Publications and Posters

Introduction: This standardized-patient-based module prepares medical students to take inclusive, comprehensive sexual histories from patients of all sexual orientations and gender identities. Health disparities faced by lesbian, gay, bisexual, transgender, and queer (LGBTQ) people are at least partially the result of inadequate access to health care and insufficient provider training. This module incorporates implicit bias activities to emphasize the important role providers can play in mitigating these disparities through compassionate, competent care. Furthermore, two of the three included cases highlight the negative impact sexual dysfunction can have on emotional well-being. Methods: Over 3 hours, students participate in a 30-minute large-group lecture and three 40-minute small-group standardized patient encounters with debrief. Prework consists of a short video on sexual history taking, assigned readings, and an implicit bias activity. These materials are included in this resource, along with lecture slides, facilitator guide, and standardized patient cases. Though the cases are adaptable to all levels of medical education, this module is designed for second-year and early third-year medical students. Results: Qualitative student evaluations were positive, and postparticipation surveys revealed statistically significant improvement in comfort with their ability to take a sexual history in general, and take one from patients with a differing sexual orientation. Deployed in the second year of our Doctoring curriculum, this module continues to receive positive evaluations. Discussion: Introducing these skills begins to address the curricular deficiencies seen across medical education and lays the foundation for a more competent health care workforce to address the needs of LGBTQ patients.

The release of the AAMC curriculum guidelines pertaining to people who are LGBT, gender nonconforming, or born with differences of sex development (DSD) in 2014 significantly enhanced medical schools’ ability to implement curricular change. At our institution, we began this process with the goal of making it as trainee-driven as possible. Though our curricular reform coalition initially consisted only of students and faculty from the School of Medicine, we have expanded to include students, residents, and faculty members, as well as trainees from other health sciences programs, including pharmacy and nursing. We have structured our efforts around the “salt and pepper” approach: incorporating small changes wherever possible to move the curriculum from heteronormative to LGBTQ-inclusive, e.g. modification of existing sexual history taking curriculum to include LGBTQ facets and appropriate reflective exercises. A needs assessment targeting one cohort of medical students informed our process. Aside from our primary goal of improving healthcare for LGBTQ people, we believe our process yields important educational and institutional benefits. Through participating in and leading our efforts, trainees are prepared to become leaders in academic medicine by practicing foundational skills including communication, coalition formation, and interprofessional collaboration. Further, trainees have presented posters, contributed to a submission being prepared for MedEdPortal, attended BNGAP conferences, and presented findings to our school’s curriculum committee. Finally, by involving people from multiple programs at every level of education, we have created a deeply-rooted collaborative that can function to provide curricular-reform resources to educators across the health sciences. This poster details our efforts with special emphasis on recruitment and involvement of trainees and interdisciplinary outreach.

The lesbian, gay, bisexual, transgender, and queer (LGBTQ) community is a diverse group that, despite recent progress, continues to face health disparities. With 3.4% of US adults identifying as LGBTQ, healthcare providers have a duty to recognize their unique needs [1]. Negative outcomes are as diverse as the community, ranging from young gay men being twice as likely to be hypertensive as their straight peers [2] to lesbian women receiving very rare or no cervical cancer screening [3]. The 2011 Institute of Medicine report on LGBTQ health identified lack of provider knowledge as one of the foremost barriers to ameliorating these disparities [4]. Furthermore, provider ignorance of LGBTQ health issues has shown to result in a negative patient experience, possibly delaying care seeking behavior [4, 5, 6].

Previous studies have shown that enhancing LGBTQ medical education has positively shaped medical students’ knowledge, attitudes and clinical skills [7, 8]. However, like most other medical schools, the University of New Mexico School of Medicine (UNMSOM) has had difficulty creating and integrating curricula around LGBTQ health, with only three hours of dedicated time versus the national median of five [9].

The assessment and intervention described below were important aspects of our continued efforts to improve sexual and gender minority health at UNMSOM. Though it is known that LGBTQ topics should be integrated into medical school curricula, we had limited data regarding the baseline knowledge and receptiveness of our institution’s third-year medical students transitioning into the clinical clerkships. To begin to fill this gap, we developed a novel assessment tool and lecture which are mapped to the LGBTQ competencies released by the AAMC in 2014 [10]. Our goals in the session were: (1) to better understand medical students’ attitudes and knowledge of terminology, basic diagnosis and management, screening and prevention, sexual history taking, and counseling; and (2) to provide students with a foundational knowledge of sexual orientation and gender identity before they entered the clerkship year.

The session took place in a 1-hour block during Transitions, which is a 4-week course at UNMSOM designed to “transition” rising third year medical students into clinical medicine. There were 79 total participants. 43 identified as female, 35 as male, and 1 declined to identify. Most were 21-25 (n=38) or 26-30 (n=35) years of age; 4 participants were 31-40 and 2 were 40+.

Our intervention was twofold, involving (1) an attitude/knowledge survey and (2) a focused mini lecture. In addition to demographic fields, the survey component contained a set of 14 vignette-style knowledge questions written to correspond to high-priority AAMC competencies [10]. We also included 15 attitudinal questions, 13 of which were previously administered to the same class during their first year in medical school.

Following the survey, we provided the students a handout containing a series of clinical vignettes similar to questions presented in the survey. Facilitators then discussed these vignettes using the Socratic method. Following each vignette, we gave a short didactic lesson. Topics addressed included common terms and definitions (difference between sexuality, gender, and gender expression), LGBTQ health issues (depression and preventive health), and how to open a conversation with your patients about sexuality and gender.

Two primary outcome measures were identified for the session. The first, and most important for our ongoing efforts, is the knowledge assessment. The average score was 60.8% which, when broken down by competency mappings, will help us target our curricular interventions. For example, when presented with a vignette depicting a patient with multiple identities, i.e. transgender man who has sex with men, only 30% were able to correctly identify sexual orientation. The second, a comparison of attitudinal questions administered during year 1, will yield insight into the effects of medical education on students’ perception of LGBTQ people.

Our data suggest that a primary barrier to medical students’ understanding of the identities and medical concerns of LGBTQ people is learners’ comprehension of sexual orientation and gender identity and the terminology that describes these entities. Mastery of these concepts is crucial to understand how sexual orientation and gender identity affect healthcare delivery. Based on the results of this assessment, we have redirected our efforts to better integrate this information in the preclinical years so that students are better prepared to learn more advanced topics e.g., how LGBTQ status affects prevention, diagnosis, and management.

Citations