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"You need to protect your own energy..."


"My name is Sabina. I’m a third year medical student at the University of Pittsburgh School of Medicine, and I plan to apply for OB-GYN next year for the match. Queerness holds a lot of importance to me in terms of not only my self-identity, but also my professional identity and career goals. I grew up in Orange County, California, which a lot of people know from TV shows like Real Housewives and Laguna Beach as a super preppy, rich, largely conservative area -- which it is. I am neither rich or preppy nor am I white or conservative, all of which are prevalent identities that exist in Orange County.


I’d always felt like an outsider growing up in that area. The beaches are great, the food is great, and the weather is obviously great; but, coming into my own identity was really difficult in that setting, especially in high school when I really started to explore my queerness and to understand what it meant to me. I had some friends, and I was part of the band, which you would think would be more queer forward -- and it was to some extent -- but, again, with the Orange County mindset, it wasn’t as queer as other band spaces could be.


So when I started exploring and telling more people that I thought I was bisexual (because I had a boyfriend at the time -- I quickly realized that I wasn’t [bi]) people started to stop being my friend, which was not fun. That was really hard for me. I had to explore [my identity] on my own, in a less public sense. I had a girlfriend, but we were very on the DL, and I didn’t really tell people. I explored my queerness through shows like The L Word -- the OG L Word, which as we know can be problematic -- and OG lesbian YouTubers like Hannah Hart. Those were people who really guided me. At the time, there also weren’t really any Black lesbians in the media, so I didn’t have that [representation] for a while, probably until mid-college.

When I graduated high school and went to college, I left for Pennsylvania -- to Philly. That was a really interesting experience because it was the first time I was really able to start fresh, and I really enjoyed that. I was able to explore what it meant to be queer as a whole and for myself without the pressure of trying to fit in to Orange County...well, I never tried to fit into Orange County, but trying to pass enough to survive Orange County. It was nice to not have that pressure. West Philly is pretty queer, so it was a really nice environment to be in to come into my own.


Through that exploration, I realized that I didn’t know anything about how my identity might or might not impact my health. When I went back home for the first time, I had an annual, and I told the doctor I was gay. She was so weird about it! She didn’t know what to do; she froze up and left the room. I didn’t know what was happening and why it was such a big deal! She wasn’t ever overtly discriminatory; she never said anything that was hurtful. But just her small actions: the pausing, the looking at me weird, the leaving the room, the tripping over her words. Everything was going well until [I said that I’m gay], and then the rest of the conversation was weird. That sat weirdly with me. So I said, ‘Well, I’m not coming back to you.’ Then I saw another doctor, and she was even weirder about it and made a whole thing about me getting pap smears. She said some sketchy things. And I was like, ‘What’s happening right now?’


I’d always known I wanted to be a doctor, so that point was when my why started to take shape in a more nuanced way than it had before. Before it was just a nebulous ‘I want to help people,’ but towards junior year of college it started to become more narrow and more focused and more relevant to myself and my passions. With these experiences, I took a course called Politics of Women’s Health at Penn. We had to do a research project, and I decided to design a survey where I’d ask lesbian and bisexual identifying people what their experiences were like with healthcare. This was in the age of Tumblr, so I just posted this survey on Tumblr, and I got so many responses. It was just for this class, and I wish it were more formal because it would have been a great thing to publish. But it wasn’t IRB approved, so it wasn’t something I could publish into the world.


Despite this, it was really great for me personally and shaped my experience with healthcare and my career goals going forward. So with all of those anecdotes as well as my own experiences, I felt validated...and also sad because this is something we’re all experiencing and it’s really shitty. Why is this happening? This was in 2015, which isn’t even that long ago, but honestly at that time, LGBT health in a medical education framework -- or really in general -- was just starting to be talked about. I really felt like I was on the forefront of something, but I was just a junior in college, and I didn’t know how to break into that world and how to push it forward. I kind of felt like I had to wait. In the meantime, I kept reading on my own and staying up to date on all of the things being published.


