LGBTQ+ Inclusivity in Neurosurgery: Exploring Physicians' Knowledge, Experience, and Competence

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals face delayed and disparate medical care. Given the growing visibility and recognition of the LGBTQ+ community in the United States, ensuring that neurosurgeons are trained to provide affirming, informed care is increasingly important to improve their outcomes. This study aimed to assess the level of comfort and knowledge of resident and attending neurosurgeons in providing care to LGBTQ+ patients.

We conducted a survey across 9 US academic neurosurgery centers assessing 3 domains: training, preparation, and knowledge; clinical practice experience; and comfort or competence in LGBTQ+ care. Responses were measured on a 5-point Likert scale. Linear regression was used to assess the relationship between knowledge and comfort/competence. In addition, a mediation analysis was performed to determine the extent to which clinical practice experience affected the relationship between knowledge and comfort/competence.

Eighty-seven neurosurgeons (35 residents and 52 attendings) completed the survey. For every 1-point increase in training, preparation, or knowledge, there was a 0.31-point increase in perceived comfort and competence [95% CI 0.24-0.39, P < .01]. Attendings reported less comfort than residents in caring for lesbian, gay, and bisexual patients, inquiring about sexual orientation, and being identified as LGBTQ-competent providers. Clinical practice experience mediated the relationship between physician training and knowledge and the respondent's perceived competence and comfort [Sobel test, 2.62; P < .01]. In addition, physicians rated their knowledge (3.68 vs 3.38, P < .01), perceived comfort/competence (4.41 vs 4.29, P < .01), and clinical experience (4.41 vs 4.11, P < .01) in caring for lesbian, gay, and bisexual individuals significantly higher than that of transgender individuals.

Neurosurgeons reported limited knowledge, comfort, and competence in LGBTQ+ care, particularly for transgender individuals. However, training and experience improve these findings. Therefore, strengthening training programs to better prepare neurosurgeons for affirming LGBTQ+ care could create an inclusive and equitable healthcare environment.