
==== Front
BMC Med Educ
BMC Med Educ
BMC Medical Education
1472-6920
BioMed Central London

39294610
6018
10.1186/s12909-024-06018-5
Research
Academic difficulties, education-related problems, and discrimination among Thai gender-diverse medical students: a cross-sectional study of Thai medical schools
Oon-arom Awirut 1
Wiwattanaworaset Pakawat pakawat.w@psu.ac.th

2
Wiwattarangkul Teeravut 3
Vadhanavikkit Papan 4
Srifuengfung Maytinee 5
Chiddaycha Mayteewat 3
Wainipitapong Sorawit 367
1 https://ror.org/05m2fqn25 grid.7132.7 0000 0000 9039 7662 Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
2 https://ror.org/0575ycz84 grid.7130.5 0000 0004 0470 1162 Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
3 https://ror.org/05jd2pj53 grid.411628.8 0000 0000 9758 8584 Department of Psychiatry, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
4 https://ror.org/03cq4gr50 grid.9786.0 0000 0004 0470 0856 Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
5 grid.10223.32 0000 0004 1937 0490 Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
6 https://ror.org/028wp3y58 grid.7922.e 0000 0001 0244 7875 Center of Excellence in Transgender Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
7 https://ror.org/0220mzb33 grid.13097.3c 0000 0001 2322 6764 Department of Global Health and Social Medicine, King’s College London, London, UK
18 9 2024
18 9 2024
2024
24 10251 4 2024
12 9 2024
© The Author(s) 2024
2024
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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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-024-06018-5.

Keywords

Sexual identity
Orientation
Discrimination
Medical education
Ratchadapiseksompotch Fund, Faculty of Medicine, Chulalongkorn UniversityRA65/040 issue-copyright-statement© BioMed Central Ltd., part of Springer Nature 2024
==== Body
pmcBackground

People with sexual and gender diversity (SGD) include people who report themselves to have diversities in gender identity, sexual identity, sexual orientation, and sexual behavior. Some might define these diversities into categories of LGBTQ + which refers to lesbian, gay, bisexual, transgender, queers/questioning, and other diversity (e.g., non-binary, asexual) [1]. Healthcare professionals with SGD reported encountering mistreatment, discrimination, and harassment from colleagues and patients [2]. This condition could lead to worse mental health outcomes such as burnout, depression, substance use, and suicidal behavior [3–5]. Seven out of ten medical students face moderate to high stress [6]. Concerningly, medical students with SGD might suffer higher stress than their peers due to fear of discrimination, concern over future career options, and lack of a supportive environment in medical school [7].

Medical students with SGD were also found to have more education-related problems. A large cross-sectional study of graduating medical students in the US demonstrated that bisexual, gay, and lesbian medical students perceived less favorable medical school learning environments in terms of emotional climate and faculty-student interactions [8]. The mistreatment of medical students was reported as a higher perception of being bullied and a lower perception of acceptance of SGD, especially from the department of general surgery and surgical subspecialties [9]. The previously mentioned mistreatment or inequality in medical school could lead medical students to perceive discrimination in medical school settings. The students with SGD also reported that the sources of discrimination are the faculty members and fellow medical students [10]. Furthermore, witnessing the derogatory comments from faculty members towards the patients who have SGD could lead medical students with SGD to abandon hopes of creating close relationships with the faculty member [11]. The burden of concealing essential aspects of the students’ identities and the external expectation of good academic performance creates a stressful work environment that contributes to poor mental health [4].

Although previous reports showing the important links between SGD, academic performance, educational problems, and discrimination in medical schools in Western countries were widely reported [12, 13], studies on the impacts of having SGD on educational problems and discrimination, specifically among medical students, especially in Asia, including Thailand, were rarely explored. The previous evidence mentioned that some medical school in Asian countries has no LGBT content in the curriculum, and some medical students developed some ideas of sexism and ridiculed LGBT from the formal medical classes and informal learning. However, some medical students were aware that they needed to prepare for LGBT patients care and acknowledged a lack of relevant professional skills in this specific population. This study aims to compare academic difficulties, education-related problems, and discrimination among medical students with SGD to the medical students who self-report themselves as non-SGD.

