Exploring Gender Identity in Medical Trainees and Practicing Physicians: A Preliminary Observation from Lebanon

Exploring Gender Identity in Medical Trainees and Practicing Physicians: A Preliminary Observation from Lebanon | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring Gender Identity in Medical Trainees and Practicing Physicians: A Preliminary Observation from Lebanon MohammadAli Jardaly, Issam Shaarani This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5870846/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Gender identity awareness is increasing in medicine, yet data collection in Lebanon remains largely binary. This study examines gender identity trends among medical trainees and physicians. Methods: A cross-sectional survey was conducted among final-year medical students, residents, fellows, and attending physicians at all six private Lebanese medical schools and affiliated hospitals. The gender question included "male," "female," and "prefer not to answer" to ensure IRB approval. Results: Among 278 respondents (17.46% response rate), 13 (4.7%) chose "prefer not to answer"—6.1% of students, 8.1% of residents/fellows, and only 1.2% of attending physicians. Nearly all were trainees. Conclusion: A trend toward expressing non-binary gender identity appears more common among younger medical professionals and doctors in training in Lebanon. Further research is needed to explore this shift and its implications for medical education and practice. Gender identity non-binary medical trainees medical education healthcare workforce diversity equity and inclusion (DEI) Lebanon physicians medical students gender trends diversity in medical workforce Figures Figure 1 Figure 2 Introduction In recent years, the importance of diversity, equity, and inclusion, including gender identity awareness among healthcare providers, in the field of medicine has increased. Gender identity within the healthcare workforce may influence perspectives, communication styles, and patient care. In Lebanon, the collection of gender-disaggregated data has traditionally been limited to binary categories—male and female. However, recent efforts indicate a shift toward more inclusive practices. In Lebanon, where gender roles are traditionally defined, understanding trends among medical trainees and physicians could provide insight into evolving perceptions of gender identity. Study Overview As part of a broader research project on financial well-being (1), we surveyed medical students, residents/fellows, and attending physicians in Lebanon. A total of 1,592 emails were sent, resulting in 278 responses (17.46% response rate) (figure 1). The survey included a question about gender, where respondents had the option to identify as male, female, or prefer not to answer. Gender Question Design When designing the survey, we initially considered including nonbinary and other gender identity options to promote inclusivity. However, to mitigate potential sensitivities and complications during the Institutional Review Board (IRB) approval process, we opted for a more conservative approach. Instead, we included a third option labeled “prefer not to answer,” allowing respondents the flexibility to avoid specifying their gender without raising concerns about sensitive topics with the IRB. This decision reflects our intention to respect respondents' privacy while adhering to local regulatory standards. Methods Study Design and Population This is a multi-institutional nationwide cross-sectional online survey-based study among medical students, residents and practicing physicians in all six private medical schools in Lebanon. The aim is to measure financial well-being and its predictors via validated instruments. Inclusion criteria. The participants in this study were final-year medical students enrolled in one of the six private Lebanese medical schools. Additionally, medical residents and fellows currently in training at the affiliated hospitals of these private medical schools were included. Practising physicians employed at affiliated hospitals and involved in academic activities, referred to as attending physicians, were also part of the study population. Exclusion criteria. The study excluded medical students who were not in their final year of study. Residents, fellows, and Jardaly et al. 3 attending physicians not affiliated with private medical schools or their hospitals were not included. Medical professionals working exclusively in private practice without any affiliation with academic centers were also excluded. Furthermore, individuals who did not provide informed consent were not part of the study. Survey Administration The participants were invited via email to complete an anonymous online questionnaire via LimeSurvey software (LimeSurvey GmbH, 2018). The survey collected data on educational debt, household income, socioeconomic status, and demographic information, including gender. Ethical approval The Institutional Review Board (IRB) of the American University of Beirut granted primary ethical approval on 23 March 2020 (SBS-2020-0058). Ethical