Diversity in the Australian speech-language pathology workforce: Addressing Sustainable Development Goals 3, 4, 8, and 10

Medical educators have expressed concern that students' professional identities do not always align with their expectations or with professional standards. The authors propose that, in constructing appropriate professional identities, medical students today are affected by the competing discourses of diversity and standardization. Between March and May 2012, the authors conducted a critical review of seminal publications to highlight the discourses of diversity and standardization in the medical education literature. They surveyed the social sciences literature on identity construction and drew examples from medical education to demonstrate how a social constructionist approach could inform the discussion about how medical students' professional identities are affected by these discourses. The discourse of diversity emphasizes individuality, difference, and a plurality of possibilities and advances the notion that heterogeneity is beneficial to medical education and to patients. In contrast, the discourse of standardization strives for homogeneity, sameness, and a limited range of possibilities and conveys that there is a single way to be a competent, professional physician. Thus, these discourses are in tension, a fact that medical educators largely have ignored. A social constructionist approach to identity suggests that medical students resolve this tension in different ways and construct different identities as a result. To influence medical students' professional identity construction, the authors advocate that educators seek change across the profession-faculty must acknowledge and take advantage of the tension between the discourses of standardization and diversity.

Background Significant health disparities between sexual minority individuals (that is, lesbian, gay, bisexual, or transgender [LGBT]) and heterosexual individuals have been demonstrated. Aim To understand the barriers and facilitators to sexual orientation (SO) disclosure experienced by LGBT adults in healthcare settings. Design and setting Mixed methods systematic review, including qualitative, quantitative, and mixed methods papers following PRISMA guidelines. Method Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT) and a qualitative synthesis was performed. Studies were included if their participants were aged ≥18 years who either identified as LGBT, had a same-sex sexual relationship, or were attracted to a member of the same sex. Results The review included 31 studies representing 2442 participants. Four overarching themes were identified as barriers or facilitators to SO disclosure: the moment of disclosure, the expected outcome of disclosure, the healthcare professional, and the environment or setting of disclosure. The most prominent themes were the perceived relevance of SO to care, the communication skills and language used by healthcare professionals, and the fear of poor treatment or reaction to disclosure. Conclusion The facilitators and barriers to SO disclosure by LGBT individuals are widespread but most were modifiable and could therefore be targeted to improve healthcare professionals’ awareness of their patients’ SO. Healthcare professionals should be aware of the broad range of factors that influence SO disclosure and the potential disadvantageous effects of non-disclosure on care. The environment in which patients are seen should be welcoming of different SOs as well as ensuring that healthcare professionals’ communication skills, both verbal and non-verbal, are accepting and inclusive.