Abstract

Health professions education, including medical education, straddles the physical and conceptual spaces of campus-based education and healthcare delivery, reflecting the preponderance of workplace-based training in the authentic learning and assessment of future healthcare professionals. While university campuses often represent centres of progressivism, including LGBTQI+ inclusivity, healthcare environments have been typically much less accepting of diverse identities, leading to discrimination of LGBTQI+ patients, staff, and learners. Moreover, heterosexual and cisgender learners, following prolonged exposure to heteronormative and cissexist environments, may adopt these cultural perspectives, contributing to the perpetuation of stigmatising beliefs in the healthcare system.

A long-held worldview centered in the positivistic paradigm, and a lasting legacy of heteronormativity and cissexism in healthcare, have resulted in adverse health outcomes disproportionately affecting LGBTQI+ patients and distress experienced by LGBTQI+ students in unwelcoming learning environments. Recognising the need to address these through educational improvements, medical schools deliver dedicated teaching modules to learners across the globe, aiming to provide the tools needed to care for these patients and create safer educational spaces for learners. However, these initiatives have often only consisted of targeted teaching and have fallen short of instigating the meaningful organisational change needed to create a culture of LGBTQI+ inclusivity in clinical settings. Faculty development is an essential aspect to consider, and we sought to address it through our QueerHPE Project.

The QueerHPE Project is a faculty development intervention to build competence of staff involved in teaching and supervision of learners in the Joint Medical Program at the Universities of Newcastle and New England. The Program employs a train-the-trainer model: we identified healthcare professionals with professional expertise of LGBTQI+ health and interest in improving the culture of learning within our distributed medical program and trained them to provide our Inclusivity Training faculty development. The Inclusivity Training modular workshop has been developed through community consultation with a co-design process and can be adapted to suit the context and learning needs of attendees, ranging from classroom facilitators to placement supervisors. In the past two years, eight trainers delivered five Inclusivity Trainings to over 40 faculty members. We present a description of our work thus far, including challenges encountered and plans for future developments.

Keywords

LGBTQI+ inclusivity, health professions education, academic development, workplace-based learning, cultural competence

Introduction: LGBTQI+ health and the persistence of cis-heteronormativity in health professions education

Critical conditions in LGBTQI+ health, despite societal advancements in LGBTQI+ inclusion and justice

The past few decades have seen landmark achievements in LGBTQI+ rights, from the decriminalisation of same-sex sexual acts to the recognition of marriage equality.^[1] Many countries have advanced their legal recognition of human rights with anti-discrimination legislation, resulting in greater and growing visibility of LGBTQI+ communities. In these countries, including Australia, these shifts have created strong cultural momentum towards inclusion. LGBTQI+ people are more represented than ever in public life, popular media, and political discourse, fostering, in some contexts, an elevated sense of legitimacy and normalcy of gender identities other than cisgender and sexualities other than heterosexuality.

However, visibility does not necessarily result in safety and acceptance. While in some settings there is a strong commitment to equity throughout systemic structures and individual activities, discrimination, tokenism, and systemic exclusion persist in others. This is acutely felt in healthcare settings. In fact, LGBTQI+ individuals frequently experience discrimination and stigmatisation in healthcare settings, which contribute to a lack of engagement of LGBTQI+ people with healthcare services (Lyons et al., 2020; Schwab et al., 2024). Healthcare environments are, and have long been, highly unsafe environments for LGBTQI+ individuals, with reported rates of discriminatory behaviours ranging from 2% to 42% (Ayhan et al., 2020; Casey et al., 2019; Lyons et al., 2020; Mezzalira et al., 2024).

Experiences of discrimination include microaggressions, slurs, and interpersonal harassment, but also include delay or refusal of care, resulting in avoidance of engagement with healthcare services or avoidance of disclosure of identity or sexuality information (Ayhan et al., 2020; Casey et al., 2019; Mezzalira et al., 2024). In particular, trans and gender-diverse individuals face significant barriers to accessing safe, affirming care, including misgendering, invasive questioning, and refusal of treatment (Lambda Legal, 2010; Lyons et al., 2020), all of which contribute to an ongoing pervasive mistrust of healthcare systems and result in delayed or avoided care among LGBTQI+ people. Data from the latest nationwide survey on the health and wellbeing of LGBTQI+ people in Australia, Private Lives 3, identified that overall only 43.4% LGBTQI+ Australians feel accepted when accessing healthcare, with stratified analysis showing that 54.8% gay-identifying Australians feel accepted, in contrast with 26.7% of queer-identifying Australians (Lyons et al., 2020).