approval was subsequently obtained from all six medical schools and their affiliated academic hospitals. Findings Out of the 278 responders, 13 (4.7%) chose not to disclose their gender identity (figure 2). Among these, 6.1% of the students and 8.1% of the residents/fellows selected "no answer," whereas only 1.2% of the attending physicians opted for this choice (figure 2). Interestingly, 12 of these respondents were students or residents/fellows, whereas only 1 was an attending physician. Although the sample size is small, this trend may hint at a shifting perspective regarding gender identity among younger members of the medical field in Lebanon. Discussion While our data are limited, this suggests a trend where younger medical professionals may be more likely to opt out of traditional gender labels. This could reflect broader social changes or a desire for greater privacy around gender identity among medical trainees. As the healthcare workforce becomes more diverse, it is essential for institutions to foster inclusive environments that respect gender identity and support all healthcare providers. Conclusion Although not conclusive, these preliminary findings warrant further exploration into gender identity in Lebanon’s medical community and the broader community. Future studies with larger samples could provide deeper insights into how gender perceptions are shifting among medical trainees and practicing physicians, as well as the general public. Understanding these changes can help medical institutions better support their workforce and promote inclusivity, which could also reflect on inclusive patient care. Declarations Ethical Considerations : The Institutional Review Board of the American University of Beirut granted the main ethical approval (SBS-2020-0058) in March 23, 2020. Ethical approval from all medical schools and hospitals followed. Consent to Participate : The landing page of the survey included the informed consent. By clicking on accept, the participants gave their written informed consent. Consent for Publication : Not applicable. Data Availability Statement: Data of this research is available upon request. Competing interests: The authors declare that they have no competing interests. Funding : The author(s) received no financial support for the research, authorship, and/or publication of this article. Authors Contribution : MJ conceived and designed the study, analyzed the data and authored drafts of the article and approved the final draft. IS conceived and designed the study, reviewed the data analysis and approved the final draft. Acknowledgements : The authors acknowledge that parts of this research were presented at the AUBMC Clinical Research E-Open House on May 2021 in Beirut, Lebanon, the WONCA World Conference on November 22, 2021, in Abu Dhabi, UAE, and the WONCA/RCGP Conference on June 28, 2022, in London, UK. References Jardaly MA, et al. Financial Literacy and Wellbeing Among Medical Students, Residents, and Attending Physicians in Lebanon: Results From a Nationwide Multi-Centered Survey. INQUIRY: J Health Care Organ Provis Financing. 2024;61:00469580241294135. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5870846","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":407661359,"identity":"24a322a0-aa7f-40bd-8453-7daca9e781f1","order_by":0,"name":"MohammadAli Jardaly","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYHCCBAYGNgYZBvYGINvAgngtPAw8B0BaJIi1CKRFIgHEIkKLbvuBh58ryux4DG4+v7rhR4EEA397dwJeLWZnEpIlz5xL5jG4nVN2swfoMIkzZzfg13IgIUGysY0ZpCXtBg9Qi4FELgEt5x8k/2xsqwc67EzazT9EabmRkAa05TCPwQ32Y7eJs+XGgzTLhnPHeSTP5LDdljGQ4CHsl/M5yTcbyqrl+I4ff3bzzR8bOf72XvxaGBh4EsCUwgEeAzCXgHIQYD8ApuQb2B8QoXoUjIJRMApGIgAAEO9LvzsgdTMAAAAASUVORK5CYII=","orcid":"","institution":"American Univeristy of Beirut Medical Center","correspondingAuthor":true,"prefix":"","firstName":"MohammadAli","middleName":"","lastName":"Jardaly","suffix":""},{"id":407661360,"identity":"4b51cb14-2d77-4268-8199-11a1eba76c8f","order_by":1,"name":"Issam Shaarani","email":"","orcid":"","institution":"Beirut Arab University","correspondingAuthor":false,"prefix":"","firstName":"Issam","middleName":"","lastName":"Shaarani","suffix":""}],"badges":[],"createdAt":"2025-01-21 06:53:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5870846/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5870846/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75003760,"identity":"8a861131-efda-45e4-8bdd-f13d87cbc733","added_by":"auto","created_at":"2025-01-29 10:22:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":39829,"visible":true,"origin":"","legend":"\u003cp\u003eResponse rates of the survey\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5870846/v1/3ecff71400f916e18ec91bea.png"},{"id":75004966,"identity":"d16cf125-91c3-4e6a-9281-4784550660cd","added_by":"auto","created_at":"2025-01-29 10:30:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":153676,"visible":true,"origin":"","legend":"\u003cp\u003eGender distribution among medical students, residents/fellows, and attending physicians\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5870846/v1/6e34e57f1772ac3867da0dd6.png"},{"id":77102192,"identity":"5c82720a-6f09-4ad8-b435-dad6ab3e2abc","added_by":"auto","created_at":"2025-02-25 07:32:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":541708,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5870846/v1/0c655856-0fbc-4689-b4ef-c30363d5bb45.