Why Nicole Sitkin adds a plus sign to LGBTQI+

When second-year medical student Nicole Sitkin speaks, her words flow quickly, her sentences packed with information, just as her professional life brims with accomplishments. In June 2013, the University of California, Davis, awarded Sitkin the University Medal, given to the top graduating senior who excels in academics, community service, and promise of future scholarship. In September 2014, Sitkin was appointed to the Learning Environment Sub-Committee of the Association of American Medical Colleges (AAMC) Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development.

She has co-authored nine peer-reviewed research articles and recently won a $5,000 medical student leadership award from Women In Medicine (WIM), a national organization that provides medical education and networking opportunities for lesbian, gay, bisexual, transgender, and queer (LGBTQ) female physicians. In November 2015, she earned a Best Poster Presentation award in Public Health at the American Medical Association interim meeting. Sitkin was subsequently elected to the board of WIM. “Nix has brought energy and clarity to LGBTQ issues, especially as they affect the education, practice, and professional experience of medical students and physicians. She has a voice in national discussions,” said Forrester A. Lee, M.D. ’79, HS ’83, associate dean for multicultural affairs and professor of medicine (cardiology). Sitkin recently sat down with Yale Medicine to talk about her work on LGBTQ issues.

How are you involved with LGBTQ issues at the School of Medicine?
Last year I was president of the student group, OutPatient, previously the Gay Straight Medical Student Alliance. One of our first orders of business was to change the name, since it wasn’t inclusive of the wonderful diversity of identities and experiences of LGBTQI+ folks. The “I” stands for intersex, an identity term sometimes used by people who biologically don’t fall into the male-female sex binary. The plus sign is meant to include whatever identities or experiences people may have. Additionally, last year I approached Dean Schwartz [Michael L. Schwartz, Ph.D., associate professor of neuro-science and associate dean for curriculum] with a presentation on LGBTQI health disparities, physicians’ power to perpetuate or mitigate those disparities, and the first LGBTQI physician training guidelines, issued by the AAMC in 2014. That conversation blossomed into an ongoing collaborative effort between faculty, staff, and students to incorporate new and enhance existing LGBTQI health content in the curriculum.

What might a sample of medical education on LGBTQ health look like?
Our idea is to provide training like a spiral staircase. You start at the bottom with the facts. For example, what do the terms LGBTQ, intersex, and cisgender mean? How does sex differ from gender, which differs from sexual orientation? As students progress, they acquire communication tools, such as by practicing inclusive interviewing with standardized patients. During clerkships, students then have the opportunity to reflect on real patient care experiences and to hone and implement their knowledge and communication skills.

In your experience, do peers feel comfortable being “out” on medical school campuses?
There has been limited institutional support for sexual and gender minority individuals at medical schools historically. Fortunately, the culture of medical education is shifting in parallel with society generally, to greater respect and recognition of the lives and identities of LGBTQI folks. That being said, everyone’s experience is different. Some folks may never want to be “out” in a professional context, while it may be very important to others to have their identity recognized. Institutional culture and visible support systems also deeply affect whether students feel comfortable and safe being out. I know students who are uncertain about whether they can be out in their professional lives. For people who are figuring it out or are coming out, it’s so important to be able to connect. I’m out, I have a partner I’m crazy and open about, and I still benefit so much from interacting with supportive allies and LGBTQ role models and mentors at the School of Medicine. At Yale, we are bringing together faculty, staff, and other resources to provide more visible, accessible support for students.

What is your partner, Mariko Zelin, doing now?
Mariko is a gifted research scientist. She’s currently doing research at a start-up company while completing a master’s of science in biotechnology at Northwestern University. She’ll be graduating in December and moving to New Haven. She’s excited to explore the opportunities in the biopharmaceutical industry out here.

What can people do to support the LGBTQI+ community?
One of the ideas I’ve talked about with Dean Angoff [Nancy R. Angoff, M.P.H. ’81, M.D. ’90, HS ’93, associate professor of medicine (general medicine) and associate dean for student affairs] and Dean Lee is what we can do to institutionalize LGBTQI programming in terms of formal curriculum, support services, and educational opportunities for the whole health campus. We are actively seeking to bring together people, LGBTQI and allies, and to identify resources to support this work. We welcome the involvement of any Yale community members interested in LGBTQI health.

Click here to watch a video of our interview with Nicole Sitkin.

Nicole explains the LGBTQIA acronym.