The prevalence of negative experiences for LGBTQI+ individuals indicates that discriminatory behaviours are far from isolated incidents, and instead constitute manifestations of systemic issues within Medicine and other healthcare professions. Explorations of this phenomenon have highlighted gaps in education and training, and the continued effects of a legacy of heteronormative, binary, and cisnormative frameworks that shape teaching, practice, and policy (Mezzalira et al., 2024; Nowaskie & Sowinski, 2019; Sanchez et al., 2017). Importantly, the consequences of embedded cis-heteronormative educational and professional stances in healthcare professional training and in the practice of healthcare delivery profoundly affect healthcare consumers. LGBTQI+ populations face disproportionately poor health outcomes across a range of indicators, including mental health, cardiovascular health, sexual health, and cancer (Lyons et al., 2020). Non-heterosexual people have higher rates of cardiovascular disease and earlier onset of hypertension (Bonomo et al., 2024); LGBTQI+ people experience earlier onset of cancer (Boehmer & Jesdale, 2025); and worse outcomes following cancer care (Waters et al., 2024). As mentioned, these health outcomes partly result from both the limited inclusion of LGBTQI+ perspectives in educational curricula and the persistence of hostile clinical environments. A substantial body of evidence shows that healthcare professionals report a lack of knowledge and confidence in caring for LGBTQI+ individuals across a range of professions and levels of training (Lu et al., 2022; Nowaskie & Patel, 2021; Nowaskie & Sowinski, 2019). This reveals the need for the field of Health Professions Education (HPE) and educational institutions to contribute to critical reflection and meaningful change, by reviewing educational content, practices, and structures towards inclusive approaches.

The conservative environment of clinical practice

Medicine has long been considered a conservative profession. With its deep roots in tradition, hierarchy, and normative assumptions about bodies and identities, the medical field has often resisted rapid social change. The HPE curricula, the cultures of academic and healthcare institutions, and the professional expectations established by medical and healthcare registering and regulatory bodies have long been ingrained in a positivistic paradigm of scientific objectivity, and centred around Western and Anglo-Saxon values.

This entrenched position has contributed to the marginalisation of diverse perspectives and perpetuated systemic inequities in medical training and care delivery, long after society had shifted to more progressive worldviews. For instance, after a significant delay following the start of the women’s movement, efforts to include women in clinical trials gained traction only in the late 20th century (Bennett, 1993). Similarly, the first report on health inequalities for ethnic minorities in the United States was conducted only decades after the civil rights movement (United States Department of Health and Human Services Task Force on Black Minority Health, 1985).

This traditionalist environment has contributed to the historical neglect and even the pathologisation of LGBTQI+ identities within medical education and healthcare practice, where non-conforming bodies and experiences have been rendered invisible, misunderstood, and alienated. In many countries including Australia and New Zealand (at the time of writing), men who have sex with men are subjected to laws and regulations prohibiting or limiting them from donating blood or organs. This difference in eligibility has been unhurriedly reconsidered over the past two decades, despite the measured effectiveness of donor screening, the availability of effective testing protocols on donated tissues, and the growing demand for blood products (Davison et al., 2021; Seed et al., 2010; Skelly et al., 2020). As another example, in the United States healthcare professionals are legally allowed to deny treatment to LGBTQI+ individuals solely on the basis of their gender identities or sexual orientation, by invoking conscientious objection (Brummett & Campo-Engelstein, 2021).

The conservative environment of health professions education and its self-perpetuating influence on learners

HPE is a field that exists at the intersection of the higher education and healthcare practice fields, both philosophically and practically: in fact, the training of future healthcare professionals is physically delivered across dedicated higher education spaces (i.e. university campuses) and dedicated healthcare practice spaces (i.e. clinical environments). Currently, despite societal momentum, most HPE programs have not kept pace with the increased visibility and inclusion of LGBTQI+ perspectives, and have only implemented limited updates to their curricular offerings and partial improvements to their learning environments. This is a stark contrast to other areas of tertiary education, where academic departments provide guidance and catalyse societal movements, such as the LGBTQI+ inclusion movement, and university campuses represent centres of progressivism (Butler et al., 2019). As discussed, healthcare systems and day-to-day healthcare practice perpetuate both subtle and overt marginalisation of LGBTQI+ individuals among both healthcare providers and healthcare consumers. This is, in part, the consequence of inadequate curricular content, educational practices, and structures.

As learners leave the campus-based educational environment and enter clinical settings, conservative norms are reinforced by professional socialisation processes that reward adherence to established practices and traditions (Hafferty, 1998; Hafferty & Castellani, 2009). During workplace-based learning and following primary qualification, students and junior practitioners quickly learn what it is acceptable to say and do, by being exposed to role models, engaged in informal conversations, and involved in the routines of the clinical setting. Through these experiences, developing professionals shape their behaviours and understandings of gender and sexuality to meet the professional norms of the clinical environment (Sorgini et al., 2024). While this results in negative outcomes for LGBTQI+ patients, there is another group of people directly impacted: LGBTQI+ healthcare learners and practitioners. In this group, enculturation within the professional space of medicine and healthcare leads to silencing, code-switching, and social withdrawal, due to the misalignment of their personal identity with the tacit expectations required of their professional selves and the risks to personal safety, and the additional emotional labour required to navigate these challenges (Crispi & Ballard, 2023; Hunt et al., 2007; Madzia, 2023; Ross et al., 2021). Moreover, the intersection between professionalism and cis-heteronormativity in healthcare settings creates an environment where expressions of LGBTQI+ identities are seen as optional, ‘political’, or inherently inappropriate, hindering the practitioner’s good standing and career prospects (Bolderston, 2021; Madzia, 2023; Ross et al., 2021).