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring Gender Identity in Medical Trainees and Practicing Physicians: A Preliminary Observation from Lebanon","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn recent years, the importance of diversity, equity, and inclusion, including gender identity awareness among healthcare providers, in the field of medicine has increased. Gender identity within the healthcare workforce may influence perspectives, communication styles, and patient care.\u003c/p\u003e\n\u003cp\u003eIn Lebanon, the collection of gender-disaggregated data has traditionally been limited to binary categories\u0026mdash;male and female. However, recent efforts indicate a shift toward more inclusive practices. In Lebanon, where gender roles are traditionally defined, understanding trends among medical trainees and physicians could provide insight into evolving perceptions of gender identity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Overview\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs part of a broader research project on financial well-being (1), we surveyed medical students, residents/fellows, and attending physicians in Lebanon. A total of 1,592 emails were sent, resulting in 278 responses (17.46% response rate) (figure 1). The survey included a question about gender, where respondents had the option to identify as male, female, or prefer not to answer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGender Question Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen designing the survey, we initially considered including nonbinary and other gender identity options to promote inclusivity. However, to mitigate potential sensitivities and complications during the Institutional Review Board (IRB) approval process, we opted for a more conservative approach. Instead, we included a third option labeled \u0026ldquo;prefer not to answer,\u0026rdquo; allowing respondents the flexibility to avoid specifying their gender without raising concerns about sensitive topics with the IRB. This decision reflects our intention to respect respondents\u0026apos; privacy while adhering to local regulatory standards.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a multi-institutional nationwide cross-sectional online survey-based study among medical students, residents and practicing physicians in all six private medical schools in Lebanon. The aim is to measure financial well-being and its predictors via validated instruments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants in this study were final-year medical students enrolled in one of the six private Lebanese medical schools. Additionally, medical residents and fellows currently in training at the affiliated hospitals of these private medical schools were included. Practising physicians employed at affiliated hospitals and involved in academic activities, referred to as attending physicians, were also part of the study population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study excluded medical students who were not in their final year of study. Residents, fellows, and Jardaly et al. 3 attending physicians not affiliated with private medical schools or their hospitals were not included. Medical professionals working exclusively in private practice without any affiliation with academic centers were also excluded. Furthermore, individuals who did not provide informed consent were not part of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurvey Administration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants were invited via email to complete an anonymous online questionnaire via LimeSurvey software (LimeSurvey GmbH, 2018). The survey collected data on educational debt, household income, socioeconomic status, and demographic information, including gender.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eapproval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Institutional Review Board (IRB) of the American University of Beirut granted primary ethical approval on 23 March 2020 (SBS-2020-0058). Ethical approval was subsequently obtained from all six medical schools and their affiliated academic hospitals.\u003c/p\u003e"},{"header":"Findings","content":"\u003cp\u003eOut of the 278 responders, 13 (4.7%) chose not to disclose their gender identity (figure 2).\u003c/p\u003e\n\u003cp\u003eAmong these, 6.1% of\u0026nbsp;the students and 8.1% of\u0026nbsp;the residents/fellows selected \u0026quot;no answer,\u0026quot;\u0026nbsp;whereas\u0026nbsp;only 1.2% of\u0026nbsp;the attending physicians opted for this choice (figure 2).\u003c/p\u003e\n\u003cp\u003eInterestingly, 12 of these respondents were students or residents/fellows, whereas only 1 was an attending physician. Although the sample size is small, this trend may hint at a shifting perspective regarding gender identity among younger members of the medical field in Lebanon.