#ACGME2024 Session Summary: Life as LGBTQIA+ in the Current Learning Environment

In recent years, strides have been made toward fostering inclusion and belonging within graduate medical education (GME) for LGBTQIA+ individuals. However, despite progress, there remains a crucial question lingering for many: would these individuals be missed if they weren’t present? This thought-provoking question served as the focal point of a sunset session at the 2024 ACGME Annual Educational Conference. ACGME Chief of Staff and Chief Education Officer Timothy P. Brigham, MDiv, MS, PhD set the stage for the discussion by introducing Donald Brady, MD, executive vice president for Educational and Medical Staff Affairs and executive vice dean for Academic Affairs at Vanderbilt University Medical Center, and noting that this session was the culmination of a dream he and Dr. Brady shared.

Explaining a core goal of the session’s design, Dr. Brigham handed the stage to Dr. Brady and the panel noting how important learning about others can be to individual growth. “The important thing in gaining empathy and fostering empathy in a relationship,” he said, “is self-disclosure.”

Dr. Brady introduced the other panelists: Mara Black, MD, a fellow in maternal-fetal medicine-genetics at Johns Hopkins; Andrew Nasca, program coordinator for the hematology/oncology fellowship program at Thomas Jefferson University; and Tyree Winters, DO, pediatrics residency program director and medical director at HealthStart Clinic, Goryeb Children’s Hospital, Atlantic Health System. Dr. Brady further contextualized the session’s structure and purpose, stating that the aim was to explore the experiences of LGBTQIA+ individuals within the GME environment and engage attendees in discussions on how to ensure their colleagues feel valued and included.

“To be on this stage, with a plenary, talking about what it’s like to be LGBT in the learning environments we have and in the society that we live in is just a testament to where we’ve come,” said Dr. Brady.

He shared some of his own journey, recounting the challenges he faced after coming out as gay during residency. Dr. Brady’s story highlighted the importance of acceptance and the impact of rejection within the medical community. The other three panelists echoed similar sentiments, underscoring the significance of representation and mentorship for LGBTQIA+ individuals in medical education and training.

Reflecting on his experiences as a Black gay man in medicine, Dr. Winters emphasized the scarcity of mentors who share his multiple identities. He also spoke of the importance of sponsorship and mentorship that transcends sexual orientation and race, enabling individuals to advocate for themselves and others.

“I have to set a narrative that has [until now] unfortunately been written for us, and has not allowed us to write the narrative ourselves,” he said.

Echoing Dr. Winters’ sentiments, Dr. Black shared how being part of multiple communities, including the LGBTQIA+ community, has enriched her GME experience and emphasized the importance of allyship in supporting those exploring their identities.

From his important perspective as a program coordinator, Mr. Nasca highlighted the significance of being a visible member of the LGBTQIA+ community within educational settings.

“I chose to be part of this panel to help give a voice to the fellows, residents, and medical students that I [work with]... to show them that the landscape is changing,” he said.

Mr. Nasca shared that he believes his presence not only facilitates open dialogue, but also fosters a sense of understanding and support among colleagues. All the panelists emphasized the need for LGBTQIA+ residents and fellows to receive the same level of support and resources as their peers, emphasizing the importance of inclusive policies and practices within GME programs.

Despite significant progress, however, challenges do persist. The panelists candidly discussed difficulties they have faced, from encountering discrimination to witnessing patients’ struggles. Dr. Black spoke of the privilege of being able to choose when to disclose her identity, acknowledging the harsh realities faced by those who lack such autonomy. Dr. Brady recounted instances of public harassment, shedding light on the ongoing stigma and discrimination faced by LGBTQIA+ individuals.

The sociopolitical landscape also looms large, influencing decisions about where to live and work. Dr. Black expressed concerns about practicing in states with hostile policies towards LGBTQIA+ individuals, highlighting the need for safe and welcoming environments for both patients and health care professionals. Dr. Brady reflected on the dilemma of staying to effect change or leaving for safety, underscoring the complexities faced by LGBTQIA+ individuals in navigating their careers.

Despite the challenges, the panelists were confident there is cause for hope. They celebrated moments of progress and resilience, from running hurdles at the Gay Games to experiencing moments of solidarity and acceptance within their professional lives. They emphasized the importance of education and advocacy in creating more inclusive environments within and beyond GME.

In fulfilment of Drs. Brigham’s and Brady’s shared dream, this year’s Sunset Session served as a poignant, eye-opening, and ultimately inspiring reminder of the ongoing journey toward inclusion and belonging for LGBTQIA+ individuals in the medical community. By sharing their stories and insights, the panelists offered valuable perspectives on existing challenges, and opportunities that lie ahead.

A sentiment that resonated throughout the session was that every individual, regardless of identity, deserves to feel valued and missed.

Dr. Brady closed with a reminder to heed the words of Dr. Parker J. Palmer. Quoting one of Dr. Palmer’s books, The Company of Strangers, Dr. Brady noted that “the stranger is the person of promise.” “Embrace the promise of the stranger,” he said, recognizing the potential for transformation and growth that comes from listening to diverse voices and experiences.

“If we approach each other as we meet and greet and grow, [remember that] the person in front of you may be a person of promise,” he closed. “Take that approach and we can have a much better world to live in, and a much better learning environment.”