Weaving Care from the Margins: How LGBTIQ+ Medical Trainees Craft Professional Identity through Vulnerability

doi:10.21203/rs.3.rs-7542805/v1

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Research Article

Weaving Care from the Margins: How LGBTIQ+ Medical Trainees Craft Professional Identity through Vulnerability

https://doi.org/10.21203/rs.3.rs-7542805/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 23 Dec, 2025

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Background
LGBTIQ+ medical trainees face distinct forms of discrimination that could shape their professional identity formation (PIF). These challenges influence how they engage with the social and cultural dynamics of medical training. While research on PIF is expanding, little is known about how LGBTIQ+ trainees craft their professional identities.

Methods
Guided by intersectionality theory and employing constructivist grounded theory methodology, we conducted 18 semi-structured interviews with LGBTIQ+ medical students and residents in Bogotá, Colombia. Data were analyzed through constant comparison and iterative coding, with theoretical sampling used to reach theoretical sufficiency. Reflexivity was central, with researchers drawing on their intersectional positionalities to enrich interpretation.

Results
LGBTIQ+ medical trainees navigated environments shaped by heteronormativity, where exclusion and violence were commonplace. To safeguard their well-being, they looked for safe spaces within and outside medicine. Experiencing vulnerability in this way deepen their empathy, especially toward marginalized patients. From this emerges the figure of the Care Weaver—a physician identity grounded in relational care and committed to challenging detached models of professionalism with a more humane conscious approach.

Discussion
This study advances PIF understanding by illustrating how LGBTIQ+ trainees actively resist and reconfigure medical norms, transforming marginalization into relational capacities. Their identity work reveals the limitations of existing PIF models and points to the value of integrating intersectionality into both research and educational design. We argue that fostering such identities must not rely on the endurance of systemic harm, but instead on structural reforms that affirm diverse ways of becoming a doctor.

Professional Identity Formation

LGBTIQ+

medical education

constructivist grounded theory

LGBTIQ + medical trainees face unique challenges during their training that may impact their professional identity formation (PIF) (Butler et al., 2024). For example, LGBTIQ + medical trainees may experience discrimination and harassment from peers and faculty members (Bradbury-Jones et al., 2020). They may also face additional stressors related to their sexual orientation or gender identity that can contribute to high rates of burnout (Ryus et al., 2022). These challenges may influence how LGBTIQ + medical trainees develop their professional identities and how they navigate the complex social and cultural dynamics of the medical profession (Butler et al., 2019). Despite a growing number of studies exploring the PIF of medical trainees, there is still a lack of research on how the intersection of their professional and LGBTIQ + identities influences medical trainees’ PIF. By understanding the intersection between LGBTIQ + medical trainees’ multiple identities and their relationship with the social power structures in which they are embedded, we could create strategies to support their PIF process while promoting their inclusion.

PIF is crucial in the journey to becoming a physician (Mount et al., 2022; Sarraf-Yazdi et al., 2021). This process is characterized as intricate, multifaceted, continuous, and evolutionary, enabling individuals to integrate their existing competencies, attitudes, values, and behaviors with those deemed essential in their chosen medical profession (Sarraf-Yazdi et al., 2021). From a conceptual standpoint, this process can be viewed as a progression of self-identified personas, unfolding from an individual's current identity to a future, desired identity that they aim to achieve (Monrouxe, 2010). This journey is highly personalized, yet it unfolds within specific contexts, anchored in psychosocial foundations, and is continuously undergoing deconstruction and reconstruction (Sarraf-Yazdi et al., 2021). This dynamism is influenced by the individual's experiences and their reactions to various events throughout their life. The significance of PIF is extensively explored within the realm of medical education, serving as the cornerstone for the ethical principles guiding medical practice. Furthermore, many authors argue that despite medical trainees acquiring the necessary skills and knowledge, their success as doctors hinges on their ability to forge a professional identity (Monrouxe, 2010).

