Academic difficulties, education-related problems, and discrimination among Thai gender-diverse medical students: a cross-sectional study of Thai medical schools

Background: Medical students with sexual and gender diversity (SGD) often face challenges in educational performance and encounter more education-related problems, potentially due to discrimination in medical schools. This study aimed to compare academic difficulties, education-related issues, and experiences of discrimination among medical students with SGD versus those identifying as non-SGD.

Methods: This was a cross-sectional study. Participants included a convenient sample of medical students aged at least 18 from five Thai medical schools, all recruited during the 2021 academic year. General demographic data, academic difficulties, education-related problems, and both positive and negative aspects of medical education, encompassing physical aspects, supporting systems, and discrimination, were assessed. The descriptive data and comparison between SGD and non-SGD medical students were performed. Binary logistic regression was adopted to evaluate the association between characteristics of discrimination in each categorized type of gender diversity.

Results: Among 1322 medical students, 412 (31.2%) described themselves as having SGD. There was no significant difference in academic performance between SGD and non-SGD students. However, SGD students reported higher dropout thoughts (39.8% vs. 23.1%, p < 0.001) and self-perceived burnouts (84.2% vs. 74.9%, p < 0.001). The SGD group perceived lower support from medical staff and higher inadequate financial support (30.3% vs. 22.1%, p < 0.01; 11.2% vs. 23.1%, p < 0.01, respectively). 64.44% of students reported witnessing at least one form of discrimination. Lesbian students were more likely to report witnessing discrimination (OR = 3.85, [1.05-14.16]). Gay students were significantly associated with experiencing sexist remarks (OR = 6.53 [3.93-10.84]) and lower selectively prohibited educational opportunities (OR = 0.36 [0.21-0.63]).

Conclusions: While academic performance did not differ between medical students with SGD and their non-SGD peers, SGD students reported more academic difficulties and perceived less support from medical staff and financial support. They also reported a higher incidence of discrimination. The need for specific interventions to address these issues should be further explored.