Bridging the Gap in Graduate Medical Education: A Longitudinal Pediatric Lesbian, Gay, Bisexual, Transgender, Queer/Questioning Health Curriculum

Educating Physicians for Competence in Caring for LGBTQ+ Patients

“…For example, a series of lectures and group discussions increased the knowledge of LGBTQ+ terminology among preclinical medical students, 9 and a single lecture increased medical students’ self-reported ability to describe health concerns often encountered by LGBTQ+ patients 10 . Similar improvements in knowledge were reported after other educational interventions, including single lectures, problem-based learning cases, and integrated grand rounds combining lectures with patient interviews and group discussions 11,12 . Although these results are encouraging, an important limitation of knowledge-based evaluation is that increasing learner knowledge may not reliably change clinical practice.…”

“…reported after other educational interventions, including single lectures, problem-based learning cases, and integrated grand rounds combining lectures with patient interviews and group discussions. 11,12 Although these results are encouraging, an important limitation of knowledge-based evaluation is that increasing learner knowledge may not reliably change clinical practice. For example, following a year-long curriculum on LGBTQ+ health, residents in one program reported increased knowledge and high intent to change practice, but many continued to infrequently ask patients about sexual orientation, specific sexual practices, and gender identity.…”

“…These include limitations surrounding the involvement of medical school faculty (both clinical faculty and faculty teaching in the foundational curriculum), prior experience among some faculty in teaching topics related to LGBTQ+ health, and time available in the curriculum. 8,9,12 Organizational policies and culture may pose a further barrier, because faculty may find themselves teaching the skills needed to treat LGBTQ+ patients while working in a healthcare system that remains structurally heterocentric and ciscentric. 4 Ideally, students would demonstrate these skills in real or simulated clinical settings; however, there may be limited opportunities for students to gain experience in clinics dedicated to LGBTQ+ health care, and the costs of coordinating clinical exposure in these settings may be prohibitive.…”

“…Although these results are encouraging, an important limitation of knowledge-based evaluation is that increasing learner knowledge may not reliably change clinical practice. For example, following a year-long curriculum on LGBTQ+ health, residents in one program reported increased knowledge and high intent to change practice, but many continued to infrequently ask patients about sexual orientation, specific sexual practices, and gender identity 12 . Paper-based case examples may unintentionally reinforce negative stereotypes of LGBTQ+ patients and fail to develop in providers clinical skills to the same extent as live encounters.…”

“…Achieving these goals will require overcoming a range of barriers. These include limitations surrounding the involvement of medical school faculty (both clinical faculty and faculty teaching in the foundational curriculum), prior experience among some faculty in teaching topics related to LGBTQ+ health, and time available in the curriculum 8,9,12 . Organizational policies and culture may pose a further barrier, because faculty may find themselves teaching the skills needed to treat LGBTQ+ patients while working in a healthcare system that remains structurally heterocentric and ciscentric 4 .…”