Unbinaried at Yale — looking back

I came to Yale in September of 2015, and graduated in December of 2018 from the dual physician assistant and public health master’s program.

I was one of the first students with non-binary gender in the official student record (both at Yale as a whole and at Yale School of Medicine), one of the first patients at the Yale-New Haven Hospital (YNHH) with non-binary gender in the medical record, and one of the first medical professional students of openly non-binary gender at the roughly dozen hospital departments and private practices in Connecticut where I did my clinical training.

And it was okay.

For context, my non-binary gender presentation is primarily visible in the way I dress (I typically wear skirts and turtlenecks) and the way I accessorize (I carry a purse). This is one of my casual looks:

The students, staff and the faculty at the Yale School of Public Health (YSPH), and the on-campus Yale Physician Associate Program at the Yale School of Medicine (YSM) did not challenge my gender presentation, and were open to feedback when they misgendered me.

I helped them navigate gendering and misgendering by carrying wallet cards that I could hand out (and hand them out I did). The cards summarized actionable aspects of my gender, and linked to a web page that covered more philosophical aspects of my gender. This is what the card looks like:

The registrar at YSPH readily updated my student record when I so requested, and the (few) resulting paperwork problems were taken care of without judgement.

At the PA program, our clinical site coordinator and I discussed in advance issues that might arise during my clinical training, and how to handle them. I walked away from that conversation with the impression the PA program had my back on this matter.

Most of the clinical staff at my training sites (both in and out of hospital) were receptive of my gender presentation, and some expressed contextually appropriate curiosity about it. I handed out more of the wallet cards to my clinical preceptors, and they were generally well-received.

The department in which I felt the least at ease with gender was obstetrics and gynecology. To be fair, ob/gyn is historically a women-only space (on the patients’ side), and gender inclusivity in such spaces today presents special challenges. While it is exciting that YSM and YNHH are making great progress in gender inclusivity, the ob/gyn department has additional cultural challenges to overcome — and it shows.

When I first approached the medical records department at YNHH about updating my medical record to reflect my non-binary gender, I was disappointed to find out that there was no way to do that, but reassured that it was being worked on.

I wasn’t sure how much hope to put in it being worked on — academic medicine and large hospitals aren’t exactly known for rapid change. I was thus pleasantly surprised when, roughly a year later, gender identity (as separate from legal sex) was prominently added to all our medical records, together with information about patients’ pronouns. Soon, gender markers will be removed from hospital identification bracelets.

When I revisited the medical records department, I learned my medical record had already been updated; someone did it proactively based on (I gather) our conversation a year prior. ⭐️

I was involved in orientation week inclusivity training at YSPH. I was also invited to speak on several panel discussions about gender and inclusivity (one for first-year MD students at YSM, one at a queer health conference at YSM, and two for physicians-in-training at YNHH). These were pivotal in helping me overcome my impostor syndrome, and led to feel not only welcome, but appreciated and respected for who I am.

Only a few patients commented on my manner of dress, and by the time that they did, I had enough experience casually responding to such comments that it did not present an obstacle to either my training or their care.

Several patients told me they were not comfortable with me, but none of them referred to my gender expression as the reason (most of them told me they didn’t want to be seen by a student). A few patients made it clear to me that they were more comfortable with me because of my gender presentation.

The year of my graduation, Yale held its first lavender graduation, and it was the only academic celebration at which I felt truly at home.

I do have massive amounts of countervailing privilege; I am white, well-educated, well-off, well-spoken, assertive, and typically misinterpreted as male. All of those things mean that people are generally not prone to laughing me out of a room, or dismissing me when I speak.

My ability to be visible in front of peers, educators, and patients for the last few years does not mean that other non-binary people would be given the same support. However, I can confidently say that Yale, YSM, YSPH, and YNHH are ahead of most when it comes to trans and non-binary inclusivity for students at large, medical professional students, clinicians, and patients.

While there were many aspects of my PA education at Yale that fell embarrassingly short of Yale’s aspiration towards excellence in education, being affirmed in my gender (both as a student and as a healthcare professional) was life-changing for me.

When people ask me whether they should attend Yale’s on-campus PA program, I find it very difficult to honestly recommend it. But if you’re trans or non-binary and considering either the PA or the MD program at YSM, my take is much simpler: it won’t be perfect, but it will be okay — and that’s head and shoulders above most other schools.