Educational gaps in 2SLGBTQIA+ healthcare: A mixed-methods survey of medical students in Eastern Canada

Sexual and gender minority populations—including Two-Spirit, lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and others (2SLGBTQIA+)—experience poorer health outcomes and reduced access to equitable care. These inequities are partly linked to inadequate training, as Canadian medical curricula lack standardized 2SLGBTQIA+ competencies. While reforms have been called for, integration remains inconsistent, and little is known about education in Eastern Canada. This study assessed medical students’ perceived (a) attitudinal awareness/comfort, (b) knowledge, and (c) preparedness for practice. A mixed-methods survey was conducted with first- through fourth-year medical students in New Brunswick and Nova Scotia. The instrument included 29 items, two questions on the learning environment, and two open-ended items on curriculum improvement. Attitudinal awareness/comfort ( M = 80.1, SD = 16.8) and knowledge ( M = 77.7, SD = 30.2) scores were high, but preparedness was low ( M = 47.3, SD = 27.0). Comfort was significantly reduced with trans and Two-Spirit patients during oral history taking, χ 2 (1, N = 59) = 23.1, p < .001; physical examinations, χ(1, N = 59) = 49.2, p < .001; and genitourinary exams, χ 2 (1, N = 59) = 63.4, p < .001 when compared to other (non-2SLGBTQIA+) patients. Only 10% felt adequately trained to care for Two-Spirit patients. Students also reported discriminatory comments from residents (44%) and physicians (54%). This first evaluation of 2SLGBTQIA+ curricula in Eastern Canada (New Brunswick and Nova Scotia), and the first to include Two-Spirit peoples, highlights persistent gaps in preparedness and underscores the urgent need for standardized, longitudinal training to improve health equity.