Initial efforts towards LGBTQI+ inclusive training for future healthcare professionals

Policy interventions and increased focus have resulted in an overall increase in the inclusion of LGBTQI+ considerations in education. However, curricular coverage is still limited (Jewell & Petty, 2024; Obedin-Maliver et al., 2011; Streed et al., 2024). Moreover, interventions have often consisted of single-spot additions rather than genuine longitudinal integrations (Jewell & Petty, 2024; Obedin-Maliver et al., 2011; Streed et al., 2024; White et al., 2015). Additionally, in some cases curricular integrations have been solely focused on the topics of psychiatric disorders and sexually transmitted diseases, which limit the discourse to, and perpetuate, stereotypical and outdated conceptions of LGBTQI+ people as mentally ill and sexually promiscuous (Muschialli et al., 2025; Streed et al., 2024).

To improve LGBTQI+ health outcomes, therefore, it is not sufficient to implement isolated curricular interventions: for instance, adding discrete lectures, modules, or assessments focused on the topic. The valuable learning resulting from such formal education would nonetheless be hindered by the limitations of the educational design. It is necessary to remember that even within an excellent educational framework, the importance of LGBTQI+ perspectives in shaping the future healthcare providers’ beliefs would be overcome by enculturation within the clinical environment. These challenges reflect the pervasiveness of the ‘hidden curriculum’ of medical and health professions education (Hafferty, 1998). The concept of hidden curriculum refers to the unwritten and often unintended lessons that students acquire during their education through observation, socialisation, and adoption of the cultural and institutional norms of their learning environment. While the formal curriculum may promote messages of inclusivity and equity, the hidden curriculum that is generated within systemic structures and conveyed by interpersonal exchanges is less amenable to intervention. When these curricula are in conflict, typically, the hidden curriculum prevails (Hafferty & O’Donnell, 2015). Thus, an integrated approach needs to be developed to address both the formal curriculum and the hidden curriculum: ensuring meaningful longitudinal integration of LGBTQI+ considerations within the programs of education, while operating to dismantle entrenched cis-heteronormative beliefs and shaping a more inclusive environment in campus-based and workplace-based educational settings. Initiatives to address and reshape the hidden curriculum may take many forms: allocation of institutional resources towards inclusive learning environments, affirmative action in inclusion and recognition of LGBTQI+ educators and learners, revision of vocabulary in use, and more. After considering our local needs and resources, we turned our focus to staff members, and decided to design a faculty development initiative.

Integrating initiatives towards LGBTQI+-inclusive training: Curriculum redesign and faculty development in the joint medical program

In our institution, a valuable initiative had previously been designed to embed LGBTQI+ health discussions longitudinally, integrating them throughout the formal curriculum of the Joint Medical Program (JMP). The initiative aimed to review all curricular content to ensure that clinical scenarios and vignettes discussed in learning activities would represent LGBTQI+ individuals in a proportion similar to that in the Australian population, estimated to be 4.5% (Australian Bureau of Statistics, 2022). As discussed, these efforts in educational design ran the risk of being unsuccessful unless paired with efforts to ensure that the hidden curriculum aligned with the formal curriculum.

Due to the distributed nature of the JMP, with campus-based education delivered at three main campuses, and workplace-based education delivered across six clinical schools, we considered that academic staff members and conjoint clinical educators play a crucial role in mediating the understanding of the content of the formal curriculum and in shaping the students’ enculturation within the medical profession, as visible role models and gatekeepers of professional values and expectations. However, if educators themselves have not had the opportunity to reflect on their attitudes and behaviours in educational and clinical settings, their teaching practices may unintentionally perpetuate assumptions and biases. While our institution, like many others, provides all-staff development on LGBTQI+ awareness, the existing training is understandably limited to general tertiary education, and does not extend to calling into question the cultural and systemic issues in the space of LGBTQI+ health. We identified this to be a significant risk to the curriculum revisions being undertaken in our program, as lack of familiarity, discomfort, and uncertainty may lead to misrepresentation or avoidance of the subject.

Faculty development in LGBTQI+ health education is therefore necessary to ensure that the explicit and integrated inclusion of LGBTQI+ considerations within the curriculum is paired with inclusive pedagogical approaches and aligned with a transformative cultural process that challenges existing cultural norms of the healthcare professions and medicine. Unfortunately, there is limited, though promising, evidence in the literature discussing the effects of a faculty development intervention as an integrated initiative to align with curriculum change (Steinert et al., 2007; van Schaik, 2021). Nonetheless, other researchers identified it as an area of need for LGBTQI+ HPE enhancement (Gisondi et al., 2023). Starting in 2022, we designed and implemented a faculty development initiative for JMP academic staff, which we called the QueerHPE Project.^[2]

The QueerHPE Project uses a train-the-trainer design that revolves around two workshops: the Training Inclusivity Trainers (TInT) workshop and the Inclusivity Training. Through the TInT workshop, LGBTQI+ Health practitioners and advocates develop the skills to effectively facilitate the Inclusivity Training, a modular and flexible faculty development workshop for campus-based academics and conjoint/clinical educators and academics involved in the delivery of the Joint Medical Program. Conducting this work offered us extensive opportunities for learning and reflection, which we describe in the next section of the chapter.

