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March 13, 2026Open Access

Experiences of LGBTQIA+ medical students: gaps and challenges during preclinical education

Key Points

The study aims to explore the experiences of LGBTQIA+ medical students during their preclinical education and identify critical barriers.
Conducted an online survey with 414 LGBTQIA+ medical students from MD and DO programs in the U.S.
Survey included 136 items about campus climate, support systems, and perceived well-being.
Analyzed responses to identify differences between cisgender and transgender or gender-expansive students.
Majority of students reported inadequate support for diversity initiatives and LGBTQIA+ representation.
Transgender or gender-expansive students experienced higher rates of differential treatment and harassment than cisgender peers.
Students in rural areas or red states reported significantly less campus inclusivity compared to those in urban areas or blue states.

Abstract

While attempts to diversify the physician workforce are ongoing, limited research exists exploring the experiences LGBTQIA+ medical students during their preclinical training. The purpose of this study is to examine how interpersonal interactions, campus climate, and the availability of campus support influence the well-being of LGBTQIA+ medical students across U.S. medical schools during their preclinical education. Medical students self-identifying as LGBTQIA + and enrolled in either Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) institutions in the U.S. in 2024 completed an online, 136-item survey. Participants were asked about preclinical medical school experiences, perceptions of their campus climate and curriculum, and perceived level of impact experiences had on their well-being. Four hundred fourteen completed records were analyzed, representing LGBTQIA+ medical students across MD (n = 295, 71.3%) and DO (n = 119, 28.7%) programs, including 309 cisgender (74.6%) and 97 (23.4%) transgender or gender-expansive (TGE) students. The majority of participants indicated that their school fell short in providing supportive diversity initiatives, LGBTQIA+ specific spaces, positive LGBTQIA+ representation, and adequate responses to discrimination. Most participants also reported that professors did poorly at using inclusive terminology and advocating for LGBTQIA+ inclusion. TGE students consistently rated their school, classmates, professors, and campus climate lower than cisgender students, and were significantly more likely to report differential treatment (55.7% vs. 23.3%, p < .001) and overt harassment (23.7% vs. 4.5%, p < .001). Students in red states or rural settings reported significantly less inclusivity and campus support than those in blue states or urban settings. LGBTQIA+ medical students face significant barriers to well-being, including adverse campus experiences, inadequate support, and limited inclusivity. This study highlights an acute need for interventions that improve the preclinical environment for LGBTQIA+, and particularly TGE, medical students.

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