Eventually, I realized that this is why I wanted to go to med school. I want to be a Black gay woman who provides care to queer and minority patients, and at the same time, helps to improve the training that we get as medical students and residents and also physicians who are already practicing who have never been exposed to this before and who need training and education too. So I became really invested in medical education, and I went on to grad school after undergrad. I also did a Master of Public Health, and I framed my thesis around LGBTQ curriculum innovations in medical education. That was around 2018, and by that point there had been a decent amount of changes and publications that had come out, but progress was still pretty slow.


Things are changing, but you still hear horror stories and there are still terrible statistics and reports about the experiences of people who are queer or gender diverse. This just doesn’t need to happen -- it just shouldn’t be this way. And the same is true for racially minoritized and marginalized patients, as well, and the intersectionality of [these identities] too is like this whole thing. So that’s what I applied to medical school for, and my entire essay and application was about that. Basically, everything that I’ve done throughout med school has been to push that gay agenda, if you will, to make it better locally at my school, but also nationally -- to push medical education to be better.


People always ask how we’re going to make it sustainable. Really, truly, the way to make anything sustainable is to teach it at the forefront, rather than try to undo what people have learned (or not learned), and get them to a point where they understand what they need to be providing patients who are queer. My motivation is to lend a voice and platform to marginalized and minoritized populations, including LGBTQ patients, across the country.

 

I applied as a Black gay med student, I got in as a Black gay med student, and I exist as a Black gay med student. It’s who I am. I came in very strong with that from the get-go, and when people would ask why I’m here, I would say this. And I think some people were rubbed the wrong way by it. I’m very forward about it, and anytime I see any small thing wrong or an opportunity to slide in some education about LGBTQ health, I’m sliding in with it. People are probably rolling their eyes in the background going, ‘Here she goes again.’ But it’s so important. [LGBTQ health] is not something that’s necessarily taught constantly, let alone in a way that people are reminded of it. There are topics in medical school that come up all the time. Right now, one of those topics is racial and ethnic populations and disparities. Whenever any of that comes up, I’ll also say that this applies to queer and other marginalized populations.


Overall, though, I’ve had good experiences. I was nervous coming into a space not really knowing how I’d be accepted in medical school -- a lot of med school spaces are cis-het and white -- but it’s been good at my institution, from a social aspect. I have really great friends and there are really great mentors here who support my efforts and my work and who have been invaluable to helping me and my peers push the school to be better about how they teach students.


With that in mind, I’ve been a part of Medical Student Pride Alliance (MSPA) since before I was even a med student. I started in the spring of 2019 when I had just gotten accepted to med school. I started as an Assistant Director for Campus Engagement, right when [MSPA] had just launched, so it’s been really neat to be a part of a national organization that was created by and for LGBTQ med students since the beginning. And with that experience, I’ve not only had great friends to vent to, fall back on, and use each other’s brain power to support local and national initiatives, but it’s also opened up a host of opportunities from networking and mentorship opportunities to things like what we’ve been talking about -- advocating for changes in the LCME, the AAMC, the ERAS application, and all of the things that MSPA has been able to participate in.

Being a part of that national organization has been such an incredible experience and, really, it’s just always nice to be a part of a like-minded group of people who know what we all want to do -- not only do we want to build a community, because there’s a lack of LGBTQ med student community in general, but we also want to make it better for ourselves, our future patients, and our allies who aren’t getting the education they might need to care for these patients. Just because you're not necessarily identifying under the LGBTQ umbrella doesn’t mean you’re not going to see these patients, right?


It’s been really nice to be a part of MSPA. I feel like I’ve grown a lot because of MSPA and the experiences with and input from my peers and my mentors. I feel like I’ve grown a lot as an advocate and, while I’m not an expert in LGBTQ health, I do feel more experienced than some of my peers. I’ve been able to grow in that realm as a researcher and an advocate at the local level, too, because of the mentorship opportunities and the peer support that I’ve had through MSPA and through my little group of friends who do a lot of work at my school too.

