• Joseph Menousek, Elhaum G Rezaii, Harlan Sayles, Matthew J Anderson, Sheritta Strong, and Linden E Fornoff.
• Department of Neurosurgery, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska. Electronic address: Joseph.menousek@unmc.edu.
• World Neurosurg. 2024 May 1; 185: e1169e1176e1169-e1176.

ObjectiveThe aim of this study is to gauge the current social climate in neurosurgical residency training and attitudes regarding sexual orientation and gender identity.MethodsWe conducted a cross-sectional study through a 35-question questionnaire distributed to roughly 1700 residents at all U.S. neurosurgical residency programs.ResultsA total of 107 responses were obtained. Seventeen residents (16%) identified as being an LGBTQ+ individual. The majority (76%) of LGBTQ+ residents were concerned about how their sexual orientation would be perceived while applying to programs, and 47% endorsed purposefully concealing sexual orientation at work for fear of rejection or reprisal. More than half (56%) of those surveyed have witnessed homophobic/transphobic remarks by patients. While at work, 29% of LGBTQ+ individuals stated they are uncomfortable being open with their sexual orientation, and 3 LGBTQ+ individuals admitted being the target of direct homophobic/transphobic comments.ConclusionsThis is the first study to our knowledge that has been conducted assessing the presence, perception, and treatment of LGBTQ+ trainees in neurosurgical residency. Our study outlines the challenges LGBTQ+ individuals face when applying to neurosurgical programs, which involves the perception of their sexual orientation, their witnessed instances of homophobic and transphobic comments by coworkers and patients, and their hesitation with discussing their social lives compared with their non-LGBTQ+ peers at work for fear of judgment or reprisal. Ongoing research is needed to address these issues to obtain workplace respect and fairness in this population and thus create an accepting atmosphere and achieve social justice in neurosurgery training.Copyright © 2024 Elsevier Inc. All rights reserved.

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