QueerHPE design: No such thing as a ‘SIMPLE’ faculty development initiative

Designing and implementing a faculty development initiative is rarely simple or straightforward. As discussed in the previous section, the educational theoretical context of the topic meant that QueerHPE’s aim was not simply to provide new information to academic staff members on LGBTQI+ Health, but rather to facilitate a critical reflection on personal beliefs and systemic practices and norms that contribute to discrimination and harm, aligning with the learning environment and hidden curriculum theory (Hafferty, 1998). Additionally, in developing the QueerHPE Project, we felt the need to reflect firstly our own processes and ensure we adopted the inclusive cultural mindset we sought to inspire. These considerations led to insightful conversations and intentional decisions in multiple aspects, outlined in this section, particularly on the formation and internal teamwork approach of the Project group, including the involvement of healthcare consumers and consideration and compensation for the contributions of group members, and the conscious design of the initiative for long-term sustainability and flexible faculty development.

The QueerHPE project group and its approach to teamwork

In this chapter, the first-person plural pronoun ‘we’ is used, yet there has not been a clear description of who ‘we’ are. It is very appropriate to provide that now, as that was an important discussion that occurred at the beginning of the development of our initiative. The QueerHPE Project did not start from academics: as frequently happens in higher education (Forrest & Geraghty, 2022; Murray, 2018), students identified an area of need in their education, offered feedback to faculty on this academic blind spot, and collaborated with faculty to co-develop a response to this identified gap.

At the beginning of 2022, the Queer Convenor of the University of Newcastle Medical Society, then a fourth-year medical student at the University of Newcastle, Katie Bird, chose LGBTQI+ health as her topic of interest in Health Profession Education to complete a selective pathway project. Dr Nora Leopardi, then Lecturer in Clinical Education, offered to serve as her supervisor. However, following the completion of the pathway project, the two decided to continue working on the subject, with the support of Professor Katie Wynne, then Associate Professor in Medicine, and the collaboration of Ms Melodie van Wy, Queer Convenor of the University of New England Medical Students Association (UNEMSA) and then second-year student at the University of New England.

The components of the Project group thus formed, in the initial phase of the QueerHPE Project, had a sexuality other than heterosexual, and/or a gender identity other than cisgender, and/or were active LGBTQI+ health practitioners, advocates, and educators. All four members contributed extensive connections within the LGBTQI+ community through their direct participation, and/or advocacy and engagement work.

The QueerHPE Project group shifted in a later stage to involve Dr Graeme Horton, Associate Professor in General Practice, subsequent UNMS and UNEMSA Queer Convenors to maintain current student perspectives, and LGBTQI+ community representatives and healthcare consumers Mr Kip Hay and Ms Ivy Scurr. Continued consideration to the composition of the group and its functioning plays an important role in ensuring the consistency of the QueerHPE Project with its vision and goals. Since the outset of the project, ensuring that the student representatives played a leadership role in the co-design of the QueerHPE Project was a critical, intentional element of our process, to ensure that the initiative centred on challenging the unwritten exclusionary practices of the culture of healthcare and HPE.

Norms and practices become less apparent to those who have existed and operated within a space for a period of time, due to the progressive negotiation of personal and professional beliefs which can result in tolerance or acceptance (Phillips, 2013). This underscored the need to continuously centre newer or less institutionally embedded voices in leadership roles, as they are often more attuned to exclusionary practices that may go unnoticed by established staff. Nonetheless, the support and visibility of JMP senior academics was necessary not only on a practical level, to facilitate solutions to logistical challenges and encourage engagement with the initiative, but also to convey the alignment of organisational priorities with the initiative. Without this support, the initiative’s alignment with its core values and goals would have been significantly compromised, and the QueerHPE Project would have been undermined from the start.

To balance these needs, a shared leadership model was the appropriate choice for this initiative, allowing Project group members to play a role that would most benefit the initiative and rely on positional strengths and sources of influence (Pearce & Conger, 2003). During the initial design and delivery, in 2022-23, the initiative targeted academic staff in the JMP who primarily deliver campus-based education; the design and content of QueerHPE, thus, centred the educational environment, and a student-led viewpoint was adopted. At the end of 2023, once the target audience of the Project grew to encompass educators across the whole medical program, including conjoint academics and educators active in the clinical setting, we recognised that our Project group should extend to include perspectives from healthcare consumers from the LGBTQI+ community.

Whilst the passion and commitment of students and community members were the force driving the QueerHPE Project forward, we were acutely aware that the initial design of the initiative was carried out voluntarily. This work was undertaken in addition to full academic and clinical workloads, placing significant demand on the Project group members. The reliance on unpaid labour in the conduct of service work, particularly from marginalised groups, is unfortunately common in higher education and HPE contexts, perpetuating systemic inequities (Pride et al., 2024; Reath et al., 2018; Social Sciences Feminist Network Research Interest, 2017). Recognising this challenge, we advocated for tangible institutional support and secured dedicated funding. Funding was used to compensate the student representatives and the healthcare consumers and community members for their time and participation in the Project group, as well as for expenses related to the community consultation sessions, and the delivery of TInT and Inclusivity Training workshops. The workload of salaried academic members of the Project group was recognised, and additional funding was allocated to support their participation in professional conferences to represent the QueerHPE Project.

Designing sustainable, flexible faculty development

The structure of the faculty development initiative was the subject of much consideration. Given the distributed nature of the JMP, with a four-way partnership involving two universities and two Local Health Districts, delivering the program on multiple campuses and clinical sites spanning a broad geographic footprint, long-term sustainability and flexibility were priority elements from the outset. To address this challenge, the QueerHPE Project was designed as a train-the-trainer model, enabling local LGBTQI+ health practitioners and advocates to be equipped to deliver Inclusivity Trainings tailored to local needs and settings. This would result in the formation of an LGBTQI+-conscious group of skilled trainers that could support the delivery of the QueerHPE Project long-term, connected to the QueerHPE Project Group and each other through a digital Community of Practice, and informed of the local contexts of LGBTQI+ healthcare practice.