 

I’ve been fortunate that my experiences aren’t as egregious as the examples that I read about or research or interview people about. The first experiences I had were the ones that I’ve already recounted -- the small subtle changes that make you anxious as a patient. Why is my doctor, after asking me if I’m sexually active and who I have sex with, now being weird? Why did she leave the room? What are they saying about me or adding to my chart? Do they even know what to tell me in terms of recommendations? I just felt like I was being othered, and I hadn’t experienced that before I had told her [that I was gay]. And then I went to a different doctor and experienced the same thing, but she was worse about it! She said she needed to get different things for me -- for a pap smear! What? She also didn’t know what to do and was fumbling and so awkward. She kind of did her thing and nothing else -- no conversation. It was very clear she was uncomfortable with me being in that space, or rather, with her being my provider in that space. So I just left and said, ‘I’m not going back to you.’ And luckily I haven’t experienced a similar thing since then.


What I have experienced as a med student, not personally for me as a patient, is that I’ve witnessed or overheard people in healthcare spaces -- providers at any level -- saying harmful things about queer-identifying patients or transgender patients. It’s really difficult as a med student to be in those spaces -- especially a med student whose entire mission is to rewrite how people think about this and how people care for LGBTQ patients -- and at the same time be graded. It’s a huge power differential! So in those spaces, I have to decide: Am I going to say something to the person who’s the only person grading me for a month, especially when it’s very clear that no matter what I say they’re not going to vibe with it? Am I going to say something or not? That’s been very difficult for me to navigate in a space where I’m being graded.


I’ve had great conversations with people about it where they’re like ‘Wow, I learned a lot, thanks,’ and I’ve also chosen not to say stuff in other situations where I really didn’t feel safe in the environment to say something. I feel really bad for the patients because I want to protect them, and I feel like it’s a duty of mine to say something, but it also could harm me in the long term if I did. So what I do instead is talk to someone within the school about it, because I feel a little more protected in that sense versus going directly to the person grading me. Regardless, I always say something, it’s just a matter of how urgently and the route I take to say something. But the minority tax of that has been an interesting dynamic to navigate as a med student.

 

I feel like a lot of times when you enter a medical education space, regardless of specialty or profession, and you’re a queer student, you feel obligated -- or people expect you, rather -- to be the all-knowing person about LGBTQ health. And obviously that’s not the case in all situations. For me, it is -- I often do find myself knowing more about a case that comes up or a standardized patient case in these teaching settings. I know more than the facilitator, and that’s frustrating in and of itself, but it’s also frustrating to feel like it’s expected of me. ‘Oh, our fake patient today is gay -- Sabina, go!’ That’s not how it should be. I’m still a student. Queer med students are still students and we’re still here to learn. Even if we might know more, the burden isn’t on us to be educators.


Something I’ve gotten better at doing that I wish I were better at at the beginning of med school is advocating for myself and my peers and saying, ‘Yes, some of us are taking it upon ourselves to train ourselves and learn more about LGBTQ health, but you can’t expect us to take on that burden to teach our peers.’ One: We’re not being paid to teach, we’re paying you to teach us. Two: It also sets up a weird dynamic between yourself, your peers, and the facilitator who is grading you.


I think schools need to take more initiative to educate and train their facilitators. It’s one thing to build into your curriculum these important and necessary problem-based learning cases and standardized patient cases that are about LGBTQ health, but then it’s another thing to throw facilitators into those situations and not provide them with the necessary training -- or the education -- that they need to feel comfortable and confident teaching that. People who went through medical school x number of years ago weren’t ever really exposed to this topic and have had to take additional learning courses on their own and take the initiative on their own [to educate themselves about the topic]..



