A national study found that lesbian, gay, or bisexual medical students, particularly those who are Hispanic, had higher rates of attrition than their non-lesbian, gay, or bisexual peers.
Authored by Nguyen et al., the study examined data from 45,296 students who matriculated between 2014 and 2017. Attrition was defined as withdrawal or dismissal for any reason. All participants had completed a first-year questionnaire and submitted complete demographic data, including sexual orientation, race, ethnicity, age, and academic performance.
Overall, 2.5% of students left medical school. The attrition rate was 2.4% for non-lesbian, gay, or bisexual (LGB) students, compared with 3.7% for gay and lesbian students and 4.2% for bisexual students. After adjustment for academic and demographic factors, bisexual students had nearly twice the odds of leaving school as non-LGB students, and gay and lesbian students had 1.47 times the odds.
Attrition also varied by race and ethnicity. Among non-LGB students, Black and Hispanic students each had an attrition rate of 4.7%, compared with 2.0% for White students. These rates corresponded to AORs of 1.42 for Black students and 1.53 for Hispanic students, relative to White students.
When examining the intersection of race, ethnicity, sex, and sexual orientation, the disparities were more pronounced. LGB Hispanic male students had an AOR of 3.52, and LGB Hispanic female students had an AOR of 3.11, indicating more than three times the odds of attrition compared with non-LGB White students.
Differences by sex were also observed. Female students had a lower attrition rate (2.2%) than male students (2.8%). After adjustment, women were 31% less likely to leave medical school than men.
Academic performance strongly correlated with attrition. Students in the lowest MCAT quartile had an attrition rate of 4.5%, while those in the highest quartile had a rate of 1.4%. Students in the lowest undergraduate GPA quartile had an attrition rate of 3.7%, compared with 1.7% in the highest quartile.
Of the initial cohort of 83,342 matriculants, 56,031 (67.2%) completed the questionnaire. Attrition was higher among nonrespondents, suggesting that early disengagement may be associated with attrition.
“The findings highlight the importance of intersectionality in understanding attrition from medical school,” wrote the authors. “Although future studies need to examine the cause of these disparities in attrition, LGB students experience discrimination within medical training environments, which may lead to risk of attrition”.
The authors concluded that recognizing intersecting identities is essential for developing support services that promote student retention.
Full disclosures are available in the original publication.
Source: JAMA Network Open
