Unlocking the Closet Door: Recurrent Identity Disclosure Experiences Among LGBTQ Students

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To the Editor: The stages of medical education create a sequence of unfamiliar settings and people—classrooms and clinics, classmates and faculty—for trainees to navigate. For students who identify as lesbian, gay, bisexual, transgender, and/or queer (LGBTQ), entering each new environment generates afresh the dilemma of whether to reveal their sexual and gender identities. Contrary to common perception, “coming out” is not a single event; rather, people who identify as LGBTQ experience a recurrent process of self-reflection and identity disclosure with each change in context.1 Even among LGBTQ individuals who identify as “out,” pursuit of a medical career adds new doors to the sexual/gender closet, and each phase of training reintroduces the negotiation of whether that new door should be opened.
My decision to disclose my identity when entering a new environment is never easy; I must balance relevance with integrity, fears of preconceived judgments with authenticity, and others’ comfort with my own. These considerations become particularly salient during medical training, when developing long-term relationships is critical for success and well-being; however, unlike coming out to family or friends—with whom sharing is embraced and from whom support is anticipated—disclosing sexual or gender identity in the medical education setting invites the uncertain response of those who teach, grade, and critique. Knowing that a single person’s assessment can affect my professional fate, this reality leads to the disheartening worry that my sexual orientation could distort crucial opinions.
Although coming out constitutes an unremitting component of identity management for LGBTQ people, entering new settings exacerbates the loss of power and vulnerability experienced with identity disclosure. Where support for LGBTQ students is palpable, however, so too is the power to disclose. Individual institutions can assist LGBTQ students through transitions by making inclusion policies transparent, specific, and accessible. For example, universities can signal an LGBTQ-friendly culture by including sexual orientation and gender identity in nondiscrimination policies and by offering opportunities for voluntary self-disclosure when collecting demographic data.2 Such efforts not only mitigate fears of hostility, ostracism, and bias against LGBTQ students but also increase the tolerance and knowledge of the broader community. While there is no universal recommendation for students disclosing their sexual or gender identities, understanding the expectations of their institutions allows them to make informed choices.
Establishing environments where LGBTQ students feel comfortable disclosing their identities without fear of denigration or negative professional consequences remains a future goal, but actions to facilitate this ideal are achievable now. With the next transition ever looming, help unlock the closet door for LGBTQ students.
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