Methods

This study was a secondary analysis of our previous survey data [14]. Participants included a convenient sample of medical students aged at least 18 from five Thai medical schools. Sample size calculation was calculated by using the prevalence of depression from a study on mental health problems among Thai medical students with the minimum medical students of 323 (n= [z2 *p{1- p}]/d2, z = 1.96, p = 0.31, d = 0.05) [15, 16]. All participants were recruited during the 2021 academic year (May 2021 to February 2022). Two medical schools are located in Bangkok (Chulalongkorn University and Siriraj Hospital, Mahidol University), while the other three medical schools are in different regional areas across Thailand (Chiang Mai University—Northern region; Khon Kaen University—Northeastern region, and Prince of Songkla University—Southern region). We informed the participants that our survey would include information about mental health, academic difficulties, behaviors, and SGD among medical students. Medical students who were studying in the first through the sixth academic year of medical school had fluency in reading and answering the questionnaire in the Thai language and agreed to participate in the study after the information was informed and discussed. We excluded the medical student who was on academic leave. Only eligible students were invited to complete the online self-administered informed consent and all questionnaires. The survey was completely anonymous, and no personal data that could be tracked was collected.

General demographic and SGD data

General demographic data (such as age, academic year of study, and current underlying health issues) were collected. We assessed SGD by using self-reported sex assigned at birth, gender identity (personal sense of own gender), and sexual orientation (gender they are sexually attracted to). The definition and explanation of each factor were provided in the questionnaire and all responses were reported as non-SGD and SGD, including lesbian, gay, bisexual/pansexual male or female, transgender (with any sexual identity and orientation), non-binary, asexuality, and questioning.

Academic difficulties and education-related problems

Academic difficulties and education-related problems were assessed using questionnaires with binary responses. They also had the option to choose ‘prefer not to answer’ for any items they felt uncomfortable addressing. Participants indicated whether they perceived these obstacles in their medical education. Regarding academic difficulties, the items assessed were: (1) failing any exams, (2) repeating academic years, (3) dropout thoughts, (4) loss of motivation in academics, and (5) feeling burnout. As for education-related problems, we addressed (1) having adequate time for learning, (2) the need to study uninterested topics, (3) feeling overwhelmed by academic workloads, (4) exhaustion from studying, (5) dissatisfaction with academic results, (6) encountering rigid academic staff, (7) falling behind in school, and (8) having financial problems. Participants were instructed to select only one response per question. We cannot provide internal consistency for academic difficulties since we separately interpreted each item in our analysis.

Positive and negative aspects of medical education

The positive and negative aspects of medical education were assessed in three aspects: physical activities aspects (e.g., hours of sleep, exercises), supporting system (e.g., from friends, adequate financial support), and discrimination. The Association of American Medical College (AAMC) Graduation Questionnaires (GQ) were adopted to assess discrimination and mistreatment in medical school. This questionnaire covered five characteristics of discrimination, including public humiliation, sexist remarks, the requirement to perform personal services, denied opportunities for training or rewards based on gender and witnessing gender/sexual discrimination. Each discrimination characteristic was identified in 4 Likert scales as never, sometimes, frequently, and always [17, 18]. The reliability estimates of the measurements used in measuring supporting systems and discrimination were reported in the emotional climate and faculty-student interaction subscales in the learning environment scale in AMCC GQ, which showed Cronbach’s alpha at 0.9 and 0.8, respectively. The reliability of measurement for the physical aspect was selected items from The Health Promoting Lifestyle Profile II (HPLPII). The overall measurements reported strong internal reliability (α = 0.90), test-retest reliability (rtt = 0.81–0.91), and convergent validity with other health measures. Internal reliability in each aspect of the current investigation in the Thai context was questionable or acceptable (supporting system α = 0.65; discrimination α = 0.75). We cannot provide internal consistency for physical activities since we separately interpreted each item in our analysis.

This multicenter study was completed following the Declaration of Helsinki as revised in 2013. The Institutional Review Board granted ethical approval for this study from all study locations.

