‘I know that I Am going to Be shaky’: Drivers and impacts of medical educator behavior when teaching sexual and gender minority health

Medical educators increasingly recognize the need to improve training about the health and healthcare of sexual and gender minority (SGM) populations, yet many report uncertainty about how to address these topics in teaching. Pervasive cisheteronormativity in the medical education system necessitates intentional effort to improve SGM teaching. This study explores the drivers and impacts of medical educator behavior when teaching about SGM individuals and their health. We conducted seven faculty educator interviews and four student focus groups (third- and fourth-year medical students, N = 18), representing experiences across the four-year medical curriculum. We used an inductive approach to identify themes about faculty behavior around SGM topics and the impacts of these behaviors on students. Faculty and students consistently value respect for SGM patients and populations. However, variability in educator comfort, local culture, and curricular complexity create inconsistent educational quality. We identified four themes: (1) SGM health education occurs through modalities beyond the formal curriculum; (2) Structural factors drive variability in SGM education; (3) Perceived importance of teaching SGM topics is tied to clinical relevance, empathy, and lived experience; and (4) Educator comfort is tied to fear of mistakes, growth mindset, and support. Quality of SGM teaching is driven not just by inclusion of SGM content but also by how educators engage with the information. SGM teaching quality is driven by educator perception of control in teaching about SGM health (e.g. knowledge, comfort, fear of making mistakes, extent of institutional support) and local norms about SGM inclusion in teaching. Institutional leadership can foster SGM inclusivity in medical curricula by providing intentional faculty development, supporting a growth mindset culture for educators, and providing centralized oversight of SGM content across the curriculum. These strategies promote alignment among educators and a cohesive curriculum for preparing future clinicians to care for SGM patients.