Impact of sexual and gender minority (SGM) identity on specialty choice, career trajectory and the physician workforce: a systematic review protocol.

Abstract

Sexual and gender minority (SGM) individuals remain underrepresented across several medical specialties and leadership positions. Training environments in medical school and residency may shape specialty choice and career development for SGM individuals through experiences of discrimination and pressures related to identity disclosure. The literature remains fragmented across stages of training and specialties, limiting understanding of how these factors collectively shape physician workforce composition. We aim to investigate and synthesise the existing literature examining the association between SGM identity and specialty choice, career trajectory and physician workforce outcomes among medical trainees and physicians. This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guideline, and the final review will be reported in accordance with PRISMA 2020. A comprehensive search was conducted in Ovid MEDLINE, Ovid Embase, Ovid APA PsycInfo and Web of Science Core Collection from database inception to March 2026. Eligible studies will include primary empirical research examining SGM medical trainees or physicians. Two reviewers will independently screen studies, extract data and assess risk of bias using design-specific tools: the Critical Appraisal Skills Programme checklist, Newcastle-Ottawa Scale and Mixed Methods Appraisal Tool. Outcomes will include specialty choice, career trajectory, workforce representation, training environment, identity disclosure, discrimination, mentorship and professional well-being. Given anticipated heterogeneity, findings will be synthesised using a structured narrative and thematic approach. At initial protocol submission, the literature search had been completed; study screening had not yet commenced. Ethics approval is not required as this systematic review will use data from previously published studies and will not involve human participants or collection of individual-level data. Findings will be disseminated through peer-reviewed publication and presentations at scientific conferences. CRD420261347745.