Underrepresented medical trainees frequently encounter challenges that place their professional identity formation under particular strain. Experiences of racism, sexism, homophobia, and classism, alongside feelings of isolation or “otherness,” often complicate their sense of belonging within medical education (Cameron et al. 2025). These students may struggle with pressure to conform to dominant cultural norms while simultaneously navigating the personal costs of managing stigma and discrimination (Joseph et al., 2017; Wyatt et al., 2021). Such tensions can lead to heightened stress, self-doubt, and burnout, undermining confidence in their professional trajectory (Hill et al., 2020; Nemiroff et al., 2024). The consequences extend beyond professional identity formation, with evidence of delayed progression, lower performance on summative assessments, and higher attrition rates among underrepresented students (Orom et al., 2013). As part of this broader category, LGBTIQ + trainees face many of the same barriers but also encounter distinct obstacles tied to their sexual orientation and gender identity (Toman, 2019). Discrimination, harassment, and pressures related to disclosure and minority stress can contribute to heightened exhaustion and burnout, further complicating their efforts to develop a stable professional identity (Bradbury-Jones et al., 2020; Butler et al., 2024; Butler et al., 2019; Ryus et al., 2022). These challenges shape not only how LGBTIQ + trainees construct their professional personas but also how they navigate the complex social and cultural dynamics of the medical field.

Despite the growth of scholarship on PIF in medical education (Ly & Chakrabarti, 2024), most research examines identities in isolation—focusing on how being, for example, Black, or low-income, or LGBTIQ + affects trainees. Such approaches risk overlooking the intersecting and compounding nature of these identities and the ways they jointly shape experiences of inclusion, exclusion, and identity formation. Equally important, there is limited attention to how trainees themselves engage with these interlocking systems of oppression—whether by resisting, adapting, or transforming them—and how such responses influence their professional identity formation. Our purpose is, therefore, to explore how LGBTIQ + medical trainees construct their professional identities from an intersectionality perspective. Understanding not only the barriers but also the strategies and outcomes of this engagement is essential for informing educational practices that both support trainees’ identity development and promote equity and inclusion within the medical profession.

Intersectionality is a theoretical framework that posits that various dimensions of social life and categories of difference, such as gender, race, class, sexuality, age, ability, ethnicity, and nationality, are not separate or discrete but rather overlap, articulate, and are mutually constitutive (Abrams et al., 2020; Wyatt et al., 2022). This framework fundamentally challenges additive thinking, which would merely sum the effects of different identities, by instead emphasizing that what is experienced at the intersection of two or more axes of oppression is a unique, multidimensional lived experience that cannot be captured by analyzing categories independently (Christensen & Jensen, 2012; Windsong, 2018). A central tenet is the recognition of power, inequality, and oppression in perpetuating inequity, examining how systems of discrimination or subordination overlap and how power relations are maintained (Rehman et al., 2023). Intersectionality illuminates how intersecting forms of discrimination can create social and material benefits for those with normative or non-marginalized statuses, such as Whiteness, maleness, heterosexuality, or upper-class status (Hankivsky et al., 2010). It views identities not as fixed but as dynamic and context-specific, shaped by socio-cultural, historical, and localized contexts (Abrams et al., 2020; Rehman et al., 2023), which is why this theory is ideal for understanding the experiences of LGBTIQ + trainees and how those experiences influence the construction of their professional identities.

Research Design

To address our research question, we employed a constructivist grounded theory approach, which is particularly well-suited to examining phenomena that remain under-studied and to uncovering the core social processes that constitute them (Charmaz, 2014b). CGT allowed us not only to foreground participants’ experiences but also to integrate our own reflections and relevant theoretical lenses (Watling & Lingard, 2012). In adopting CGT, we situate our work within a constructionist paradigm that views knowledge as co-constructed by researchers and participants embedded in specific sociocultural contexts (Rees et al., 2020). As LGBTIQ + scholars, our insider positionality compelled us to treat our own experiences as inseparable from those of our participants. Thus, our design and epistemological stance emphasize how participants and researchers collaboratively construct their realities in relation to the phenomenon under study (Savin-Baden & Major, 2023).

Bringing intersectionality into dialogue with CGT strengthens these methodological commitments by ensuring that the constructed results remain attentive to power, privilege, oppression, stigma, and resistance (Levitt et al., 2025). Intersectionality highlights identity as relational, dynamic, and situated in systems of power, while CGT emphasizes knowledge co-construction and reflexivity. Both perspectives resist essentialism: where intersectionality exposes how identities are fluid and shaped by structural inequities, CGT provides analytic tools to trace how those identities are negotiated and made meaningful in social interaction (Baird, 2021). Taken together, they allow us to move beyond simplistic categorizations and interrogate how broader structural forces—such as neoliberalism, capitalism, racism, and imperialism—become entangled with local contexts to shape everyday experiences (Kassam et al., 2020).