I really think if you're going to be a medical school in this day and age, it’s important to teach about LGBTQ+ health and healthcare, and it’s important to train your educators in how to teach it. I think that’s something that more med schools are doing now, and I think as queer med students, if you feel comfortable being that go-to person, that’s fine. Just recognize that it’s not your duty and you don’t have to feel the pressure to always be sitting on those committees and always be sitting at that table educating others. That’s not our role, and if it is, they need to be paying us for it! I think that’s something I wish more med schools and medical education spaces would recognize as an issue that they need to address.

Plus there are tools out there [designed to train educators about LGBTQ health]. MSPA has the Teaching LGBTQ Health CME course that’s free and openly sourced through Stanford, for example. How many people know about that? There's also Safe Zone and OutCare Health.There are all these organizations that are providing schools with free resources to train their educators so that students don’t have to carry that weight and burden while they’re just trying to be medical students and become doctors.

 

As queer pre-meds, med students, or professionals at any stage of this profession, it’s really difficult -- from our own personal experiences, of course, which play a role in how we navigate these spaces -- because we don’t have as many people to turn to for advice and mentoring and experience, because the numbers are small. We don’t have a set number because that's never been tracked before, but the representation is lacking, obviously. I think as queer students entering the space, it’s okay to seek a school that’s going to support you. A lot of times we’re told, in general, as med students, to just go wherever will take you. I don’t think that should apply to anyone, but I specifically don’t think that it should apply to people who identify within marginalized and minoritized populations. You have to go somewhere that will support you and that will provide you with the space to thrive as a student and an individual.


If I had listened to people who were telling me to apply to these schools regardless of their politics and where they’re located and what they can offer me because I just need to be a doctor, I wouldn’t have the current experience that I have in med school, and I wouldn’t have the freedom and support to do the research and work and advocacy things that I do. I wouldn’t feel safe doing it, but then I also wouldn’t have the people to support me to do it. Students need to feel confident and like they deserve -- because they do -- to go to a place that’s going to support them. You don’t have to settle. And a lot of people tell students to settle -- ‘Wherever life’s going to take you, it’s going to take you.’ But you have to go somewhere that’s going to support you and where you’re going to feel safe.


Another thing is that you don’t have to feel cornered or pressured into doing this work. You can operate and identify as a queer student and not be sitting at those committee tables and not be doing constant LGBTQ-only focused health research because there’s more to you than that! Like, I could be a Black gay woman interested in studying and pipetting cells in a lab, but I’m not. And if I was, the cells aren’t gay -- or maybe they are, I don’t know! I think that a lot of times we feel pressured and cornered to only do work and operate and provide input in our specific niches. To the school, those niches equal our identities, which is problematic in itself, but I don’t feel like you should feel pressure to do that work. It takes energy, it takes tax, it’s all of the above, and you need to protect your own energy.


Do what you’re passionate about, recognize that people will come to you for support and look up to you, but if you’re being invited to committee upon committee and you don’t have the capacity or energy for that, you don’t have to say yes -- it’s fine. And again, schools need to start paying us! It’s okay to go to a school that supports you, and it’s okay to say no if you’re feeling overstretched. We’re underrepresented and schools take advantage of that, which isn’t cool.


Last piece of advice, I think social media is great -- I love social media with all of my heart. I think that a lot of students who identify as underrepresented in medicine and LGBTQ can really benefit from creating professional identities on social media and using that platform to seek out mentors and peers who they might not have access to within their own institutions, just because of a lack of numbers. It’s not great that we have to take that extra step, but I can say from personal experience that it's been invaluable. I’ve connected through MSPA, which operates solely online and on social media, and through my own personal connections through my own platforms. It’s just opened up so many worlds and opportunities for me. And I wish more schools talked to students about using social media as a professional development tool, because it really can be leveraged that way. So, take advantage of that."

-Sabina Spigner, Pittsburg, PA (she/her)




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