LWW 01/11/15 4 Color Fig(s):0 16:2 Art: AcadMed-D-14-00683 Academic Medicine, Vol. 90, No. 5 / May 2015 1 Research Report Sexual and gender minority (SGM) health care providers face discrimination and often work in environments unfriendly to both SGM patients and practitioners. 1,2 The term SGM is inclusive of all nonheterosexual and noncisgender individuals, including, but not limited to, those who identify as lesbian, gay, bisexual, transgender (LGBT), queer, or questioning. Small studies demonstrate that SGM medical students face obstacles during undergraduate medical training and residency applications, but their experiences remain widely unstudied. 3–8 Unfriendly and unsafe environments in medicine prevent SGM students from “coming out” (being publicly open about their identity); instead, they remain “in the closet” (concealing their identity). 5,7 Concealing one’s identity can have significant negative effects on physical and mental well-being. 9–12 The Liaison Committee on Medical Education forbids discrimination based on sexual orientation or gender identity in medical education programs. 13 In addition, the Association of American Medical Colleges (AAMC) recommends that all institutions “ensure a safe learning environment for all students, regardless of their sexual orientation or gender identity.” 14 In spite of these recommendations, SGM students still experience discrimination in medical school. 3–8 According to responses to the 2013 AAMC Graduation Questionnaire, 2.3% of respondents reported being subjected to offensive remarks related to their sexual orientation. 15 Yet, little is known about the experiences of SGM students during medical school. We hypothesized that a significant number of medical students enrolled in MD- and DO-granting institutions in the United States and Canada identify as SGM and that many of these individuals conceal their identity. In this study, we explored medical students’ “outness” and their reasons for concealing their SGM identity during undergraduate medical training. Method Survey development and study population Our research instrument was designed primarily to assess students’ perceptions of SGM-specific medical school curricula, but it also included questions about sexual identity, gender identity, and identity disclosure. To inform the study design, we searched MEDLINE for all English-language publications containing “lesbian,” “gay,” “homosexual,” “bisexual,” “transgender,” “medical education,” “medical student,” or “curriculum” in the title, abstract, or both, along with related National Library of Medicine Medical Acad Med. 2015;90:00–00. First published online doi: 10.1097/ACM.0000000000000657 Abstract Purpose To assess identity disclosure among sexual and gender minorities (SGMs) pursuing undergraduate medical training in the United States and Canada. Method From 2009 to 2010, a survey was made available to all medical students enrolled in the 176 MD- and DO- granting medical schools in the United States and Canada. Respondents were asked about their sexual and gender identity, whether they were “out” (i.e., had publicly disclosed their identity), and, if they were not, their reasons for concealing their identity. The authors used a mixed-methods approach and analyzed quantitative and qualitative survey data. Results Of 5,812 completed responses (of 101,473 eligible respondents; response rate 5.7%), 920 (15.8%) students from 152 (of 176; 86.4%) institutions identified as SGMs. Of the 912 sexual minorities, 269 (29.5%) concealed their sexual identity in medical school. Factors associated with sexual identity concealment included sexual minority identity other than lesbian or gay, male gender, East Asian race, and medical school enrollment in the South or Central regions of North America. The most common reasons for concealing one’s sexual identity were nobody’s business (165/269; 61.3%), fear of discrimination in medical school (117/269; 43.5%), and social or cultural norms (110/269; 40.9%). Of the 35 gender minorities, 21 (60.0%) concealed their gender identity, citing fear of discrimination in medical school (9/21; 42.9%) and lack of support (9/21; 42.9%). Conclusions SGMs continue to conceal their identity during undergraduate medical training. Medical institutions should adopt targeted policies and programs to better support these individuals during training. AQ2 Please see the end of this article for information about the authors. Correspondence should be addressed to Matthew Mansh, Stanford University School of Medicine, 291 Campus Dr., Stanford, CA 94305; telephone: (215) 605-3457; e-mail: mmansh@stanford.edu. Sexual and Gender Minority Identity Disclosure During Undergraduate Medical Education: “In the Closet” in Medical School Matthew Mansh, William White, MA, Lea Gee-Tong, Mitchell R. Lunn, MD, Juno Obedin-Maliver, MD, MPH, Leslie Stewart, MD, Elizabeth Goldsmith, MD, MS, Stephanie Brenman, MD, Eric Tran, MFA, Maggie Wells, David Fetterman, PhD, and Gabriel Garcia, MD Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A260.