Context

This study was conducted at two private medical schools in Bogotá, Colombia. Both institutions offer undergraduate and postgraduate medical education, maintain high-standard accreditation, and consistently rank among the top universities in the country. Their trainees participate in diverse clinical placements of varying complexity, both within Bogotá and in surrounding rural areas. However, neither institution has implemented specific recruitment strategies focused on diversity, equity, and inclusion, which limited our ability to include, for example, trans participants in the current study. At the same time, national government programs have sought to widen access by supporting high-achieving students from low-income backgrounds—covering full tuition costs and providing stipends for living expenses. As a result, while the majority of students in these programs come from high-income families, a small but significant proportion of low-income students are also enrolled.

Colombia has established one of the most progressive legal frameworks for LGBTIQ + rights in Latin America. Over the past two decades, the country has decriminalized homosexuality, recognized same-sex marriage and adoption, and permitted legal gender changes without medical prerequisites. While these legal and institutional achievements represent a strong formal commitment to equality and human rights, most of them were secured through the judiciary, as legislative efforts have frequently stalled in Congress. Despite this legal progress, a significant gap persists between legal recognition and lived experience. LGBTIQ + Colombians, particularly trans women and those in marginalized or rural communities, continue to face high levels of violence, discrimination, and impunity. Cultural resistance, entrenched conservative norms, and weak government enforcement mechanisms undermine the effectiveness of existing protections.

Data collection and analysis

We conducted eighteen semi-structured interviews for data collection. This method was chosen due to the anticipated sensitivity of the topics under exploration; individual interviews provided a context that supported open and in-depth discussion without discomfort (Savin-Baden & Major, 2023). We employed a combination of purposive and convenience sampling strategies to recruit participants with varied intersecting identities, including sexual orientation, gender, race, and social class. Additionally, we sought to include students from different semesters of the undergraduate program, as well as from clinical and surgical specialties within the residency programs (See Table 1). Through this approach, we aimed to capture a broad range of trainee experiences to deepen our understanding of the study phenomenon and enhance the transferability of the findings (Stalmeijer et al., 2024). Initially, recruitment was conducted via invitations shared on social media platforms and through outreach to university LGBTIQ + support groups. Subsequently, we employed snowball sampling by inviting participants to refer peers who matched our sampling criteria. An initial interview guide was developed in alignment with our research aims, incorporating sensitizing concepts drawn from our conceptual and theoretical frameworks (Charmaz, 2014a). Following a theoretical sampling approach, the guide was revised twice to support the development of theoretical sufficiency (Charmaz, 2014c; Dey, 1999) (See Supplementary Material).

All interviews were conducted individually by members of the research team. They lasted approximately one hour, ranging from 45 to 115 minutes. Participants did not receive any material compensation for their involvement. To ensure anonymity and create a safe environment for participants, interviews were conducted online via Zoom. All participants joined from the privacy of their homes, and cameras remained on (except in on ocassion due to system issues) throughout to facilitate the observation of nonverbal communication. Interviews were recorded using the platform's built-in transcription tool, with transcripts subsequently reviewed and anonymized by the research team.

We employed an iterative approach to data collection and analysis, drawing on constant comparison techniques and memo writing to support the development of the study's final categories (Eppich et al., 2019; Watling & Lingard, 2012). Individual memos were written following each interview, after coding sessions, and as preparation for group meetings. These meetings were used to discuss constructed findings, revise the interview guide, and inform further analysis steps. Initial coding was conducted jointly by FOV and FAJ to explore the dataset and identify preliminary concepts and patterns. Sensitizing concepts from intersectional theory guided the coding process, allowing us to remain grounded in participants' experiences while elevating the analytical depth of the process (Mcowen et al., 2023). We then engaged in focused coding, selecting the most salient and conceptually rich initial codes to develop into preliminary categories. At this point we had a clear understanding of how trainees navigate oppression in relation to their intersecting identities, however it was not clear yet how this vulnerability influence their PIF. Theoretical sampling—including both the recruitment of specific participants and adjustments to the interview guide—enabled further refinement of these categories. Through this process we were able to understand how participants responded to interlocking systems of oppression by crafting a professional identity. The final three interviews were used to assess whether the categories adequately accounted for participants' experiences, allowing us to establish theoretical sufficiency (Varpio et al., 2017). Throughout the analysis, the research team met regularly to monitor progress and consolidate each phase of the coding process. We used Quirkos software throughout the whole analysis process.

