Affirming and Inclusive Care Training for Medical Students and Residents to Reduce Health Disparities Experienced by Sexual and Gender Minorities: A Systematic Review

Abstract

Purpose: Providing inclusive and comprehensive gender-affirming care is critical to reducing health disparities (gaps in care) experienced by sexual and gender minorities (SGM). Currently, little is known about how medical students and residents are being trained to address the health needs of SGM persons or of the most effective methods. Methods: We conducted a systematic review of the research literature from 2000 to 2020 on the effectiveness of teaching medical students and residents on knowledge, attitudes, and skills in addressing the health of SGM persons and the strength of the research sample, design, and methods used. Results: We identified a total of 36 articles that assessed the impact of medical student and resident education on knowledge, comfort, attitudes, confidence, and skills in working with SGM patients. All studies utilized quasi-experimental designs, and found efficacious results. No study examined the impact of training on patient outcomes. Conclusion: Future studies will need to be powered and designed to assess the impact of training on patient outcomes.

Transforming Medical Education to Provide Gender-Affirming Care for Transgender and Gender-Diverse Patients: A Policy Brief

“…Out of 27,090 articles screened and subjected to various inclusion and exclusion criteria and full-text review, 36 articles had educational intervention components that focused on transgender, gender-diverse, and gender-nonconforming care and medical students and/or residents. 17 All of the studies were qualitative studies having quasi-experimental and preexperimental (theoretical) designs. The majority focused on medical student training, with few including residents.…”

Curricular Interventions in Medical Schools: Maximizing Community Engagement Through Communities of Practice

“…The CoP conducted a systematic review of the literature on each research topic to identify how medical schools in United States have addressed the topics in their educational curriculum and to identify the effectiveness of educational programs in addressing the needs of LGBTQ patients, people experiencing homelessness, and migrant farm workers on a series of topics, including: medical student/physician implicit bias, 44 interpersonal violence, 45 adverse childhood experiences, 46 opioid use, 47 pre-exposure prophylaxis, 48 affirming and inclusive care. 30 As part of our systematic reviews, we conducted searches of online databases (eg, MEDLINE/ PubMed, PsycINFO, Web of Science, Scopus, Ingenta, Science Direct, and Google Scholar) for original articles published in English and collected various study characteristics, including sample, study design, program format, program target, and pertinent outcomes. Effectiveness of interventions included those that increased knowledge about the health care needs of each of the 3 vulnerable populations, promoted positive attitudes toward them, increased comfort in working with them, and/or resulted in behavioral change.…”

“…29 Recent technological innovations in the communications sector have created new opportunities for online collaboration that allow individuals to meet in a virtual setting, eliminating geographical barriers (time zones notwithstanding) and transforming the traditional CoP into a virtual CoP (VCoP). Recent results of our own comprehensive review of literature of the successes of VCoP, 30 and a web-based survey of health care providers, 2 found satisfaction with the quality of shared knowledge, operations, and service provided by VCoP.…”

Educating Physicians for Competence in Caring for LGBTQ+ Patients

“…Assessing medical students in clinical skills related to LGBTQ+ health—and not only on knowledge or self-reported competence—could better prepare students to address the persistent disparities in health and medical care that affect LGBTQ+ patients 13 . A recent review of 36 medical education interventions related to LGBTQ+ health found that only six included any assessment of skills, and typically only through self-report 14 . This gap in assessment can be filled by objective structured clinical examinations (OSCEs), which offer an opportunity to conduct performance-based evaluation of medical student competency in caring for LGBTQ+ patients, starting during the preclinical years 15 .…”

“…13 A recent review of 36 medical education interventions related to LGBTQ+ health found that only six included any assessment of skills, and typically only through self-report. 14 This gap in assessment can be filled by objective structured clinical examinations (OSCEs), which offer an opportunity to conduct performance-based evaluation of medical student competency in caring for LGBTQ+ patients, starting during the preclinical years. 15 OSCEs also can provide structured exposure to LGBTQ+ health issues in clinical settings, especially when schools are limited in ensuring students' structured, planned clinical exposure to patients who identify as LGBTQ+.…”