Presented By: Simisola Onanuga, Imperial College London
Co-Authors: Raksha Aiyappan, Nanyang Technological University
Ana Baptista, Imperial College London
Michael Fu, Imperial College London
Susan Smith, Imperial College London
Xinyu Ye, Imperial College London
Tangming Zou, Nanyang Technological University

Purpose
Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) individuals have health needs specific to their identities but face discrimination that often translates into poor healthcare. Evidence suggests doctors are inadequately trained to care for LGBTQ+ patients, and medical students are well-placed as the future workforce to establish affirming behaviours. This study garners patients' LGBTQ+ healthcare experiences, where limited qualitative evidence exists, and explores whether students have insight into these experiences. 

Methods 
30 LGBTQ+ healthcare users and 20 students divided evenly across Singapore and the United Kingdom (UK), two different countries legally and culturally, consented to semi-structured interviews evaluating their LGBTQ+ healthcare perceptions. Thematic analysis was conducted with a collaborative, iterative process involving five investigators over Zoom videoconferencing with frequent auditing of data interpretation. 

Results 
Most users described implicit biases with a lack of support and professionalism from doctors, hindering health outcomes. Users expressed instances of misgendering and lack of recognition of sexual and gender diversity; students appreciated the need to acknowledge patient identity. Perceptions surrounding sexual, reproductive, and mental health were similar between users and students in both countries, whilst users' voices on the complexity and dissatisfaction of gender-diverse care contrasted with students' lack of insight. Singapore users were more concerned with sociolegal acceptance affecting health needs, whilst UK users noted more nuanced barriers to healthcare. Although many students were unsure about specific health needs and perceived a lack of training, they expressed willingness to create an equitable healthcare environment. 

Conclusions 
LGBTQ+ users provided powerful narratives on discrimination surrounding their healthcare needs. To address these, medical students must be encouraged by healthcare educators to develop identity-affirming behaviours as future change-makers and challenge cis-heteronormative views that may be dehumanising. Alongside vital institutional changes tailored to each country, patients and students' collective action would create meaningful educational opportunities to reach culture change.