Table 1
Participants Characteristics. Note: All categories were consensuated with participants to respect self-determination.
Total Participants	18
Average age (years)	24.9
Minimum age (years)	19
Maximum age (years)	34
Level of training	Undergraduate	10
	Posgraduate	7
	Fellowship	1
Gender Identity	Cisgender female	9
	Cisgender male	6
	Non-binary	2
	Queer	1
Sexual Orientation	Gay	6
	Bisexual	6
	Lesbian	5
Race	Black	2
	Latino	3
	Does not identify with a specific race	13

Reflexivity

We employed several strategies to ensure reflexivity throughout the research process. As previously noted, three members of the research team identify as gay cisgender men, and all researchers are clinical educators at the universities where data collection occurred. This positioned us in particular ways in relation to both the phenomenon under study and the participants. Consistent with a constructionist paradigm, we sought to leverage our subjectivities not as biases to be bracketed, but as resources to enrich the analytical process (Olmos-Vega et al., 2023).

To engage in personal reflexivity, we each wrote autobiographical narratives, reflecting on our past and present experiences as LGBTIQ + individuals (Koopman et al., 2020). These narratives were structured using the first version of the interview guide, allowing us to critically examine how our identities and histories intersect with the topic under investigation. We shared these narratives within the research team and convened a dedicated meeting to facilitate a reflective discussion about our individual and collective positionalities (Barry et al., 1999). One member of the research team identifies as a straight cisgender man, offering a valuable "outsider" perspective within the group. This intra-group diversity added further depth to our reflexive engagement and interpretive processes. By uncovering our understanding of the phenomenon under study, we were also able to compare that to those of our participants actively.

Interpersonal reflexivity was addressed through iterative memo writing. Given that our study was informed by intersectionality theory, we paid close attention to how we were positioned—and how we positioned ourselves—relative to our participants across multiple identity dimensions (Rodriguez & Ridgway, 2023). For instance, we acknowledged that, as white cisgender male clinical educators, we held institutional power and privilege that shaped the research encounter. At the same time, our identities as LGBTIQ + individuals created potential points of connection and solidarity, particularly with participants who shared experiences of marginalization.

This complex interplay of identities influenced the dynamics of each interview. In one illustrative case, FOV was scheduled—via snowball sampling—to interview a queer student. Unbeknownst to either party at the time of recruitment, they had met previously in a clinical setting: FOV had administered anesthesia for a participant’s surgery. During the interview, the participant recalled experiencing significant anxiety before the operation and noted that FOV had taken the time to offer reassurance. He specifically remembered one of FOV’s pin that had an LGBITQ + rainbow with a legend that said “YOU ARE SAFE WITH ME”, describing it as a source of comfort. The participant disclosed that he had initially hesitated to accept the interview invitation but felt reassured upon recognizing who the interviewer was. An impression that was further solidified by getting to know that he was also gay. We used these moments to emphasize the importance of acknowledging and reflecting on how shared and divergent identities, institutional roles, and prior interactions shape our relationships with participants. Rather than minimizing these complexities, we embraced them as a means of deepening the trust, authenticity, and analytic insight within our study. Addressing reflexivity from an intersectional perspective also helped us to avoid privileging specific categories and to continuously recalibrate the analytical results to better understand the multifaceted realities of the participants (Locke, 2015).

Ethics

We obtained ethics approval from the research ethics committees of both participating universities. Given the importance of creating safe spaces for participants and the potential for the collection of sensitive data, we took rigorous steps to ensure anonymity and confidentiality. Informed consent was obtained from all participants, with clear information provided regarding the study’s aims, procedures, and their rights throughout the research process.

LGBTIQ + medical trainees navigate a heteronormative training environment that is often abrasive, unsafe, and marked by subtle and overt forms of violence and oppression. Within this toxic culture, they actively seek out safe spaces—both inside clinical settings and beyond the walls of medicine—to preserve their well-being and affirm their identities. Their own experiences of vulnerability often foster a deepened capacity for empathy, particularly toward marginalized patients; for some, this empathic stance extends to all patients, grounded in a recognition of illness as a shared condition of human fragility. From these experiences emerges a distinctive mode of professional identity that we conceptualize as The Care Weaver. This figure challenges traditional models of detached, impersonal medical professionalism, instead embodying a relationally grounded approach to care. Rooted in lived marginalization and a critical awareness of structural power, the Care Weaver crafts their clinical identity through personal experience, empathic attunement, and a commitment to making medicine safer and more humane. We expand these concepts within the following four main categories of our analysis.

