Perceptions of Institutional Engagement and Inclusion by Sexual Orientation and Gender Identity.

Importance: There is a paucity of research regarding the experiences of self-identified lesbian, gay, bisexual, and transgender (LGBT+) individuals in academic medicine. Objective: To examine LGBT+ individuals' perceptions of institutional engagement and workplace inclusivity. Design, Setting, and Participants: In this survey study, in 2015, 2018, 2021, and 2023, the Diversity Engagement Survey (DES) supplemented with specific questions about LGBT+ visibility and engagement in the workplace was sent to faculty, students and trainees, and staff at a single academic medical center in Pennsylvania. Exposures: Sexual orientation was self-identified as heterosexual; lesbian, gay, or bisexual [LGB]; or other. Gender identity was self-identified as men; transgender, queer, or nonbinary [TQNB]; women; or other or unknown. Main Outcomes and Measures: Workplace culture inclusivity was assessed using 8 validated DES constructs summarized into 3 scores: perceptions of shared vision and purpose, camaraderie, and appreciation of contributions to the institution. Three questions evaluated statements about institutional welcoming of LGBT+ individuals, comfort working with LGBT+ colleagues, and LGBT+ institutional visibility. Potential attrition was assessed through a question about job change considerations due to inappropriate, disruptive, or unprofessional behavior by a coworker or supervisor. Results were weighted to account for nonresponse. Results: Among 23 708 respondents (15.9% of approximately 149 500 survey recipients), 2068 (8.7%) identified as LGB and 169 (0.7%) as TQNB. Compared with heterosexual respondents, LGB respondents reported lower institutional engagement (vision and purpose: adjusted difference (AD), -1.2 [95% CI, -1.6 to -0.9]; camaraderie: AD, -1.1 [95% CI, -1.3 to -0.9]; appreciation: AD, -0.9 [95% CI, -1.1 to -0.6]) and were less likely to agree with statements of LGBT+ institutional inclusivity (welcoming: adjusted relative ratio [ARR], 0.88 [95% CI, 0.85-0.90]; visibility: ARR, 0.90 [95% CI, 0.86-0.94]). Compared with men, TQNB respondents reported lower engagement (vision and purpose: AD, -4.1 [95% CI, -5.5 to -2.6]; camaraderie: AD, -3.2 [95% CI, -4.1 to -2.3]; appreciation: AD, -2.6 [95% CI, -3.5 to -1.7]) and were less likely to agree with LGBT+ institutional inclusivity statements (welcoming: ARR, 0.65 [95% CI, 0.53-0.80]; visibility: ARR, 0.78 [95% CI, 0.61-1.00]). LGB (vs heterosexual; ARR, 1.26 [95% CI, 1.15-1.38]) and TQNB (vs men; ARR, 1.48 [95% CI, 1.17-1.88]) respondents were more likely to report job change consideration. Conclusions and Relevance: In this survey study, the findings demonstrated a need for focused and subgroup-specific intentional initiatives to optimize productivity and improve workplace culture, sense of belonging, and retention for self-identified sexual and gender minority individuals within academic medical communities.