To ensure the flexibility of the intervention, the Inclusivity Training was conceptualised as a modular workshop (see Table 20.1), with different pre-prepared modules covering different learning objectives. Each QueerHPE module contained core didactic materials and a range of interactive activities that could be chosen to best suit the setting and timing of the training as well as the needs of the audience. In the initial development, three modules were prepared: ‘LGBTQI+ health basics’; ‘Avoiding assumptions’, and ‘Using appropriate language’. As mentioned, these were mainly intended to be delivered to academics involved in campus-based education, such as lectures and small-group classroom sessions. However, following the initial piloting of this training, the scope of the QueerHPE Project was expanded to also include the clinical settings and the workplace-based placements of the JMP.

In order to create Inclusivity Training modules that reflected the breadth of needs and experiences of LGBTQI+ individuals as healthcare consumers in clinical settings, we decided that more formal community consultation processes should be pursued. To this end, we conducted two community consultation sessions, hosted by community healthcare consumers Ms Scurr and Mr Hay, in the welcoming setting of the Newcastle LGBTQI+ nightlife centre, Bernie’s Bar. The sessions were organised in hybrid format, to maximise accessibility for differently abled participants, and all community members were compensated for their participation. The consultations provided a forum for listening, discussing, and identifying shared challenges and experiences, allowing us to revise the training materials to better resonate with the needs of the community. Thanks to these sessions, we identified three further areas to address and prepared three additional Inclusivity Training modules available for delivery to clinical academics and educators: ‘Sensitive physical examinations’; ‘Navigating the healthcare system’; and ‘Intersectionality’ (see Table 20.2).

Table 20.1. The Training Inclusivity Trainers workshop (TInT). The TInT structure focuses on empowering LGBTQI+ Health practitioners to deliver the Inclusivity Training, focusing on building facilitation skills in an academic setting. The workshop has an ideal duration of three hours, but it can be adapted to meet local needs.

Ultimately, the considerable effort that went into designing an inclusive, sustainable, and flexible faculty development project provided immensely valuable opportunities for growth in its own right. However, the QueerHPE Project has generated powerful outputs through its delivery, notwithstanding challenges emerging in its implementation and areas for continued improvement, as described in the next section.

Table 20.2. Current modules available for Inclusivity Training. Each module can be flexibly delivered to suit the needs of the target group and the training setting.

QueerHPE implementation

The first ‘Queer Competencies in Medical Education’ training was delivered in Newcastle in February 2022, as Dr Bird’s Pathway Course project prior to her graduation. That initial training, and the recognition of the need for additional work in this space, led to the creation of the QueerHPE Project, with the formation of the initial Project group and the conceptualisation of the initiative as a long-term faculty development process. During the following 18 months, the group completed the design of the train-the-trainer TInT workshop, prepared the three initial modules of the Inclusivity Training, and delivered the first TInT. Eight healthcare professionals active in the field of LGBTQI+ health participated in the first TInT; they were later involved in the delivery of two Inclusivity Trainings on the Callaghan campus of the University of Newcastle, to over 20 Associate Lecturers employed in the JMP.

These initial workshops were very well received by all participants, encouraging the Project group to pursue ambitious goals for future growth. However, a challenge was identified in the implementation of QueerHPE at the JMP’s regional sites, with the cancelled delivery of a TInT on the Armidale campus of the University of New England: unfortunately, all registrants for the workshop did not attend, and subsequent attempts at rescheduling were unsuccessful. Despite the temporary setback, the project expanded and evolved in the second half of 2023 and 2024, through the described recruitment of additional Project group members, the two community consultation sessions, and the development of three additional Inclusivity Training modules.

During this time, the Project group and the Inclusivity trainers facilitated the delivery of two further Inclusivity Trainings, one on the Callaghan campus and one at the Central Coast Clinical School of the University of Newcastle. In particular, the training delivered at the Central Coast Clinical School was the first to be delivered to both campus-based and workplace-based educators, organised with the auspices of the New South Wales Health Central Coast Local Health District. To date, over 45 educators within the JMP have attended an Inclusivity Training. In addition to these, two modified Inclusivity Trainings were delivered at professional gatherings of Health Professional Educators: one was delivered at the annual Conference of the Australia and New Zealand Association for Health Professional Educators (ANZAHPE) and one at the Annual Conference of The International Association for Health Professions Education (AMEE). These trainings were designed to include one of the modules prepared for Inclusivity Training and provide a detailed description of the QueerHPE Project to the audience of healthcare professionals and educators in attendance. The combined total of 36 academics who attended a modified Inclusivity Training provided extremely positive feedback via the conferences’ feedback surveys, with two groups subsequently reaching out to the QueerHPE Project Group via email to share their progress in developing faculty development initiatives in their own countries (Brazil and Germany).

