Document Type


Publication Date

Summer 8-5-2022


Medical Education Research Awards



Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people experience health disparities. Implicit bias and mistreatment by healthcare providers can also lead LGTBQ+ people to delay care or avoid it entirely. Clinical skills training in the care of LGBTQ+ patients is therefore critical to health equity. Standardized patient (SP) encounters allow medical students to be assessed as providers in a mock clinical setting.


The study population was rising third-year medical students at the University of Louisville School of Medicine in 2022. Out of 149 total encounters, coders reviewed all encounters with gender diverse SPs (n=86) and coded microaggressions, which are brief exchanges that send denigrating messages to certain individuals. Each video was reviewed by 3 coders.


LGBTQ+ microaggressions occurred in the majority (66%) of encounters between medical students and SPs. However, student use of homophobic or transphobic language was rare (3% of encounters). Generally, students appeared neutral or positive when speaking about hormone use and gender transition. Transgender and gender diverse SPs identified moments of discomfort and/or ways that students could improve in the care of trans and gender diverse patients in debriefs. Many SPs reported discomfort with the students' assumptions, whether or not they were accurate.


LGBTQ+ healthcare microaggressions are pervasive. Addressing microaggressions requires practice and accountability. Outcomes from this work can be synthesized as part of curriculum development and as recommendations for medical training. Because this project focused on encounters between students and standardized patients, it may be limited in generalizability to actual patients.