“Encouraged to be your true self”: an interpretative phenomenological study of medical students’ experiences of role models in shaping sexual minority identity at medical school

Journal article

Sexual and gender minority (SGM) identifying individuals experience worse health outcomes compared to non-SGM identifying counterparts. Representation of SGM individuals within medical schools may improve the delivery of more equitable healthcare through reducing biases and normalising the SGM presence within healthcare spaces. Our initial aim was to explore the extent to which role models may influence personal SGM identities within medical schools in the United Kingdom, using an interpretative phenomenological approach. This methodology allowed us to develop meaning from, and give voice to, participants’ relationship with their bespoke experiences, respecting differing narratives within the broad ‘SGM’ umbrella, rather than attempting to establish commonalities. Semi-structured interviews were conducted with five medical students and three medical school faculty within three medical schools, who identified as SGM. Due to a lack of gender minority identifying participants, we unfortunately could not adequately speak to their experiences, and therefore narrowed our eventual focus to sexual minority (SM) individuals. The developed themes followed a cyclical process of: (1) role model identification; (2) role model selection, influenced by matched wider identities including generation, hierarchy and power; (3) trait assimilation, particularly where identity deficits were perceived; and (4) identity projection, where students used role models to both emulate comfortable SM identity projection, and become advocatory role models themselves. Throughout, participants described role models as multifaceted in their direction (vertical and horizontal), influence (positive and negative) and locus of effect (as individuals, and as part of a collective). Unexpectedly, identity, power, and hierarchy-matching meant peer-to-peer role modelling was often experienced more positively than vertical faculty-tostudent role modelling. However, as expected, heteronormativity exerted an inhibitory effect on this process. From these results, we built upon existing social cognitive paradigms to develop a ‘doublefunnel’ model to represent how social contexts can map onto individual SM identities and vice versa, mediated by role models. The triangulation of these three aspects in relation to medical education presents novel understandings to the field. Greater explicit institutional support of studentled SM societies, and facilitation of the presence and discussion of SM symbols and personal identities within professional spaces, may go a long way in redefining ‘normativity’ in medical schools.

Authors: Zacharias, A; Aitken, D

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Taylor & Francis
• Journal: Teaching and Learning in Medicine
• Publication date: 2025-01-15
• Acceptance date: 2024-12-20
• DOI: 10.1080/10401334.2025.2451911
• EISSN: 1532-8015
• ISSN: 1040-1334
• Language: English
• Keywords: heteronormativity; sexual minorities; medical students; interpretative phenomenological analysis; role modelling