Educating Physicians for Competence in Caring for LGBTQ+ Patients

Abstract

P atients who identify as lesbian, gay, bisexual, transgender, queer/questioning, and others (LGBTQ+) are less likely than their heterosexual or cisgender peers to receive appropriate medical care and more likely to experience bias and discrimination in healthcare settings. 1,2 Consequently, negative experiences with healthcare providers may discourage LGBTQ+ patients from seeking care and prevent treatment or management of health concerns. 3 Many physicians are reluctant to discuss sexual orientation or gender identity with their patients, and surveys of medical students reveal a lack of knowledge about LGBTQ+ health. [4][5][6] Postgraduate training programs have been developed to train physicians interested in subspecializing in LGBTQ+ health care. 7 Addressing physician bias and lack of knowledge must begin during undergraduate medical education to ensure that physicians across all specialties are equipped to provide culturally competent care to this patient population. In recent years, medical schools have revised their curricula to systematically educate students on topics related to LGBTQ+ health. 8 To fulfill the potential of these curricular changes, we argue that evaluation strategies must move beyond assessing gains in knowledge or confidence and focus on replicable assessment of competence in caring for LGBTQ+ patients.Prior research has typically paired education on LGBTQ+ health with knowledge-based assessments administered in fixed-choice format. [9][10][11] Test-based assessments may be preferred because of the low cost of administration and ease of measuring gains in knowledge after education. 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 From the