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWhile our data are limited, this suggests a trend where younger medical professionals may be more likely to opt out of traditional gender labels. This could reflect broader social changes or a desire for greater privacy around gender identity among medical trainees. As the healthcare workforce becomes more diverse, it is essential for institutions to foster inclusive environments that respect gender identity and support all healthcare providers.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAlthough not conclusive, these preliminary findings warrant further exploration into gender identity in Lebanon\u0026rsquo;s medical community and the broader community. Future studies with larger samples could provide deeper insights into how gender perceptions are shifting among medical trainees and practicing physicians, as well as the general public. Understanding these changes can help medical institutions better support their workforce and promote inclusivity, which could also reflect on inclusive patient care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e: The Institutional Review Board of the American University of Beirut granted the main ethical approval (SBS-2020-0058) in March 23, 2020. Ethical approval from all medical schools and hospitals followed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e: The landing page of the survey included the informed consent. By clicking on accept, the participants gave their written informed consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e: Not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e Data of this research is available upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: The author(s) received no financial support for the research, authorship, and/or publication of this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contribution\u003c/strong\u003e:\u0026nbsp;MJ conceived and designed the study, analyzed the data and authored drafts of the article and approved the final draft. IS conceived and designed the study, reviewed the data analysis and approved the final draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: The authors acknowledge that parts of this research were presented at the AUBMC Clinical Research E-Open House on May 2021 in Beirut, Lebanon, the WONCA World Conference on November 22, 2021, in Abu Dhabi, UAE, and the WONCA/RCGP Conference on June 28, 2022, in London, UK.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJardaly MA, et al. Financial Literacy and Wellbeing Among Medical Students, Residents, and Attending Physicians in Lebanon: Results From a Nationwide Multi-Centered Survey. INQUIRY: J Health Care Organ Provis Financing. 2024;61:00469580241294135.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Gender identity, non-binary, medical trainees, medical education, healthcare workforce, diversity equity and inclusion (DEI), Lebanon, physicians, medical students, gender trends, diversity in medical workforce","lastPublishedDoi":"10.21203/rs.3.rs-5870846/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5870846/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eGender identity awareness is increasing in medicine, yet data collection in Lebanon remains largely binary. This study examines gender identity trends among medical trainees and physicians.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA cross-sectional survey was conducted among final-year medical students, residents, fellows, and attending physicians at all six private Lebanese medical schools and affiliated hospitals. The gender question included \"male,\" \"female,\" and \"prefer not to answer\" to ensure IRB approval.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eAmong 278 respondents (17.46% response rate), 13 (4.7%) chose \"prefer not to answer\"\u0026mdash;6.1% of students, 8.1% of residents/fellows, and only 1.2% of attending physicians. Nearly all were trainees.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eA trend toward expressing non-binary gender identity appears more common among younger medical professionals and doctors in training in Lebanon. Further research is needed to explore this shift and its implications for medical education and practice.\u003c/p\u003e","manuscriptTitle":"Exploring Gender Identity in Medical Trainees and Practicing Physicians: A Preliminary Observation from Lebanon","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-29 10:22:54","doi":"10.21203/rs.3.rs-5870846/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d44acf2d-765b-4b7c-bbb1-84d72540d55e","owner":[],"postedDate":"January 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-25T07:23:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-29 10:22:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5870846","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5870846","identity":"rs-5870846","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}