a training program. It is a feasible, sustainable way to build residency classes that better reflect the patient population we serve in the United States.