Our simple curricular intervention led to significant short-term changes in a small number of survey items assessing students' knowledge and beliefs about LGBT persons.

Little is known about the experiences of lesbian, gay, bisexual, and transgender (LGBT) physicians in the workplace. There is little formal education in medical school about LGBT issues, and some heterosexual physicians have negative attitudes about caring for LGBT patients or working with LGBT coworkers, setting the stage for an exclusive and unwelcoming workplace. The current study used an online survey to assess a convenience sample of 427 LGBT physicians from a database of a national LGBT healthcare organization, as well as a snowball sample generated from the members of the database. Although rates of discriminatory behaviors had decreased since earlier reports, 10% reported that they were denied referrals from heterosexual colleagues, 15% had been harassed by a colleague, 22% had been socially ostracized, 65% had heard derogatory comments about LGBT individuals, 34% had witnessed discriminatory care of an LGBT patient, 36% had witnessed disrespect toward an LGBT patient's partner, and 27% had witnessed discriminatory treatment of an LGBT coworker. Few had received any formal education on LGBT issues in medical school or residency. It appears that medical schools and health care workplaces continue to ignore LGBT issues and operate in discriminatory fashion far too often.

In 2005, medical educators at the University of California, San Francisco (UCSF), began developing the Parnassus Integrated Student Clinical Experiences (PISCES) program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants' career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center.

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To support and sustain the reward of LIC teaching for faculty, LIC developers should focus on targeted faculty development and resource allocation to clinical teaching.