Navigating Medical Terrain as a Risk Map

Participants described medical school and residency as structured by implicit norms of heteronormativity, cisnormativity, classism, racism, and professional rigidity. These overlapping systems of oppression created heightened vulnerability for LGBTIQ + trainees, particularly for those situated at the intersection of diverse sexual orientations, gender identities, social class, racial or ethnic background, and mental health histories. The violence they experienced could be overt or physical, but also took the form of subtle, cumulative harm. Trainees responded with emotional self-monitoring, anticipatory fear of rejection or discrimination or silence in the face of microaggressions. The following excerpt exemplifies this:

“I feel that I was an easy target, […] at one point I also suffered stigma against HIV, without having HIV, […] people started to say that I had HIV because I always handed out condoms and I was always involved in that, I was part of, like a health prevention group, they gave me condoms to hand out. […] Once I had an incident and then I started taking HIV prophylaxis and it was really bad for me […] it made me really, really, really sick […] so people start rumouring I had HIV” Participant 1

This violence made the act of navigating medical culture a constant negotiation of risk, visibility, and safety. Many learned to read the landscape as a risk map, carefully deciding when and how to disclose parts of their identity. However, for those at the intersection of multiple marginalized identities—such as being both racialized and perceived as a woman—concealment was often not an option. Visibility was not always a choice but a condition imposed by social perception, rendering some trainees vulnerable regardless of their intent to disclose. In these cases, the very possibility of strategic invisibility collapsed, exposing the uneven distribution of risk within the LGBTIQ + community. Visibility, then, functioned both as a tactical decision and as an unavoidable condition shaped by embodiment and context. The following participant describes this complexity:

“I am many minorities in one; I am a woman by birth, I'm black, I'm bi, but I have a preference for women. I'm non-binary, I hate the molds, so it's like I express too many sides. I'm a shitty, I'm a chaos […] I also am a scholarship holder, so people used to ignore me or throw in my face the fact that I did not have the same economic capabilities as they did. So at the end of the day, that always felt ugly because it's not my fault that my family doesn't have the, I don't know how many millions, to pay for the semester and all of that. […] And now, when men perceive me as a woman they call me “young lady”, or “princess”, and I'm like ‘I'm not a princess, I'm a doctor’. Participant 6

Participants also voiced a sustained critique of the absence of policies, academic training, and clear institutional guidelines regarding sexual and gender diversity in medical schools and residency programs. Beyond individual experiences of discrimination or silence, a collective awareness emerged: the medical environment was unprepared to include, educate, or care for LGBTIQ + individuals—whether as trainees or patients. Institutional invisibility functioned as a form of passive yet persistent violence—not by explicitly prohibiting identity expression, but by actively avoiding naming it, legitimizing it, or preparing to recognize it, as explained in the following quote:

“No, I've never had a class at university or anything that made me think: ‘I'm more prepared to care for a trans person or an LGBTIQ + person.’ The approach has always been rather heteronormative or cisnormative; that topic has never been discussed in class.” Participant 5

This critique extended beyond the classroom. In clinical settings, participants described unease at how the lack of specific and sensitive training led to stigmatizing practices—even in specialties where gender awareness should be central, such as gynecology, infectious disease, or public health. Several recalled situations in which faculty framed patients’ sexual orientation as crude clinical risk markers, reinforcing harmful stereotypes. This placed LGBTIQ + trainees in a conflicted position: they understood firsthand the consequences of such reductionism, yet lacked the tools and institutional support to question it safely. The following excerpt shows an example of this:

“Yesterday a lady came to us with an HPV infection, a daily occurrence in gynecology. So, the doctor told her what he always tells the patients, but then the lady asked: ‘doctor, but what if I have [sexual] relations with women and the only option you tell me to not get infected and reinfect myself is to use a condom’, the doctor said ‘it depends on what you want, but what we advice you is to use a condom’, I was shocked that day.” Participant 2

Building Refuge to Endure and Belong

In response to exclusion or symbolic violence, participants sought or created spaces of refuge. Outside of medicine, these included drag and clown communities, queer artistic collectives, close friendships, activist groups, and intimate relationships—spaces where they felt not only safe but fully seen and celebrated. These environments allowed participants to reconnect with joy, express complexity, and recover from the daily emotional toll of navigating medical institutions. This is exemplified by a participant (a pansexual cis male on a poliamorous relationship) when talking about his friends outside the medical field:

“They are, I mean, they are my safe place. So I can tell them things, and that really gives me a lot of peace because, let's say at the beginning, well, at the hospital or with other people I was not transparent, so I felt uncomfortable, but now, I don't know, being with my friends, telling them “I'm going to see my boyfriends” That, even though it sounds like something minimal, I think it's pretty nice to be tranquil, because hiding is ugly.” Participant 16