The future of QueerHPE: Challenges and future direction

Despite the strong impact of QueerHPE thus far, ongoing work is required to maintain the project and address emerging challenges. In the latter part of 2024, QueerHPE has slowed its momentum, particularly in light of shifts in the context of its implementation. The funding received has been exhausted, and internal changes within the JMP, alongside competing demands, have resulted in limited visibility of the QueerHPE Project in many academic committees. Moreover, academic staff turnover has caused delays in the revision of the formal curriculum, and the planned convergent initiatives of curricular integration of LGBTQI+ health topics and cultural and organisational change have not progressed in steady alignment with each other.

Ultimately, there is ongoing need to recruit local QueerHPE champions, to ensure the sustainability of the Project across the footprint of the JMP. While the Project group works to reposition QueerHPE at the centre of the JMP priorities, plans for continued growth and refinement of the initiative are only postponed, rather than cancelled. A core area of future development is the evaluation of the impact of the Project on the practices and attitudes of academics and clinical educators, and the effects of these practices on our learners. While the Project has been incredibly meaningful to all involved, as expressed through informal feedback by participants and in reflective practice by the QueerHPE Project Team members, the workload required to establish a coordinated evaluation of outcomes and impact sits beyond the current capacity of those involved.

An additional area of development is the expansion of the initiative beyond the medical program, to other healthcare professional settings and educational programs, including postgraduate education. Lastly, an ambitious but meaningful goal is the establishment of collaborative partnerships across the healthcare education and clinical practice spheres to foster nurturing learning and working environments, and to promote a coherent culture of LGBTQI+ inclusion in healthcare across educational and clinical institutions, underpinned by shared policies and organisational values.

Conclusion

The QueerHPE Project represents a tangible step towards dismantling systemic barriers to LGBTQI+ inclusion in healthcare and Health Professions Education. By acknowledging the deep-rooted influences of cis-heteronormativity in both formal and hidden curricula, and actively working to challenge these through aligned interventions on curricular integration and faculty development, we have laid the foundation for cultural change within the Joint Medical Program and beyond. The Project’s success in producing and delivering educational content underscores the value of shared leadership, community and learners’ co-design, and flexible, sustainable models of educational delivery.

Importantly, our work highlights that meaningful progress is not quick or easy: it demands ongoing reflection, adaptation, and institutional commitment. As we move forward, sustaining and expanding the QueerHPE Project will require renewed efforts to secure resources, foster local leadership, and evaluate long-term impacts on teaching practices and student experiences. Ultimately, the vision that generated QueerHPE extends beyond educational change. It aspires to create learning and clinical environments where LGBTQI+ individuals are respected, valued, and safe. We will continue to work with the aim of shaping a healthcare system that reflects our goal of health for all, particularly those whose identities have been historically excluded or marginalised.

References

Australian Bureau of Statistics. (2022). Estimates and characteristics of LGBTI+ populations in Australia. https://www.abs.gov.au/statistics/people/people-and-communities/estimates-and-characteristics-lgbti-populations-australia/latest-release

Ayhan, C. H. B., Bilgin, H., Uluman, O. T., Sukut, O., Yilmaz, S., & Buzlu, S. (2020). A systematic review of the discrimination against sexual and gender minority in health care settings. International Journal of Health Services, 50(1), 44–61. https://doi.org/10.1177/0020731419885093

Bennett, J. C. (1993). Inclusion of women in clinical trials – Policies for population subgroups. New England Journal of Medicine, 329(4), 288–292. https://doi.org/doi:10.1056/NEJM199307223290428

Boehmer, U., & Jesdale, B. M. (2025). Cancer disparities by age: A focus on sexual and gender minorities. Cancer Causes & Control, 36(3), 243–254. https://doi.org/10.1007/s10552-024-01932-x

Bolderston, A. (2021). Coming out or staying in? Disclosure experiences of lesbian and gay radiation therapists in practice. Radiography, 27(4), 1142–1148. https://doi.org/https://doi.org/10.1016/j.radi.2021.06.003

Bonomo, J. A., Luo, K., & Ramallo, J. A. (2024). LGBTQ+ cardiovascular health equity: A brief review. Frontiers in Cardiovascular Medicine, 11(2024). https://doi.org/10.3389/fcvm.2024.1350603

Braun, T. (2020). Dignity in diversity: Dismantling the criminalisation of sexual orientation and gender identity using the right to dignity. In A. Gattini, R. Garciandia, & P. Webb (Eds.), Human Dignity and International Law (pp. 138–153). Brill | Nijhoff. https://doi.org/https://doi.org/10.1163/9789004435650_014

Brummett, A., & Campo-Engelstein, L. (2021). Conscientious objection and LGBTQ discrimination in the United States. Journal of Public Health Policy, 42(2), 322–330. https://doi.org/10.1057/s41271-021-00281-2

Butler, K., Yak, A., & Veltman, A. (2019). “Progress in medicine is slower to happen”: Qualitative insights into how trans and gender nonconforming medical students navigate cisnormative medical cultures at Canadian training programs. Academic Medicine, 94(11). https://journals.lww.com/academicmedicine/fulltext/2019/11000/_progress_in_medicine_is_slower_to_happen__.39.aspx

Casey, L. S., Reisner, S. L., Findling, M. G., Blendon, R. J., Benson, J. M., Sayde, J. M., & Miller, C. (2019). Discrimination in the United States: Experiences of lesbian, gay, bisexual, transgender, and queer Americans. Health Services Research, 54(S2), 1454–1466. https://doi.org/https://doi.org/10.1111/1475-6773.13229

