Key Points Question Is there an association between sexual orientation and burnout among US medical students, and is this association mediated by experiences of mistreatment? Findings Cross-sectional surveys of 2016 and 2017 graduating US medical students showed significantly higher rates of perceived mistreatment and burnout symptoms among lesbian, gay, or bisexual (LGB) medical students compared with heterosexual students. Perceived experiences of mistreatment mediated the association between LGB sexual orientation and burnout but did not completely account for excess burnout reported by LGB students. Meaning The findings of this study suggest that medical students in sexual minority groups report increased symptoms of burnout regardless of their perceived experiences of mistreatment.

The World Health Organization has identified many barriers to improving the health of lesbian, gay, bisexual, and transgender (LGBT) patients, including challenges to incorporating and teaching about healthcare for such patients, which we call "sexual and gender minority" (SGM) health content. These challenges include structural and logistical barriers to incorporating SGM health content into undergraduate medical curricula, as well as lack of support in identifying high-quality pedagogical methods for teaching this material. Here, we provide twelve tips for incorporating and teaching SGM health curricular content in undergraduate medical education, including resources and strategies to support individual educators. Based on our success in developing and implementing this content, we believe that our approach can be effectively used by individual educators aiming to incorporate SGM health curricular material into their teaching, and to support individuals or groups championing the inclusion of a SGM health topical sequence in medical curricula.

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Background The boxed warning (also known as ‘black box warning [BBW]’) is one of the strongest drug safety actions that the U.S. Food & Drug Administration (FDA) can implement, and often warns of serious risks. The objective of this study was to comprehensively characterize BBWs issued for drugs after FDA approval. Methods We identified all post-marketing BBWs from January 2008 through June 2015 listed on FDA’s MedWatch and Drug Safety Communications websites. We used each drug’s prescribing information to classify its BBW as new, major update to a preexisting BBW, or minor update. We then characterized these BBWs with respect to pre-specified BBW-specific and drug-specific features. Results There were 111 BBWs issued to drugs on the US market, of which 29% (n = 32) were new BBWs, 32% (n = 35) were major updates, and 40% (n = 44) were minor updates. New BBWs and major updates were most commonly issued for death (51%) and cardiovascular risk (27%). The new BBWs and major updates impacted 200 drug formulations over the study period, of which 64% were expected to be used chronically and 58% had available alternatives without a BBW. Conclusions New BBWs and incremental updates to existing BBWs are frequently added to drug labels after regulatory approval.

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