Barriers and facilitators to creating an inclusive surgical learning environment for transgender and gender diverse medical students and residents

Recruitment of transgender and gender diverse (TGD) trainees is crucial to create a more inclusive surgeon workforce. Healthcare outcomes improve when physicians have life experiences that closely match those of their patients. Therefore, increasing representation of TGD surgeons may also improve care for TGD patients. The objective of our study is to examine the experiences of TGD surgical learners and to identify barriers and facilitators to their inclusion in surgical education.

We conducted semi-structured interviews with TGD surgical residents and medical students that have completed surgical rotations. Participants were recruited via convenience and snowball sampling. Each interview was recorded, and interviews continued until thematic saturation was reached. Qualitative data from the interview transcripts were coded to perform thematic analysis. We used a constructivist grounded theory approach to create a conceptual model from these themes.

We interviewed 11 TGD students and residents (age: 22–41 years). Using participants’ terms for themselves, gender identities reported included trans woman, trans male, nonbinary, genderqueer, transmasculine, and agender. Five participants used they/them pronouns. Only four reported usually being out at work or school. Nine participants were from the US Midwest, South, or Northeast regions. One participant was training in Canada, and one participant was training in “sub-Saharan Africa.” Themes included: (1) inequitable access to bathrooms, locker rooms, and scrubs, (2) lack of institutional support, (3) misgendering in surgical environments, (4) surgical culture as less inclusive, (5) learners search for signals to identify allies, (6) learners want attending surgeons to practice proactive allyship, and (7) interest in working with the TGD patient population, including in fields like gender affirming surgery. A conceptual model describing how surgeons can create a more equitable learning environment for TGD learners was created.

To recruit a more diverse surgeon workforce and to improve healthcare outcomes for TGD patients, surgeon leaders should practice proactive allyship. Participants recommended surgeons display signals of allyship such as inclusive websites, pronouns in signatures, and pride flag pins. They encouraged surgeons to approach TGD learners early and often to express support and assess needs. They recommended that surgeon educators could address challenges such as name change requests or scrub machine locations on behalf of the learner. These steps should help create a more inclusive surgical learning environment, leading to improved recruitment and retention of TGD surgical trainees.