Statistical analysis

Descriptive statistics were used to describe the demographic data. Categorical variables were presented as counts and percentages, while the mean and standard deviation or the median and interquartile range were used to present continuous variables depending on data distribution. The participants with missing data were excluded before the analysis. Chi-square, Fisher’s exact test, and t-test or Mann-Whitney test were used as appropriate to determine the difference between the two groups. Binary logistic regression was adopted to assess the association between characteristics of discrimination in each categorized type of gender diversity. Each discrimination characteristic was interpreted into binary data by scoring any frequency as presence and scoring ‘never’ as absence. SGD were categorized into seven groups (Lesbian, Gay, Bisexual, Transgender, Non-binary, Asexuality, and Questioning). All statistical tests were two-tailed comparisons, and a p-value of ≤ 0.05 was considered statistically significant. The SPSS version 29.0 (IBM) was utilized to analyze this study.

Results

The response rate in this survey was 16.5%, based on the total number of 8031 medical students in Thailand when we launched the survey. A total of 1,322 medical students completed the questionnaires, and 412 (31.2%) described themselves as SGD. The mean age of SGD medical students was 21.06 years, which did not differ significantly from the overall participants. A substantially higher proportion of SGD medical students was found in the regional medical schools and regional hometowns. No statistically significant differences were observed in academic years, parental status, or financial support. Regarding gender identity, approximately half (50.4%) reported female as their assigned sex at birth. Bisexuality was reported to be the highest prevalence (16.8%), comprising 11.5% bisexual females and 5.3% bisexual males, followed by gay men (7.6%). Meanwhile, non-binary and questioning people were less frequent than 1%, and 0.6% chose not to report their sexual orientation. The demographic data were previously addressed in our study on sexual behaviors [14] and are provided in Supplementary Table 1. The breakdown of specified gender diversity profiles for all participants can be found in Supplementary Table 2.

Academic difficulties and education-related problems among SGD medical students

Regarding academic performance, there were no significant differences in the semester Grade Point Average (GPA) and the accumulated GPA (GPAX) between SGD and non-SGD students. However, the SGD group reported higher rates of dropout thoughts and self-perceived burnout compared to the non-SGD group (39.8% vs. 23.1%, p < 0.001, and 84.2% vs. 74.9%, p < 0.001, respectively). Factors such as failing examinations, repeating academic years, and losing motivation did not show statistically significant differences between the groups. Regarding education-related problems, 40.2% of SGD students and 42.7% of non-SGD students reported at least one education-related problem (see Table 1). SGD students reported significantly greater difficulties related to inadequate time for studying, falling behind in school, and financial issues. Meanwhile, other problems examined showed no significant differences between the groups as presented in Table 2.

Table 1 Academic profiles between Non-SGD and SGD students

Variables	Non-SGD (N = 910)
N (%) or Median [IQR]	SGD (N = 412)
N (%) or Median [IQR]	P-value	
Academic performances

GPA

GPAX

	3.58 [3.20,3.83]

3.56 [3.20,3.80]

	3.60 [3.20,3.81]

3.55 [3.20,3.83]

	0.82

0.86

	
Academic difficulty

Failing any exams

Repeating academic years

Dropout thoughts

Loss of motivation

Feeling Burnout

Reporting at least one education-related problems

	110 (12.1)

19 (2.1)

210 (23.1)

180 (19.8)

682 (74.9)

366 (40.2)

	48 (11.7)

15 (3.6)

164 (39.8)

64 (15.5)

347 (84.2)

176 (42.7)

	0.82

0.10

< 0.001*

0.07

< 0.001*

0.39

	
Note *p < 0.05 Abbreviations: SGD, Sexual and gender diversity; GPA, grade point average; GPAX, accumulated grade point average; IQR, interquartile range

Table 2 Reported education-related problems

Variables	Non-SGD (N = 366) N (%)	SGD (N = 176)
N (%)	P-value	
Inadequate time for learning	305 (83.3)	162 (92.0)	0.006*	
Need to study the uninterested	251 (68.6)	134 (76.1)	0.07	
Overwhelming by academic workloads	225 (61.5)	114 (64.8)	0.46	
Exhausted from studying	342 (93.4)	169 (96.0)	0.23	
Dissatisfaction with academic results	256 (69.9)	129 (73.3)	0.42	
Academic staffs	106 (29.0)	60 (34.1)	0.23	
Falling behind in school	265 (72.4)	144 (81.8)	0.02*	
Financial problems	67 (18.3)	52 (29.5)	0.003*	
Note *p < 0.05 Abbreviations: SGD, Sexual and gender diversity