Crispi, V., & Ballard, W. L. (2023). “That’s a bit gay for work”: Medicine is not doing enough for LGBTQ+ colleagues. Postgraduate Medical Journal, 99(1173), 647–650. https://doi.org/10.1136/pmj-2022-141733

Davison, K. L., Reynolds, C. A., Andrews, N., Brailsford, S. R., & the UK Blood Donor Survey Steering Group. (2021). Blood donation by men who have sex with men: Using evidence to change policy. Vox Sanguinis, 116(3), 260–272. https://doi.org/https://doi.org/10.1111/vox.13033

Forrest, L. L., & Geraghty, J. R. (2022). Student-led initiatives and advocacy in academic medicine: Empowering the leaders of tomorrow. Academic Medicine, 97(6). https://journals.lww.com/academicmedicine/fulltext/2022/06000/student_led_initiatives_and_advocacy_in_academic.30.aspx

Gisondi, M. A., Keyes, T., Zucker, S., & Bumgardner, D. (2023). Teaching LGBTQ+ health, a web-based faculty development course: Program evaluation study using the RE-AIM framework. JMIR Medical Education, 9, e47777. https://doi.org/10.2196/47777

Hafferty, F. W. (1998). Beyond curriculum reform: Confronting medicine’s hidden curriculum. Academic Medicine, 73, 403–407. https://doi.org/10.1097/00001888-199804000-00013

Hafferty, F. W., & Castellani, B. (2009). The hidden curriculum. A theory of medical education. In C. Brosnan & B. S. Turner (Eds.), Handbook of the Sociology of Medical Education. Routledge.

Hafferty, F. W., & O’Donnell, J. F. (2015). The hidden curriculum in health professional education. Dartmouth College Press.

Hunt, R., Cowan, K., & Chamberlain, B. (2007). Being the gay one: Experiences of lesbian, gay and bisexual people working in the health and social care sector. Stonewall London.

Jewell, T. I., & Petty, E. M. (2024). LGBTQ+ health education for medical students in the United States: A narrative literature review. Medical Education Online, 29(1), 2312716. https://doi.org/10.1080/10872981.2024.2312716

Lambda Legal. (2010). When health care isn’t caring: Lambda Legal’s survey of discrimination against LGBT people and people with HIV. https://legacy.lambdalegal.org/sites/default/files/publications/downloads/whcic-report_when-health-care-isnt-caring_1.pdf

Lu, P.-Y., Hsu, A. S. C., Green, A., & Tsai, J.-C. (2022). Medical students’ perceptions of their preparedness to care for LGBT patients in Taiwan: Is medical education keeping up with social progress? PLoS One, 17(7), e0270862. https://doi.org/10.1371/journal.pone.0270862

Lyons, A., Hill, A. O., McNair, R., Carman, M., & Bourne, A. (2020). Private Lives 3: The Health and Wellbeing of LGBTIQ People in Australia. Australian Research Centre in Sex, Health & Society.

Madzia, J. L. (2023). “To be professional, it isn’t necessarily our full selves”: How medical students with minoritized identities manage tensions between medical professionalism and their own professional identities. SSM – Qualitative Research in Health, 4, 100313. https://doi.org/https://doi.org/10.1016/j.ssmqr.2023.100313

Mezzalira, S., Carone, N., Bochicchio, V., Cruciani, G., Quintigliano, M., & Scandurra, C. (2024). The healthcare experiences of LGBT + individuals in Europe: A systematic review. Sexuality Research and Social Policy. https://doi.org/10.1007/s13178-024-01068-2

Mignot, J.-F. (2022). Decriminalizing homosexuality. A global overview since the 18th century. Annales de démographie historique, 143(1), 115–133. https://doi.org/10.3917/adh.143.0115

Murray, J. (2018). Student-led action for sustainability in higher education: A literature review. International Journal of Sustainability in Higher Education, 19(6), 1095–1110. https://doi.org/10.1108/IJSHE-09-2017-0164

Muschialli, L., Santino, C.-F., Zoë, G., & Connolly, D. J. (2025). Twelve tips for LGBT+-inclusive undergraduate and postgraduate medical education. Medical Teacher, 47(1), 43–49. https://doi.org/10.1080/0142159X.2024.2344617

Nowaskie, D. Z., & Patel, A. U. (2021). LGBT cultural competency, patient exposure, and curricular education among student pharmacists. Journal of the American Pharmacists Association, 61(4), 462–469. e463. https://doi.org/https://doi.org/10.1016/j.japh.2021.02.009

Nowaskie, D. Z., & Sowinski, J. S. (2019). Primary care providers’ attitudes, practices, and knowledge in treating LGBTQ Communities. Journal of Homosexuality, 66(13), 1927–1947. https://doi.org/10.1080/00918369.2018.1519304

Obedin-Maliver, J., Goldsmith, E. S., Stewart, L., White, W., Tran, E., Brenman, S., Wells, M., Fetterman, D. M., Garcia, G., & Lunn, M. R. (2011). Lesbian, gay, bisexual, and transgender–related content in undergraduate medical education. JAMA, 306(9), 971–977. https://doi.org/10.1001/jama.2011.1255