Within the medical field, some participants identified select faculty members, senior residents, but mostly peers as sources of refuge—those who demonstrated openness, used affirming language, or created learning environments free from judgment. However, these medical safe spaces were often perceived as more limited or conditional: dependent on individual allies rather than institutional support, and often requiring high performance or cautious self-presentation. The following participant describes this complexity:

“I have never told a doctor I have been with ‘look I am bisexual’, I have never shared an experience like that, what I do think is true is that there are doctors that maybe you realize or they openly share that they are part of the [LGBTIQ+] community and in that sense you feel a little more confident […] when a doctor says I am gay, bisexual or whatever, I feel more confident with that doctor.” Participant 11

These refuges were not marginal to their formation; they were foundational. Participants described them as lifelines that allowed them to process trauma, feel affirmed and legimitized, and reconnect with their desire to become doctors. These spaces offered emotional repair and, often, clarity about the kind of physician they hoped to be, as described by the following participant:

“I worked for a year with the Psychological and Health Counseling Center of the University. And there I did very well. I mean, I don't know if it was because we were all interested in mental health issues, but... it was like a more open-minded, a very pleasant environment, I felt welcomed, I felt I could talk freely. […] what we did was like active listening interventions on campus, we did a course on emotional first aid, mainly that, but we met every Friday to plan activities around mental health, […] which is what I would like to do in the future as doctor.” Participant 3

Knowing Vulnerability from the Inside

Participants expressed that their own experiences of precarity, exclusion, or mental distress shaped how they understood vulnerability in patients. This was especially evident in how they related to other marginalized patients like low income, queer or trans patients—for some of them also expanded into a broader understanding of illness as a condition of dependence, fear, and stigma as one of our participants described in the following excerpt:

“Well, that's the way I treat my patients, the moment I understood that illness is like the most vulnerable moment of a person, something changed mentally in me, that makes me much more understanding of the reasons as to why people behave the way they do and eventually knowing that the way I can treat that person will change something in their life, even if it is small, that's what generally fills me up.” Participant 2

Rather than distancing themselves emotionally, these trainees used their own pain as a point of connection. Their empathy was not abstract—it was embodied, practiced, and grounded in recognition. One participant shared how his strained relationship with his mother, who struggled for years to accept his sexuality, shaped his understanding of defensiveness in trans women patients. He recognized their reactivity not as hostility, but as a protective response rooted in long histories of rejection. His experience of managing love and tension with his mother helped him approach patients with similar emotional guardedness with greater openness, patience, and care, as it is articulated in the following quote:

“Trans women tend to be a bit more demanding as patients. They tend to be more reactive [...] I think that in a certain way, one can understand where that reactivity comes from. [...] I remember that I was very reactive with my mom when I fought with her, and over nothing, I was predisposed, because you say: ‘whatever comes out of her mouth, she's going to attack me’. And for them [trans women], it's their day-to-day life with everyone. They always encounter people who masculinize them, who don't use the right pronouns. So they are always super predisposed all the time. So, I feel like I understand them because I've lived that a little bit.” Participant 14

Crafting the Care Weaver

For our participants, vulnerability was not solely a liability—it was also a conduit for connection. Vulnerability became an interpretive lens through which they could relate to patients’ distress. As they reflected on their professional identities as doctors, many voiced a deliberate rejection of dominant ideals of medical detachment, criticizing its dehumanizing effects. Instead, they envisioned a different kind of a doctor—one grounded in relationality, openness, and empathical responsiveness. The intersection of these two forces—recognizing shared vulnerability and rejecting emotional distance—sparked a transformative reimagining of what it means to be a doctor. In this crucible, the identity of the Care Weaver was not only formed but actively claimed, signaling a refusal to separate care from selfhood, or empathy from authority.

“Being that detached, that seems absurd to me,[…] I think about that every day, because it really bothers me, the classic approach of medicine bothers me, everything quantitative, everything, it's the hormone, it's this value, it's the cut-off point, this is the treatment, that bothers me because I feel that it's not real [...] I had many problems with seeing myself as a doctor, and here, I mean, I really did not feel it was my place, I wanted to connect with people, and I realized that they do not have to be different things, I mean, who says we can not help vulnerable groups, [...] In a way, my queer identity enabled me to reconcile with my identity as a doctor.” Participant 3

Participants envisioned their consultations as places where patients, especially those marginalized by gender, sexuality, or class, could feel emotionally and physically safe. Their intention was not only to avoid harm, but to actively foster environments of affirmation, respect, and human connection. The following quotes exemplify this:

