Experiences during medical school can systematically shape biases and attitudes against gay and lesbian individuals, according to a study published by researchers from Yale, Oregon Health & Science University, Syracuse University and the Mayo Clinic.

The study, published on Aug. 5 in the journal Social Science & Medicine, is part of a large long-term research project called the Medical Student Cognitive Habits and Growth Evaluation Study, more commonly known by the title CHANGES. CHANGES, a longitudinal study of medical students, seeks to understand the “culture of medicine” that promotes or inhibits physician expression of biases, according to a 2015 study report published in the Journal of General Internal Medicine.

“Bias can influence physicians’ medical decision-making, as well as their behavior toward patients,” said Natalie Wittlin GRD ’21, lead author of the study. “The goal of this research was to understand experiences during medical training that may contribute to or mitigate physician bias against lesbian and gay individuals — and ultimately health disparities.”

In this component of the CHANGES project, researchers sought to understand the influence of medical school on physician biases against sexual minorities. According to the study, these biases can impede the delivery of high-quality health care and contribute to the prevalence of poor health outcomes within these populations.

“Social psychologists have given more attention recently to sexual orientation biases than ever before, but they still remain underexamined relative to certain highly prototypical forms of race and gender bias,” said Sara Burke, one of the authors of the study and an assistant professor of psychology at Syracuse University.

In the CHANGES project, the researchers collected data from 2,940 medical students across a number of U.S. medical schools at three time points: their first semester of medical school in the fall of 2010, their last semester in the spring of 2014 and their second year of medical residency in the spring of 2016.

Through surveys taken at these time points, the researchers examined the relationship between experiences reported by heterosexual, cisgender medical students during medical school and explicit and implicit biases against lesbian and gay individuals during their residency. Explicit biases refer to overtly expressed attitudes towards a group of people, while implicit biases are defined as unconscious negative associations with a specific group of people.

The researchers found that students who had more contact and favorable interactions with LGBT individuals during medical school expressed less explicit and implicit bias towards sexual minorities during their residency. On the other hand, students who were exposed to “negative role modeling” during medical school expressed more explicit bias against sexual minorities.

According to Burke, the next iteration of the study will involve physicians evaluating hypothetical patients presenting different symptoms. She added that the researchers plan to continue contributing to the discussion on sexual orientation biases within medicine.

“We hope to participate in the larger conversation about how to structure medical training so as to maximize its beneficial consequences and minimize harmful side effects,” Burke said. “There is much more to be done.”

Wittlin added that the team will continue to follow up with the original cohort of medical students. The researchers will be able to observe how these biases change over time, as well as the long-lasting effects of experiences during medical training. She added that though the team has not tested any interventions, she expects that increasing diversity and inclusivity in medical schools could help to reduce bias against lesbian and gay individuals.

The CHANGES project is primarily funded by the National Institutes of Health, according to the project’s website.

Madison Mahoney | madison.mahoney@yale.edu