Out in the Match

OBJECTIVE: To explore LGBTQ+ general surgery resident experiences during the Match process. SUMMARY BACKGROUND DATA: General surgery (GS) applicants negotiate the residency match process through the lens of their identities, but little is known about LGBTQ+ applicant experiences. This study explored how current LGBTQ+-GS residents navigated their identity and evaluated programs for psychological safety and belonging during the Match. METHODS: This qualitative study utilized semistructured interviews with current US LGBTQ+-GS residents recruited using purposive and snowball sampling from Oct to Dec 2025. Interviews focused on LGBTQ+ identity, experiences throughout medical school, recruitment, and residency, and how psychological safety was assessed. Interviews were audio-recorded, transcribed verbatim, and analyzed using a deductive-inductive approach to identify themes. RESULTS: Of 17 participants, mean age was 30.7±1.8 years, and most identified as male (52.9%) and White (76.5%). Five themes were identified: (1) Participants strategically disclosed identity: disclosing as a "litmus test" to filter for identity-affirming programs or concealing identity in fear "that's the reason why I don't get ranked." (2) Participants relied on subtle micro-signals to indicate psychological safety (eg, pronouns, pride symbols). (3) Participants scrutinized the manner and tone of responses to LGBTQ+-related questions in addition to the content. (4) Representation of LGBTQ+ residents/faculty reduced belonging uncertainty. (5) Participants "used geography as a proxy for acceptance," weighing regional sociopolitical climates when assessing their potential to thrive. CONCLUSIONS: LGBTQ+ trainees assessed a variety of micro- and macro-signals to evaluate residency programs. Residency programs can design their programs around these signals to enhance recruitment of LGBTQ+-GS applicants.