Burnout More Common Among Gay, Lesbian, and Bisexual Medical Students

A new cross-sectional study found that medical students in the sexual minority (SM) – gay, lesbian, and bisexual students- had less favorable perceptions of medical school learning environments than their heterosexual classmates.

The study results also suggested that these environments were associated with higher rates of burnout among gay, lesbian, and bisexual students.

Various studies have noted the importance of diversity in the health care workforce, as the inclusion of different groups could lead to improvements in health disparities, patient satisfaction, and improved financial performance.

However, the discrimination that nearly 8% of the US population who identify as lesbian, gay, bisexual, or transgender face has been known to affect the medical workforce and invariably lead to increased burnout.

Prior to this study, no large-scale studies examined the differences in students’ perceptions of learning environments by SM status or how these environments are associated with burnout.

As such, a team led by Caitlin R. Ryus, MD, MPH, Yale School of Medicine, examined the student perceptions of medical school learning environments and self-reports of burnout in a large cohort of medical students based on SM status.

Ryus and colleagues examined responses from medical students who graduated in 2016 and 2017 who had responded to the Association of American Medical Colleges’ Graduation Questionnaire (GQ). The questionnaire collected data on student demographic characteristics, career plans, mistreatment, burnout symptoms, and perceptions of the learning environment.

Sexual identity was determined by self-report, with response options being heterosexual or straight, lesbian or gay, and bisexual.

From there, the team looked at scores from the Medical Student Learning Environment Survey (MSLES), a validated instrument used to assess student-faculty interactions and student perceptions of the emotional climate, the latter of which was determined via a 3-item component that examined the individual’s sense of achievement, self-valuation, and confidence in academic abilities.

Burnout was assessed via the Oldenburg Burnout Inventory for Medical Students (OLBI-MS) and measured by exhaustion and disengagement.

A total of 25,757 respondents were included in the study, 48.6% of whom were women and all of whom were approximately 26 years or younger.

Among these respondents, 568 self-identified as bisexual (2.2%), 854 as gay or lesbian (3.3%), and 24,335 as heterosexual (94.5%).

Ryus and colleagues observed that both bisexual and gay/lesbian students reported less favorable perceptions of their learning environments than heterosexual students (P<.001).

Additionally, Bisexual and gay or lesbian students were more likely to be in the top quartile for burnout scores (bisexual: odds ratio [OR], 1.71, 95% CI, 1.42-2.07,) (P < .001) ( gay or lesbian: OR, 1.53, 95% CI, 1.31-1.79) (P < .001), findings that were attenuated when accounting for student perceptions of the learning environment with poorer perceptions being associated with higher burnout symptoms.

Investigators recommended that future research was needed to identify elements of learning environments that contribute to burnout among SM students.

“Addressing the experience of medical school learning environments among SM students could improve the inclusivity of medical schools, mitigate burnout, decrease attrition, and ultimately diversify the health care workforce,” the team wrote.

The study, "Burnout and Perception of Medical School Learning EnvironmentsAmong Gay, Lesbian, and Bisexual Medical Students," was published online in JAMA Network Open.