“As I said, it is very important for me to find safe spaces and that is how I would like to project myself in the future, that is, to be a safe space for someone else, because I consider that at least for now I think I am very attentive to my patients, I always listen to what they have to tell me, their problems, I think I am very open for them to tell me things and I would like to continue working on that, I see doctors who are very cold, who are very distant,[…] that is not how I would like or how I see myself in the future. Really, just as I´m constantly looking for those safe spaces, I would also like to make a safe space for someone else, especially for patients.” Participant 4

At times, this included strategic decisions to tone down or repress aspects of their own gender expression—for instance, choosing not to wear nail polish or visibly queer attire—so that even conservative patients would feel at ease. Rather than interpreting this as assimilation, participants framed it as a form of relational sacrifice made in service of safety and care, as explained in the following quote:

“For example, I really like to paint my nails but I stopped painting my nails because I was afraid of losing the connection with the patients, which I feel I have a very good connection with, it is also like there is an effort to connect with the patient and that kind of diversed expressions I stopped doing because well, I didn't want it to compromise the relationship I have with the patients, because even if a patient is sexist, the relationship I have with him is due to a state of vulnerability that the patient has” Participant 0

Empathy, for Care Weavers, was not a soft skill but a hard-earned form of clinical intelligence. Their ability to listen deeply, read between lines, and respond to emotional undercurrents stemmed from their lived experience. Rather than viewing empathy as oppositional to scientific rigor, they positioned it as essential to good care:

“If a woman tells me she doesn’t use contraception, I don’t immediately question her or judge her, like some doctors might—saying, ‘Why not? What do you mean you don’t plan?’ Because I’ve been in that situation myself. I’m a lesbian, so pregnancy isn’t a concern for me, but doctors have still asked me if I use birth control, and when I say no, they look at me like something’s wrong. They just don’t get it. And then keep insisting me to take oral contraceptives, it is quite uncomfortable. So when a patient says something similar, I don’t assume anything—I think, maybe she’s like me” Participant 17

Professional identity formation is often portrayed as a gradual alignment with the norms and values of the medical profession. Yet for our participants, this process unfolds not as seamless integration but as a high-stakes negotiation within environments that frequently marginalize their very existence. Our study illuminates how these trainees navigate, resist, and ultimately reshape the professional mold, crafting identities rooted in empathy, critical consciousness, and a deep relational commitment to care. The figure of the Care Weaver captures this identity: one forged not despite marginalization, but through the identity labor of transforming vulnerability into connection.

LGBTIQ + trainees face oppression and violence, as previously documented in the literature (Bradbury-Jones et al., 2020; Butler et al., 2024; Butler et al., 2019). Our study advances this literature by showing how intersectionality complements existing accounts of oppression with greater nuance. Cameron et al. highlights how underrepresented students are positioned within a spectrum of invisibility and hypervisibility: either erased in curricula and institutional structures or singled out as representatives of difference. Sankar et al. (2025) on the other hand add to the discussion by describing how LGBTIQ + trainees negotiate these external gazes through strategies of concealment and disclosure. Our findings bring these strands together: while some cisgender gay men could strategically conceal their identities and thus evade hypervisibility, participants who were racialized, gender non-conforming, or economically disadvantaged often had visibility imposed upon them, leaving concealment unavailable as a protective strategy. Intersectionality thus reveals concealment itself as a form of privilege and underscores how PIF unfolds within a complex interplay between how institutions perceive trainees and how trainees manage their own legibility.

These struggles, however, are not solely about survival. Our participants also described how experiences of exclusion cultivated heightened sensitivity to patient vulnerability. Rather than adopting detachment, they embraced an empathic stance grounded in recognition of shared fragility. We conceptualize this as the identity of the Care Weaver: a physician who transforms personal vulnerability into relational capacity, weaving bonds of safety and affirmation with patients. This stands in contrast to prevailing models of professionalism that valorize emotional distance (Pedersen, 2010). Importantly, this transformation is not an inevitable “silver lining” of oppression but a deliberate act of identity work, undertaken despite and against structural violence. Nemiroff et al. (2024) reinforce this interpretation by showing how underrepresented medical students, when confronted with the hidden curriculum, often experience moral injury—the distress of being pressured to internalize values that contradict their own. Rather than passively assimilating, these students frequently resisted, drawing on identity resonance with patients’ lived experiences to fuel empathy and moral clarity. Our findings echo and extend theirs: LGBTIQ + trainees similarly resist dehumanizing norms, but in doing so, they craft a distinct professional identity centered on relationality and care.

