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Perceptions of Campus Climate and Inclusivity Among LGBTQIA+ Osteopathic Medical Students: A Cross-Sectional Study
Varin, P. [1]
Temucin, S. [3]
Reese, A. [1]
Florescu, N. [2]
Grace, C. [1]
Bettiker, R. [1]
Sonneville, K. [1]
Fiscus, V. [1]
Tanaka, L.A. [1]

Journal: Journal of Osteopathic Medicine Date: 2025/12, 125(12):Pages: A718–719. doi: Subito , type of study: cross sectional study

Full text    (https://www.degruyterbrill.com/document/doi/10.1515/jom-2025-2000/html)

Keywords:

campus environment [1]
cross sectional study [842]
inclusivity [3]
LGBTQ [4]
medical students [647]
osteopathic medicine [2025]
USA [1656]

Abstract:

Context: This study was created to address significant gaps in the literature regarding the experiences of LGBTQIA+ medical students. While numerous studies have documented the barriers faced by students Underrepresented in Medicine (URIM), LGBTQIA+ students have yet to be included in this classification, and challenges they face during preclinical training remain underexplored. While osteopathic programs are known for emphasizing an empathetic, whole-person approach, the specific experiences of LGBTQIA+ medical students at osteopathic programs have yet to be studied. Disparities in institutional support and inadequate LGBTQIA+ inclusion may negatively impact student well-being and success. This study reveals the interpersonal, curricular, and campus climate factors that impact LGBTQIA+ osteopathic medical students during preclinical years, aiming to identify targeted strategies that promote inclusion and equity in medical education. Objective: To investigate LGBTQIA+ medical student perceptions of professor and institutional inclusivity, while also identifying perceived levels of impact that these experiences had on their well-being during medical school. Methods: 119 self-identifying LGBTQIA+ medical students at Doctor of Osteopathic Medicine (DO) programs across the U.S. were recruited via email and social media to complete an anonymous, mixed-methods online survey. Students were asked about perceptions of professor and classmate inclusivity, their campus environment overall, adverse experiences, and the impact of these factors on their success during their didactic years. Students were also asked to reflect on different inclusivity components of Osteopathic Manipulative Medicine (OMM) lab. Statistical analysis was performed using IBM SPSS v.29. Results: 119 DO students responded to the survey. 92 (77.4%) identify as cisgender and 26 (21.8%) identify as transgender and/or gender-expansive (TGE). Participants attend programs across regional settings, with 50 (42.0%) at urban schools, 47 (39.5%) suburban schools, and 22 (18.5%) rural schools. When reflecting on classmates, only 27 (32.2%) students rated peers positively at using correct pronouns for TGE individuals, and 41 (36.0%) rated peers positively at advocating for LGBTQIA+ inclusion. Similarly, 51 (43.6%) students rated classmates positively at using inclusive terminology when discussing the LGBTQIA+ community, patients, or experiences. TGE participants were significantly less likely than cisgender participants to give classmates positive ratings on correct pronoun use (p<0.001), and were more likely to be impacted by correct pronoun use for them (p<0.001), inclusive terminology (p=0.006), and correct pronoun use for patients (p=0.038). Similar results emerged regarding professor and faculty ratings, with approximately a third of students giving positive ratings regarding advocating for LGBTQIA+ inclusion, providing inclusive lecture material, and using correct pronouns for TGE individuals (32.7% (n=37), 33.6% (n=40), and 36.8% (n=39), respectively). 41.0% (n=48) of students gave professors positive ratings on using inclusive terminology regarding the LGBTQIA+ community. TGE students rated lecture inclusivity (p=0.036) and use of correct pronouns for students (p<0.001) lower than cisgender participants, and were more likely to report impact (p<0.001). Regarding OMM lab, less than half of students gave their OMM department a positive rating (indicating “well” or “very well”) at using gender-neutral terminology for body parts, allowing them to select a lab partner they feel comfortable with, and ensuring use of correct pronouns (46.8% , 46.8%, and 47.9%, respectively). 63.3% of participants (n=69) rated their OMM department positively at providing lab dress code options that allow them to present in alignment with their gender. Of note, 79.8% of participants (n=95) rated their OMM department positively at emphasizing consent, with 102 (85.7%) reporting that this impacts their well-being. Compared to cisgender students, TGE students rated their OMT departments more poorly at using correct pronouns for students (p = 0.003), and their wellbeing was more impacted by inadequate use of gender-neutral terminology for body parts (p = 0.02). Students in rural settings rated their OMM departments more poorly at allowing students to choose lab partners they feel comfortable with, compared to those at urban and suburban schools (p = 0.001). Reflecting on the overall campus environment, 73.9% (n=88) of participants reported feeling the need to educate others on their LGBTQIA+ identity, and 57.1% (n=68) felt that LGBTQIA+ experiences were presented as niche, exotic, or othering by classmates, professors, or both. 55 (46.2%) reported censoring their speech or mannerisms around others at school. 40 (33.6%) participants reported being treated differently based on their identity, and 17 (14.3%) experienced overt harassment. 15/26 (57.7%) TGE respondents reported being misgendered or deadnamed at school. Notably, TGE students were over twice as likely as cisgender peers to report differential treatment (p=0.002) and 6.5 times more likely to report overt harassment (p<0.001) due to their identity. 7 (5.9%) of respondents considered transferring or dropping out of medical school as a result of their experiences as an LGBTQIA+ student on campus. Conclusion: The results of this study reveal that LGBTQIA+ DO students often face disparities in institutional support and overall comfort at their institution. These students report a lack of inclusivity on the classmate, professor, and campus levels, and indicate that these factors impact their success and wellbeing during preclinical years. OMM departments do well at emphasizing consent during OMM lab, but stand to improve on inclusive terminology, pronoun use, and lab partner selection. Overall, LGBTQIA+ students face an unsupportive campus environment, with many experiencing differential treatment, misrepresentation of their identities, self-censorship, and overt harassment. Additionally, TGE students were consistently more likely to give poor ratings and to report adverse campus experiences, and were more likely to report an impact on their wellbeing. These findings highlight an acute need for interventions at osteopathic medical institutions that improve the preclinical environment for LGBTQIA+, and particularly TGE, medical students. The core tenets of osteopathic medicine highlight the connection of body, mind, and spirit – DO schools have the duty to honor these tenets by holistically supporting students of all identities as they develop into osteopathic physicians.

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