“Progress in Medicine Is Slower to Happen”: Qualitative Insights Into How Trans and Gender Nonconforming Medical Students Navigate Cisnormative Medical Cultures at Canadian Training Programs
Bibliographic record
Abstract
PURPOSE: Trans and gender nonconforming (TGNC) people face significant health disparities compared with their cisgender (nontrans) counterparts. Physician-level factors play a role in these disparities, and increasing the participation of individuals from sexuality and gender minority (SGM) communities in medical training has been proposed as one way of addressing this issue; however, very little is known about the experiences of TGNC medical students. This study aimed to understand the experiences of TGNC medical students in Canada. METHOD: Between April 2017 and April 2018, 7 TGNC participants either currently enrolled in or recently graduated from a Canadian medical school completed audiorecorded semistructured interviews. Interviewers asked about experiences with admissions; academic, clinical, and social environments; and interactions with administration. The authors analyzed interviews using a constructivist grounded theory approach. RESULTS: The authors developed 5 overarching themes: navigating cisnormative medical culture; balancing authenticity, professionalism, and safety; negotiating privilege and power differentials; advocating for patients and curricular change; and seeking mentorship in improving access and quality of care to TGNC patients. This article focuses on the first theme, with associated subthemes of culture and context; interactions with classmates, curriculum, policy, and administration; and gendered spaces. CONCLUSIONS: The results of this study delineate heterogeneous experiences of medical cultures with a shared underlying pattern of erasure of TGNC people as both patients and clinicians. Findings were largely consistent with previously published recommendations for improving academic medical institutional climates for SGM people, though the need for access to appropriate gendered spaces beyond washrooms was highlighted.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".