Clockwise from left are Erryn Tappy, third-year student; Robert W. Irwin, M.D.; and Nikhill Bhardwaj, second-year student.
Special to UM News
“It’s not easy feeling you have to pretend you’re something you’re not. It’s a continual challenge, and it wears on you.”
Erryn Tappy, a third-year M.D./M.P.H. student, is talking about her sexual orientation. It is not uncommon, she says, for other students, or even faculty members, to simply assume everyone in hearing range is heterosexual and to make comments or jokes—sometimes about a student, sometimes about a patient—that are disrespectful or “heteronormative,” a term describing the belief that heterosexuality is the only “normal” or correct orientation.
“Personally, I’ve had many experiences like this,” said Tappy. “I identify as bisexual, and there have been countless occasions where I’ve been with a preceptor who assumes I’m straight, and I’m afraid to correct them. I don’t always know how they will respond and if it will affect my evaluation. I feel like I have to choose between my identity and my grades, so I pick my battles.”
Instances like those Tappy describes—some subconscious and unintended, others deliberate and critical—occur regularly at the Miller School of Medicine, she says. For LGBTQ students, it potentially has a serious impact, both personally and professionally.
“In a survey of Miller School medical students last year, 17 percent of the 132 respondents reported they had been harassed, marginalized, or judged because of their orientation,” said Robert W. Irwin, M.D., associate clinical professor of physical medicine and rehabilitation and assistant dean for Student Affairs. “In addition, 54 percent had overheard faculty and students making comments that were not LGBTQ-inclusive.”
The survey also found that nearly 20 percent of medical students know someone who, or themselves, had felt the need to conceal their sexual orientation or gender identity, and 60 percent were unaware of any resources available for LGBTQ medical students.
As a result, the Miller School has adopted a new training program, called SafeSpace, to give members of the administration, faculty, and staff a greater sensitivity regarding LGBTQ issues and prepare them to serve as mentors or allies for LGBTQ medical students. The offices of those who complete the SafeSpace program become a “safe space”—identified by a stylized “U” logo—where LGBTQ medical students can feel welcome. On the Coral Gables campus, the IBIS Ally Network has a similar mission of training faculty, staff, and students to be effective allies to UM’s LGBTQ community and will hold its inaugural training session on Thursday, April 2.
“We are committed to fostering diversity, and the SafeSpace program is an important part of that commitment,” said Pascal J. Goldschmidt, M.D., Senior Vice President for Medical Affairs, Dean of the Miller School of Medicine and CEOof UHealth, who was one of the first administrators to attend the 90-minute SafeSpace workshop. “Diversity enriches and strengthens the medical environment, and it better prepares us to face the challenges of the future.”
The larger issues extend far beyond the boundaries of the Miller School campus.
“There are serious concerns—not just with medical students, but also with the patient population we serve,” said Irwin, who oversees SafeSpace. “Here in Miami, 20 to 40 percent of the homeless teens on the street are LGBTQ; so are 40 percent of all suicides, on a national level. We want to be able to reach people who want to talk and need to talk with someone who understands their issues.”
Nor are they confined to UM.
“In 2007, the Association of American Medical Colleges came out with national survey results in which one medical student in five reported they had been subjected to abuse,” said Irwin. As a result, the Miller School program has had strong support from LGBTQ students.
“In my second year, I was co-director of MedicOUT, the Miller School’s student LGBTQ organization, so SafeSpace was a natural extension of those interests,” said Tappy, who is one of two student trainers working with Irwin. After the program was initiated by fourth-year M.D./M.P.H. student Adam Crosland and Irwin, she took the lead role in conducting and analyzing the Miller School survey, and she is making it her capstone project.
“We wanted to learn what the experiences have been for Miller School students,” she said, “and the data has been very rich and very telling.”
In fact, some of the instances reported on the survey have been startling:
• Publicly humiliating students about their sexual orientation and asking detailed questions about their sexual behaviors
• Criticizing male students for the way they walk or stand, or suggesting they are gay for having effeminate mannerisms
• Discouraging students from pursuing certain medical specialties because of their gender
• Being treated differently and spoken to less after being found out to be gay
• Being subjected to fear and stress from openly anti-gay conversations that took place in a preceptor’s office
“Improving the campus climate for LGBTQ students means increasing knowledge about and sensitivity toward challenges they may face,” said Tappy. “Part of the training is case-based learning, and we have adapted situations that came out of our survey for the cases.”
Here are the three cases used in the workshop that Goldschmidt and other administrators attended:
Case 1: A small group of medical students is talking between classes. One of them compliments a female student on a new piece of jewelry she is wearing. Another asks if it was a gift from her boyfriend. Later the female student tells a peer that the question made her uncomfortable because she identifies as a lesbian. The peer then makes an inappropriate sexual comment about her identity.
Case 2: A preceptor being shadowed by a student makes a homophobic comment about an HIV-positive patient. The student, who identifies as gay, has heard this same preceptor make similar remarks and tells his advisor that he wishes to switch preceptors.
Case 3: A transgender student is told by her attending during surgery rotation that she should dress more like a “normal” man because she was making a patient uncomfortable. The student was very upset but didn’t want to say anything to jeopardize her evaluation. She confides in her advisor, who later runs into the attending at a lunch meeting. During the conversation, the attending continues to make transphobic remarks.
The trainers have also decided to continue with the survey, to see if there are changes over time. They recognize that changing how people think and act—especially when they mean well and don’t realize that they may be making others uncomfortable—can be a difficult task.
“Stereotypical beliefs are often very subconscious, and much of what we discuss involves undoing some of the ways we may have been taught to think,” said Nikhill Bhardwaj, a second-year M.D./M.P.H. student who is the other trainer in the program. “The workshop gives participants time for reflection, and the feedback so far has been very positive.”
The participants focus on a mix of cases, terminology, and interactive exercises that Irwin says are intended to make them an “ally”—someone LGBTQ students can seek out, knowing they will be both familiar with and supportive of any issues they want to discuss.
SafeSpace is really just a starting point.
“Looking across the country, however, only five hours out of four years of medical school, on average, are spent discussing related topics, and that includes AIDS and HIV,” said Irwin. “Moreover, in our survey, only 40 percent of respondents said we were addressing LGBTQ-specific health topics in our medical curriculum, and only 35 percent said they felt ‘very much’ or ‘quite a bit’ prepared to provide healthcare to LGBTQ patients.”
Part of the answer, said Bhardwaj, is for the program to grow.
“So far we have only worked with deans and administrative staff, but we hope to expand the program to include the larger Miller School community,” he said. “Ideally, exposure to the SafeSpace material will not be confined to just one session, but will be integrated into student learning throughout all four years.”
Information about SafeSpace, including a downloadable copy of the training manual, can be found here on the Miller School website. Individuals seeking additional information can contact Irwin at RIrwin@med.miami.edu or 305-243-2003.