Trainees who are applying for residency or fellowship often consider numerous factors when looking for a program that provides the perfect “fit.” Geography, location (e.g., urban v. rural), and program size can significantly influence decision-making. Learners who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ+) may have additional questions about the program: will they feel welcomed and included? Will they be able to identify role models and mentors with shared lived experience? Should they “out” themselves in their application? While the answers to these questions are personal and often nuanced, this article provides tips to help learners identify a training program that provides an affirming environment, mentorship relevant to their identity, and an inclusive curriculum.

Applying

Identifying Potential Programs

In addition to finding a program that matches your professional goals, it is important to consider which program(s) will provide you personalized support throughout your training and are welcoming of LGBTQ+ trainees. Consider the following questions as you peruse program websites:

• Does the program explicitly state its commitment to diversity and inclusion?
• Are there any mentorship programs or OUTLists that provide opportunities for LGBTQ+ trainees to learn from LGBTQ+ faculty?
• What are the institutional policies, including insurance coverage and familial leave, for explicit inclusion of diverse sexual orientations and gender identities as well as expansive definitions of “family” to include partners regardless of marital status?
• Are there specific curricula or training opportunities dedicated to LGBTQ+ health?

Writing Your Personal Statement

Ultimately, the choice to be “out” in your application materials is a personal one. As in every application process, reasons for not receiving an invitation to interview will remain unknown to the applicant. As such, many may choose not to be out in their application but will be out during the interview to assess a program in real-time. Alternatively, by being out in your application, less welcoming programs may not offer you an interview and more welcoming programs may offer you an interview; you may essentially avoid less supportive programs and find more supportive programs. Unfortunately, there has not been much research on the application process as it relates to LGBTQ+ applicants.

Interviewing

After receiving an interview offer, the interview is largely about fit. If you are out in your application, receiving an interview likely bodes well for a welcoming training environment. During the interview, you may have additional opportunities to explore how and to what extent a program is welcoming of LGBTQ+ applications.

The questions that programs may ask applicants are tightly regulated. As such, they are allowed to ask you any questions related to your application materials, and you are allowed to bring up additional topics which are open then to further questioning. Programs cannot ask you your relationship status or family planning unless included in your application. If family planning, child care, or being openly LGBTQ+ are important to you, you are not only welcome but also encouraged to bring these up during the interview; this can lead to a helpful and informative conversation.

As the interview is focused on “fit” and ensuring you find the program that is going to best prepare you for your career, be sure to ask questions that relate to your personal and professional goals in areas such as research, advocacy, and/or community engagement:

• Who could be a mentor as an Out LGBTQ+ leader in your program/institution/organization?
• Can you tell me about the culture for LGBTQ+ individuals at this program?
• What opportunities exist to address LGBTQ+ health?
• What family/partner benefits exist for same-sex couples with or without children?
• How does the health insurance policy address LGBTQ+ health? Is there explicit inclusion of gender-affirming medical and surgical care?
• Does the health care system provide explicit guidance for persons who undergo gender-
  affirming care during training? Does Human Resources provide training on respectful conduct?
• How do you recruit and retain LGBTQ+ applicants and future physicians?

Conclusion

Ultimately, finding a program that prepares you for your chosen specialty is about ensuring you are supported and encouraged to thrive. By finding a supportive environment with welcoming leadership and peers, you can more easily become the best clinician you aspire to be.