Clinical competence and attitudes towards LGBT patients among medical residents in Japan

BACKGROUND: Sexual and gender minorities face persistent health disparities, partly due to the limited competence of healthcare providers in LGBT-inclusive care. Although education can improve these skills, little is known about LGBT-related competence in non-Western contexts such as Japan, where LGBT health content is scarcely integrated into medical curricula and visibility remains limited. METHODS: We conducted a nationwide cross-sectional study of postgraduate year-1 (PGY-1) residents in Japan from April to May 2025. The sampling frame comprised examinees of the GM-ITE administered at the start of PGY-1 training at participating training hospitals. Competence was assessed using the Japanese version of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale, which comprises four subscales: Attitudinal Awareness, Basic Knowledge, Clinical Preparedness, and Clinical Training. Demographic and institutional factors were examined using univariable and multivariable linear regression. RESULTS: Of 748 eligible residents, 280 completed the survey (response rate: 37.4%). Nearly half reported no LGBT-related education during medical school, and over 80% reported none during residency. The mean overall score on a 1–7 scale was 4.0, with higher scores for Attitudinal Awareness (5.3) than for Basic Knowledge (3.9), Clinical Preparedness (2.5), or Clinical Training (2.3). Female residents scored higher than male residents (β = 0.30, 95% CI: 0.15–0.45). Training in university or urban hospitals and older age were linked to higher preparedness and training scores. CONCLUSIONS: Among Japanese PGY-1 residents, LGBT-related clinical competence was moderate, with supportive attitudes but limited knowledge and preparedness. Scores were lower than those reported in Western studies, reflecting the limited integration of LGBT health into curricula. Structured LGBT education across medical training is needed to reduce disparities and promote inclusive care in Japan.