Pearce, C., & Conger, J. (2003). Shared leadership: Reframing the hows and whys of leadership. SAGE Publications. https://doi.org/10.4135/9781452229539

Phillips, S. P. (2013). Blinded by belonging: Revealing the hidden curriculum. Medical Education, 47(2), 124–125. https://doi.org/10.1111/medu.12103

Pride, T., Beagan, B. L., MacLeod, A., & Sibbald, K. (2024). Educational experiences of health professionals from marginalized groups: “It definitely takes more work”. Diaspora, Indigenous, and Minority Education, 18(1), 51–67. https://doi.org/10.1080/15595692.2022.2149485

Reath, J., Abbott, P., Kurti, L., Morgan, R., Martin, M., Parry, A., Gordon, E., Thomas, J., & Drysdale, M. (2018). Supporting Aboriginal and Torres Strait islander cultural educators and cultural mentors in Australian general practice education. BMC Medical Education, 18(1), 236. https://doi.org/10.1186/s12909-018-1340-x

Ross, M. H., Hammond, J., Bezner, J., Brown, D., Wright, A., Chipchase, L., Miciak, M., Whittaker, J. L., & Setchell, J. (2021). An exploration of the experiences of physical therapists who identify as LGBTQIA+: Navigating sexual orientation and gender identity in clinical, academic, and professional roles. Physical Therapy, 102(3). https://doi.org/10.1093/ptj/pzab280

Sanchez, A. A., Southgate, E., Rogers, G., & Duvivier, R. J. (2017). Inclusion of lesbian, gay, bisexual, transgender, queer, and intersex health in Australian and New Zealand medical education. LGBT Health, 4(4), 295–303. https://doi.org/10.1089/lgbt.2016.0209

Schwab, A., Nedra, P., Karen, L., & Jessani, A. (2024). “Expectation is always that the practitioner might not be okay with queerness”: Experiences of LGBTQ+ with the healthcare system in Saskatchewan, Canada. Journal of Homosexuality, 71(1), 56–71. https://doi.org/10.1080/00918369.2022.2103871

Seed, C. R., Kiely, P., Law, M., & Keller, A. J. (2010). No evidence of a significantly increased risk of transfusion-transmitted human immunodeficiency virus infection in Australia subsequent to implementing a 12-month deferral for men who have had sex with men. Transfusion, 50(12), 2722–2730. https://doi.org/10.1111/j.1537-2995.2010.02793.x

Skelly, A. N., Kolla, L., Tamburro, M. K., & Bar, K. J. (2020). Science over stigma: The need for evidence-based blood donation policies for men who have sex with men in the USA. The Lancet Haematology, 7(11), e779–e782. https://doi.org/10.1016/S2352-3026(20)30326-4

Social Sciences Feminist Network Research Interest Group. (2017). The burden of invisible work in academia. Social inequalities and time use in five university departments. Humboldt Journal of Social Relations, 39, 228–245.

Sorgini, A., Istl, A. C., Downie, M. L., & Kirpalani, A. (2024). Pride & prejudice: A scoping review of LGBTQ + medical trainee experiences. Medical Teacher, 46(1), 73–81. https://doi.org/10.1080/0142159X.2023.2229503

Steinert, Y., Cruess, R. L., Cruess, S. R., Boudreau, J. D., & Fuks, A. (2007). Faculty development as an instrument of change: A case study on teaching professionalism. Academic Medicine, 82(11), 1057–1064. https://doi.org/10.1097/01.Acm.0000285346.87708.67

Streed, C. G., Michals, A., Quinn, E., Davis, J. A., Blume, K., Dalke, K. B., Fetterman, D., Garcia, G., Goldsmith, E., Greene, R. E., Halem, J., Hedian, H. F., Moring, I., Navarra, M., Potter, J., Siegel, J., White, W., Lunn, M. R., & Obedin-Maliver, J. (2024). Sexual and gender minority content in undergraduate medical education in the United States and Canada: Current state and changes since 2011. BMC Medical Education, 24(1), 482. https://doi.org/10.1186/s12909-024-05469-0

United States Dept of Health and Human Services Task Force on Black Minority Health. (1985). Report of the Secretary’s task force on Black & minority health: Homicide, suicide, and unintentional injuries. U.S. Department of Health and Human Services.

van Schaik, S. M. (2021). Accessible and adaptable faculty development to support curriculum reform in medical education. Academic Medicine, 96(4), 495–500. https://doi.org/10.1097/acm.0000000000003804

Waters, A. R., Jin, M., Jones, S. R., Datta, G. D., Butler, E. N., Kent, E. E., Nichols, H. B., & Tan, K. (2024). Chronic health conditions, disability, and physical and cognitive limitations among LGBTQ+ cancer survivors. Cancer Epidemiology, Biomarkers & Prevention, 33(11), 1405–1413. https://doi.org/10.1158/1055-9965.Epi-24-0166

White, W., Brenman, S., Paradis, E., Goldsmith, E. S., Lunn, M. R., Obedin-Maliver, J., Stewart, L., Tran, E., Wells, M., Chamberlain, L. J., Fetterman, D. M., & Garcia, G. (2015). Lesbian, gay, bisexual, and transgender patient care: Medical students’ preparedness and comfort. Teaching and Learning in Medicine, 27(3), 254–263. https://doi.org/10.1080/10401334.2015.1044656