Preventive and risk factors related to medical education among medical students with SGD

Table 3 displays the positive and negative aspects of medical education. Among medical students with SGD, the perceived support from medical staff and inadequate financial support were addressed significantly lower than the non-SGD groups (Perceived good support from staff; non-SDG 30.3% vs. SGD 22.1%, p < 0.01; inadequate financial support non-SDG 11.2% vs. SDG 23.1%, p < 0.01, respectively), while perceived support from peers was not significantly different. Students with SGD also had a higher number of SGD friends (non-SDG 2.00 vs. SDG 3.00, p < 0.01). Regarding academic-related health risk factors, SGD reported a greater impact of night shifts during the daytime (non-SGD 94.9% vs. SGD 99.4%, p = 0.01). At the same time, they had no difference in hours of sleep at night, daytime sleepiness, and number of exercises per week.

Table 3 Positive and negative aspects of medical education

Variables	Non-SGD (N = 910)
N (%) or mean ± SD	SGD (N = 412)
N (%) or mean ± SD	P-Value	
Support from peers

Poor support

Fair support

Good support

	50 (5.5)

228 (25.0)

632 (69.5)

	34 (8.2)

107 (26.0)

271 (65.8)

	0.13	
Support from staff

Poor support

Fair support

Good support

	220 (24.2)

414 (45.5)

276 (30.3)

	134 (32.5)

187 (45.4)

91 (22.1)

	0.001*	
Number of LGBT Friends

(Median ± IQR, Mann-Whitney U test)

	2.00 ± 4.00	3.00 ± 4.00	< 0.001*	
Financial support

Adequate

Inadequate

	808 (88.8)

102 (11.2)

	317 (76.9)

95 (23.1)

	< 0.001*	
Exercise per week

> 3 times/week

< 3 times/week

Never exercise

	216 (23.7)

505 (55.5)

189 (20.8)

	91 (22.1)

235 (57.0)

86 (20.9)

	0.80	
Hours of sleep per night	6.29 ± 1.09	6.31 ± 1.19	0.37	
Daytime sleepiness

Marked

Mild

Not at all

	192 (21.1)

668 (73.4)

50 (5.5)

	97 (23.5)

292 (70.9)

23 (5.6)

	0.60	
Nightshift impact (N = 602)

Impacted during daytime

Not impacted

	411 (94.9)

22 (5.1)

	168 (99.4)

1 (0.6)

	0.01*	
Discrimination

Witness any discrimination

Public humiliation

Verbal or physical abuse

Sexist remark

Being limited opportunities

Requirement to perform personal services

	567 (62.3)

353 (38.8)

71 (7.8)

105 (11.5)

309 (34.0)

208 (22.9)

	285 (69.2)

177 (43.0)

26 (6.3)

126 (30.6)

142 (34.5)

95 (23.1)

	0.02*

0.15

0.34

< 0.001*

0.86

0.94

	
Note *p < 0.05 Abbreviations: SGD, Sexual and gender diversity; LGBT, lesbian, gay bisexual, and transgender; SD, standard deviation

Discrimination

Most medical students (64.4%) reported witnessing at least one form of discrimination, with no significant difference between SGD and non-SGD groups. Public humiliation was the highest discrimination experienced by all medical students (40.1%), followed by selectively prohibited educational opportunities (34.1%), being requested to do personal services other than education (22.9%), sexist remark (17.5%), and verbal or physical abuse (7.3%). Medical students with SGD reported witnessing higher discrimination and had significantly higher experiences of sexist remarks (non-SGD 62.3% vs. SGD 69.2%, p = 0.02 and non-SGD 11.5% vs. SGD 30.6%, p < 0.001, respectively) (See Table 3).

From Bivariate logistic regression (Table 4), Students self-identifying as lesbian were associated with witnessing any discrimination (OR = 3.85, [1.05–14.16]). Meanwhile, being gay was associated with higher experiences of sexist remarks (OR = 6.53 [3.93–10.84]) and lower selectively prohibited educational opportunities (OR = 0.36 [0.21–0.63]). Additionally, being transgender was associated with experiencing sexist remarks (OR = 7.49 [2.99–18.72]), while students with questioning identity were associated with experiencing verbal or physical abuse (OR 8.98 [1.28–62.87]).

