By: W. Tyler Crawley
Pride in residency is difficult, especially in surgery. How you are evaluated and how you are able to participate within the operating room are directly decided by the attending surgeon. Meaning that how you are viewed by an attending can impact not only your clinical experience but also your advancement within the program. This creates a power dynamic in which residents are put in a position to “get along” in order to “go along.”
This is problematic for two reasons; the first is that it discourages residents from speaking up, whether that be an inappropriate joke, an inaccurate statement, or even something as simple as misgendering a patient. Personally, when I was an auditioning medical student and starting my surgical training, I was very discreet when it came to my personal life, especially around attendings. I heard many jokes and false narratives about the LGBTQIA+ community, and while most of these comments came from a place of naiveté, they were/are nevertheless harmful.
The second reason is that it can force residents into trying to fit a mold. LGBTQIA+ individuals are a unique population and what makes us diverse is not always externally visible. As a result, especially in medicine, we have to choose how much of ourselves to share, whether that be with attendings, colleagues, or patients. In the political environment of today, the queer community is constantly under attack and queer issues have become strongly contentious. You never know when someone might react negatively to what they perceive, inaccurately, as a “choice” or “lifestyle.” When it comes to residents, we depend on the team around us and are constantly trying to impress the surgeons we are working with since they are the ones who will evaluate us. While it is improving, much of the medical community continues to perpetuate the idea of a “model” trainee with underrepresented minorities more likely to receive narrative evaluations based on appearance rather than on clinical performance. When I made the decision to pierce one of my ears during residency, a part of me was worried that it would potentially be viewed as “gay” and unprofessional.
Addressing these challenges is no small task. As I have grown more comfortable with my attendings and fellow colleagues, I find myself more likely to speak up and have found support in that. There is a time and a place though, and learning when it is appropriate to address things and have individual conversations is equally important. Personally, I like to pull people aside to discuss, whether that’s when debriefing a case or just grabbing something to eat. I believe this allows for a better discussion and comes from a place of education rather than judgment. When it comes to being “out” at work, I often hear people say that their identity as an LGBTQIA+ individual does not impact them as a surgeon. While I agree that it might not impact your clinical abilities, I do believe that who we are as individuals impacts how we interact as physicians. Everyone should be able to be comfortable in who they are, wherever they are, whether that be at work or anywhere else. I started small by being open with my fellow residents, and eventually found my support system.
These changes have to start from the top in order to shift this power dynamic. As a rising PGY-4, I know the impact my voice can have on students, trainees, and the hospital. This visibility and representation are important because it shows that LGBTQIA+ individuals do exist within surgery and medicine as a whole. Being a role model can be as simple as “if you see something, say something,” and support those who do speak up. Remember that who you are does matter – for your colleagues, your patients, and for yourself.
William Tyler Crawley is a rising fourth-year surgical resident at HealthOne – Swedish Medical Center in Denver, CO. Originally from Albuquerque, NM, his interests are in medical education and LGBTQIA+ representation in the surgical community. Outside of work, he enjoys running, cycling, and spending time with his husband and two dogs.