Seen in this light, PIF cannot be understood as a process of assimilation into a pre-existing mold—typically Western, white, and heteronormative (Ly & Chakrabarti, 2024; Mokhachane et al., 2024). Instead, as Varpio et al. (2025) argues, professional identity could be crafted: it is an active, imaginative, and sometimes resistant process through which trainees assemble and reassemble what it means to be a doctor. Our findings build directly on this reconceptualization. By introducing the figure of the Care Weaver, we show how LGBTIQ + trainees do not simply adapt themselves to dominant expectations but instead engage in creative identity work that foregrounds connection, vulnerability, and social consciousness. This metaphor extends the crafting perspective by illustrating how marginalized trainees can transform personal experiences of exclusion into new, relationally grounded ways of inhabiting medical professionalism.

Despite receiving little support from their sociocultural environment in shaping their professional identity, LGBTIQ + trainees gravitate toward qualities -such as empathy- that are often eroded during medical training (Costa-Drolon et al., 2021; Pedersen, 2010), aspiring to become the kind of doctors most needed today (De Carvalho Filho & Hafferty, 2025). The emergence of the Care Weaver raises then an urgent question: how can medical education foster such relational forms of professionalism without requiring systemic harm as their catalyst? Curricular reform is one avenue—embedding LGBTIQ + health into teaching not only addresses patient care disparities but also affirms LGBTIQ + trainees’ identities. Equally important are structural supports: explicit diversity, equity, and inclusion (DEI) policies, safe reporting mechanisms, and mentorship structures that reduce reliance on individual allies and instead create institutionalized cultures of belonging. Intersectionality again provides a roadmap, reminding us that DEI efforts addressing single identity categories in isolation will inevitably fall short (Hunting & Hankivsky, 2024; Lam et al., 2024).

This work is not without limitations. First, we were unable to include any trans trainees in our sample. This exclusion may be attributed to the absence of formal DEI strategies for student retention at either of the two participating universities, as well as to the broader sociocultural conservatism of the Colombian context. Ample evidence indicates that trans individuals experience distinct—and often more severe—forms of oppression and violence compared to their LGBTIQ + peers (Butler et al., 2024). This underscores the imperative to investigate PIF specifically within trans populations. Second, our study design did not allow us to explore how the identity of the “care weaver” evolves through time. While we gained insight into the factors that drive this transformation, we were not able to explore how trainees navigate and experience this process longitudinally. Future research should aim to deepen this understanding, exploring how care weavers interact with and adapt to their sociocultural environments, and how this identity mediates their relationships with peers, supervisors, and interprofessional health care teams.

Professional identity formation is often framed as a process of aligning with the norms of the medical profession. Yet, for LGBTIQ + trainees, it is more accurately understood as a complex negotiation within environments that frequently render them invisible or unsafe. Our study reveals how these trainees confront overlapping systems of oppression and, in doing so, craft a distinctive professional identity we conceptualize as the Care Weaver—a doctor who draws on lived experiences of marginalization to offer relational, empathetic, and socially conscious care. This identity is not shaped despite vulnerability but through it, challenging dominant notions of professionalism that prize detachment and conformity. Such acts of identity work are both ethical and political, pointing to the urgent need for medical institutions to move beyond token inclusion efforts and embrace structural changes grounded in intersectionality. Creating learning environments where diverse identities are not merely tolerated but valued is essential—not only for the well-being of LGBTIQ + trainees but also for reimagining what humane, just, and effective medical practice can be.

The authors declare that this research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors have no competing interests to disclose.

Author Contribution

FOV: Conceptualization, methodology, data collection, formal analysis, writing – original draft, writing – review & editing, project administration.CAC: Data collection, formal analysis, writing – review & editing.JGN: Data collection, formal analysis, writing – review & editing.FAJ: Data collection, formal analysis, writing – review & editing.All authors contributed to the interpretation of the findings, critically revised the manuscript for important intellectual content, and approved the final version of the manuscript.

Acknowledgement

We are deeply grateful to all the participants who opened up to us and entrusted us with their vulnerable experiences; their generosity made this work possible. We also thank Marco de Carvalho for his thoughtful and insightful comments on an earlier draft of this manuscript.

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No competing interests reported.

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Weaving Care from the Margins: How LGBTIQ+ Medical Trainees Craft Professional Identity through Vulnerability

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Abstract

Introduction

Theoretical Framework

Methods

Research Design

Context

Data collection and analysis

Reflexivity

Ethics

Results

Navigating Medical Terrain as a Risk Map

Building Refuge to Endure and Belong

Knowing Vulnerability from the Inside

Crafting the Care Weaver

Discussion

Conclusion

Declarations

Author Contribution

Acknowledgement

References

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