Table 4 Bivariate logistic regression of discrimination among SGD medical students

Identity/ Orientation	Types of Discrimination	
Witnessing	Humiliation	Abuse	Sexist remark	Opportunities	Personal	
OR
(95%CI)	P	OR
(95%CI)	P	OR
(95%CI)	P	OR
(95%CI)	P	OR
(95%CI)	P	OR
(95%CI)	P	
Lesbian	3.85

(1.05–14.16)

	0.04*	1.10

(0.44–2.75)

	0.61	N/A	N/A	1.54

(0.55–4.31)

	0.41	0.60

(0.22–1.59)

	0.60	1.45

(0.54–3.87)

	0.46	
Gay	0.89

(0.74–2.15)

	0.39	1.24

(0.77-2.00)

	0.38	0.84

(0.38–1.85)

	0.67	6.53

(3.93–10.84)

	< 0.001*	0.36

(0.21–0.63)

	< 0.001*	0.89

(0.52–1.52)

	0.66	
Bisexual	1.04

(0.72–1.49)

	0.84	1.06

(0.77–1.48)

	0.71	0.56

(0.28–1.09)

	0.89	1.65

(1.12–2.44)

	0.01	1.16

(0.80–1.67)

	0.43	0.73

(0.49–1.07)

	0.12	
Transgender	0.73

(0.27-1. 96)

	0.54	1.04

(0.43–2.49)

	0.93	0.60

(0.13–2.80)

	0.52	7.49

(2.99–18.72)

	< 0.001*	0.45

(0.17–1.18)

	0.10	1.39

(0.55–3.49)

	0.48	
Non-binary	3.92

(0.52–36.36)

	0.23	0.78

(0.18–3.47)

	0.75	1.29

(0.18–3.47)

	0.83	3.39

(0.79–14.54)

	0.10	0.81

(0.18–3.66)

	0.79	0.56

(0.12–3.29)

	0.55	
Asexuality	0.93

(0.33–2.67)

	0.90	1.23

(0.43–3.52)

	0.70	0.81

(0.10–6.79)

	0.85	0.79

(0.16–3.84)

	0.77	0.36

(0.09–1.47)

	0.16	1.39

(0.40–4.79)

	0.60	
Questioning	0.93

(0.33–2.67)

	0.50	0.16

(0.02–1.08)

	0.06	8.98

(1.28–62.87)

	0.03*	1.33

(0.23–7.61)

	0.75	1.02

(0.20–5.18)

	0.98	0.85

(0.15–4.75)

	0.85	
Note *p < 0.05 Abbreviations: SGD, Sexual and gender diversity; OR, odds ratio

Discussion

This study is one of a few studies that explore medical students with SGD regarding their education-related problems and discrimination in Thailand and Asia. Most previous studies in Asian countries mainly described attitudes, perceptions, and knowledge toward individuals with SGD and SGD healthcare. According to a few pieces of studies in Asia that described the discrimination and inadequate skills from the curriculum, the findings emphasized the integrating issues of gender into medical education, such as gender sensitivity language use, and broadening the experiences of those LGBT who have been discriminated would be helpful in understanding the diversity of human in the medical education setting [19–22]. In this study, although no differences in academic performance between SGD and non-SGD were found, medical students with SGD encountered more educational-related problems, including inadequate time for studying, being left behind by others, and financial issues. In addition, they perceived lower support from medical staff and financial support. More than half of medical students had witnessed discrimination in medical school, while SGD students reported significantly higher witnesses and experiences of sexist remarks.

Contrary to prior studies indicating reduced academic performance among SGD medical students and associated mental health challenges [23, 24], our findings diverged. We hypothesized that medical students with SGD in our settings, despite reporting more educational-related problems, might benefit from positive factors that prevent them from having lower academic results. Strategies promoting inclusive environments, such as fostering a safe and supportive climate, educator intervention, and SGD-related curricula, can be instrumental [25]. Notably, one Thai study on medical students highlighted that a significant portion of medical students exhibit neutral to positive attitudes toward people with SGD, with positive attitudes often correlated with personal connections to SGD individuals like family members and friends [22]. In addition to supportive resources, positive attitudes can mitigate stigma, a key factor influencing academic difficulties like dropout [26].

