Applying to surgery residency programs is daunting no matter who you are. Wondering if you’ll be accepted not just for your board scores but also for who you are turns up the anxiety a few notches.
Steven Xie, M.D., an incoming general surgery intern at Michigan Medicine, knows that feeling well. Xie, who is gay, applied to programs ranking the usual factors: quality of training, program reputation, location. He also assessed how welcoming programs were to people from the LGBTQ community.
“There’s a difference between being accepted and being included. With some programs I felt accepted but I didn’t think I would necessarily be included. At Michigan I felt both,” Xie said.
The journey to an identity
Xie grew up in Hoboken, New Jersey, the second son of Chinese immigrants who valued academic achievement and wanted their children to realize the American dream through it. (Xie said they drew inspiration for his first name from the institution they attended in Hoboken, Stevens Institute of Technology.)
With their support, Xie did achieve. He skipped a grade early on, attended a magnet high school in Brooklyn, attended Boston University for undergrad and Rutgers University for medical school. The academic journey went to plan, but he struggled with navigating his sexual identity. There was no handbook for that.
Xie learned the importance of identifying allies and confidantes, which he did while playing in a volleyball club while an undergrad in Boston.
“My junior year I confided in another teammate who was in the LGBT community and since then I have become more comfortable and more outspoken. I ultimately reached a place where I’m very comfortable and happy with where I am, and that led me to the decision to be out on my application to residency programs.”
Taking a leap of openness
The decision to be up front about his sexual identity in his residency application materials stood in contrast to how he’d interacted with faculty in medical school. He didn’t tell his mentors in medical school he was gay because he worried disclosure could negatively affect him, even if they thought his performance on his clerkship or subinternship was excellent.
“I was scared that this piece of information would change their evaluations of me or the way that they saw me enough that it would reflect in a letter of recommendation,” Xie said.
Xie included a nod to his sexual identity in his personal statement, saying it was a facet of his personality that made him who he is. He also highlighted his interest in research around mental health and burnout within the LGBTQ medical community.
It was scary to put what he’d hidden from others to paper for prospective program matches. It was also calculated; he reasoned that if programs steered away from him because of that disclosure, the culture wouldn’t be a fit for him. His impression was that surgery generally wasn’t the most welcoming place to people from the LGBTQ community and firgured his statement would be a good litmus test.
Jamila Picart, M.D., another incoming general surgery intern at Michigan Medicine, also first decided to be more open about her identity as a queer woman while exploring residency programs. While she didn’t address it in her materials, she surfaced it in interview conversations.
“My research interest is in education and I said that any effort to improve education should include LGBTQ people because those are near and dear to my heart,” Picart said.
The message she hoped interviewees took away: “This is she.”
It was a long way from how she felt growing up in a rural area of West Palm Beach, Fla., where dirt roads formed dusty grids, and being queer—and sharing it— seemed unacceptable.
“I hadn't even questioned what my identity could be in high school. I thought, ‘If I get an answer that isn't straight, it's going to be a wild ride in this community,’” Picart said.
When it came to assessing cultures of acceptance, Picart examined programs from multiple identity angles: whether she’d not only feel at ease in a program as a gay woman but also as a Black woman.
Personal connections help decision-making
Picart and Xie had conversations with people that helped them understand whether certain institutions would be a fit for them.
Xie spoke with residents from underrepresented groups at Michigan Medicine and other programs and asked whether they felt supported, and if their programs took harassment and discrimination seriously or paid lip service to action.
Conversations with Michigan Medicine surgery residents Brooke Bredbeck, M.D., and Glenn Wakam, M.D., made a strong impression on him. Wakam connected with Xie about being a minority in the program. Bredbeck directed Xie to other LGBTQ trainees for their perspective.
Picart had a resident-mentor at the University of Chicago who gave her insight into programs she thought were welcoming and that had potential mentors Picart would identify with. Michigan Medicine was one of those programs.
The contacts Picart made within programs were by chance and tied to her Black identity, she said. One such chance connection was made via a plastic surgeon and fellow church member in Chicago. He knew Gifty Kwakye, M.D., from medical school and suggested Picart speak to Kwakye. The conversation with Kwakye, a Black woman, helped Picart triangulate the acceptance of all identities at Michigan Medicine.
“That was two or three aspects of identity, right there. If there are opportunities for other parts of my identity, as a Black person and as a woman, I hoped that sexual identity would also be included.” Picart said.
Assessing programs from afar
With so much of the process virtual, programs’ websites and social media feeds provided visible clues about their cultures—and a check of whether they practiced what they preached.
Picart scrutinized faculty and resident pages to assess the mix of people and priorities.
“Are you hiring according to what you say you are interested in? If you're not, then where am I going to find mentors? Are there Black faculty who are not just assistant professors, but full professors?” Picart asked.
If a program had Black residents, but they weren’t represented in relevant social media feeds, Picart took that as a sign that those residents weren’t included or comfortable.
Xie looked for information about programs’ efforts around diversity, equity and inclusion efforts. It was important to him that they have clear initiatives in place to actually achieve their goals.
“There were programs that were very up front with a whole page on DEI and all of the efforts the program is doing to be more diverse. With Michigan there was the Michigan Promise which made me excited to interview at Michigan,” Xie said.
Picart and Xie wanted to make sure they would be welcomed outside of the hospital walls, and researched the surrounding communities.
Ann Arbor’s proximity to Ferndale, a Detroit-area city known for being LGBTQ-friendly, was a draw for Picart, as was being close to Detroit itself.
Xie was heartened to hear LGBTQ residents tell him that Ann Arbor is a safe haven for people from different backgrounds. Reading people for acceptance is a burden that Xie is eager to let go, to serve himself and his patients.
“If you could imagine holding back 50 percent of yourself because you’re scared people are going to react differently, you can see how that affects patient interactions. Once I became more comfortable with myself, I found myself relating to patients better,” Xie said.
There were other people Xie wanted to stop holding parts of himself back from before leaving New Jersey for Michigan: his parents. He was afraid of what they would think, and how they would react.
They were shocked, and there were tears, but they quickly came around. They reassured Xie that they loved him and wanted him to be happy, just as they’d wanted him to be successful.
Being openly himself is a start.
By Colleen Stone