A previous study highlighted that mistreatment intensity among medical students with SGD increased the odds of burnout in a dose-response manner. A greater proportion of humiliation and mistreatment, either specific or non-specific to gender and sexual orientation, were found in medical students with SGD [4]. In our study, the types of mistreatment were expansively identified, and the most reported discrimination was humiliation, which was relevant to the previous studies. Our finding also found that another interesting mistreatment experience was selectively prohibited educational education towards medical students with SGD. This finding underlined the existence of authority abuse in medical school [27, 28]. The problematic issues in authority abuse in medical school included hierarchy and a culture of self-sacrifice, resilience, and deference. Medical students perceived that these factors created barriers to reporting mistreatment as it would lead to being labeled a ‘troublemaker’ and affecting career progression. These abusive environments could lead to a lower sense of belonging, which was associated with higher levels of depression and anxiety afterward [13]. However, medical students in the study might have compensated for a sense of belonging derived from the medical staff by having peer support from non-SGD and SGD friends, which could be observed by higher numbers of SGD friends among SGD medical students. This is relevant to previous studies, which demonstrated that the sense of belonging tends to effectively develop among the people who belong to SGD [29, 30]. The intervention strengthening the sense of belonging could be an effective method to rescue medical students with SGD who experienced education-related problems, mistreatment, and discrimination [31].

Some limitations should be considered when interpreting the results. First, this is a secondary analysis of an observational cross-sectional study. We could only discern associations, not causations. Additionally, the voluntary recruitment method used in the study introduced selection bias, capturing only those willing to participate, especially the participants with SGD tend to be more interested in response to the SGD issue. Accordingly, the absence of international standardized questionnaires measuring academic difficulties, education-related problems, and discrimination in the Thai language caused limitations, potentially affecting the study’s interpretation and generalizability when contrasted with research using different tools.

Our study employed several strengths. It was conducted in an Eastern context, shedding new aspects on SGD and its association with academic performance within medical education. We gathered data from a large number of participants across the country, ensuring the representation of varied identities. We delved into a wide range of positive and negative factors within medical education. Crucially, the survey maintained complete anonymity, ensuring responses were unaffected by concerns, authority, or potential stigma.

Further studies should focus on the specific needs of medical students concerning education-related problems, mistreatment forms, and discrimination experiences, paving the way for targeted intervention. The study underscored the significant impacts of staff within medical schools. Rather than solely focusing on students, early interventions should encompass enhancing the knowledge, attitudes, and behaviors of staff toward students, patients, and SGD issues in a social context. Qualitative studies are necessary to discern these needs across different contexts and develop tailored interventions.

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.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Acknowledgements

We thank all participants for their time in responding to our survey. Also, we are grateful for the collaboration and support from all organizations to help complete this national study. This study is partially supported by the Faculty of Medicine, Chiang Mai University, regarding resource utilization.

Author contributions

Awirut Oon-arom: Validation, Visualization, Writing – Original Draft, Visualization; Pakawat Wiwattanaworaset: Validation, Investigation, Resources, Writing – Review & Editing; Teeravut Wiwattarangkul: Conceptualization, Methodology, Investigation, Resources; Papan Vadhanavikkit: Validation, Investigation, Resources, Writing – Review & Editing; Maytinee Srifuengfung: Validation, Investigation, Resources, Writing – Review & Editing; Mayteewat Chiddaycha: Conceptualization, Methodology, Formal analysis, Data curation, Writing – Review & Editing; Sorawit Wainipitapong: Conceptualization, Methodology, Formal analysis, Writing – Original Draft, Project administration, Funding acquisition.

Funding

This study was financially supported by the Ratchadapiseksompotch Fund, Faculty of Medicine, Chulalongkorn University, grant no. RA65/040.

Data availability

The quantitative data used in and analyzed during the current study cannot be publicly available for confidentiality reasons. Still, they can be available on request from the corresponding author.

Declarations

Ethics approval and consent to participate

The present study was approved by the Institutional Review Board (IRB) of all medical schools participating in the study, including Chulalongkorn University (0006/2022), Siriraj Hospital, Mahidol University (167/2022), Chiang Mai University (PSY-2565-08832), Khon Kaen University (HE651083), and Prince of Songkla University (65-085-3-1). All participants completed the online self-administered informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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