Residency Education on Sexual and Gender Minority Health

Abstract

Dermatologists play a significant and multifaceted role in caring for sexual and gender minority (SGM) patients, an expansive population that includes individuals who identify as lesbian, gay, bisexual, asexual, queer, transgender, and gender nonconforming and those with differences in sex development. Multiple social determinants, including stigma and discrimination in health care and a lack of knowledgeable clinicians, have created health inequities for SGM individuals, leading the National Institutes of Health in 2016 to designate SGM individuals as a healthdisparity population. 1,2 Sexual and gender minority patients also face dermatology-specific disparities, ranging from increased rates of skin cancer among sexual minority men to higher rates of human papillomavirus infection among sexual minority women. 3 To provide excellent care for SGM individuals, dermatologists must be able to deliver culturally competent care to SGM individuals with routine dermatologic conditions and address their population-specific health needs. These health needs include, but are not limited to, the screening for and prevention of certain sexually transmitted infections among high-risk SGM individuals, the management of cutaneous effects of gender-affirming hormone therapy, and the use of minimally invasive, gender-affirming procedures. 3,4 In this issue of JAMA Dermatology, Jia and colleagues 5 address a key component of improving clinical care and mitigating health disparities for SGM individuals-dermatology graduate medical education.To our knowledge, this is the first published study of SGMspecific curricula in dermatology residency training. This is an important area of inquiry because, although the Association of American Medical Colleges issued recommendations for the inclusion of SGM health-related content in undergraduate medical education in 2014, 6 implementation of these recommendations has been variable. In 2011, a survey found that students received a median of 5 hours of SGM health-related content in medical school curricula 7 ; as of 2018, medical students continued to report that they received inadequate education in SGM health. 8 A review of the American Academy of Dermatology (AAD) Basic Dermatology Curriculum, an online curriculum used by medical students, found minimal SGM healthrelated content. 9 Thus, residents entering dermatology graduate medical education training may have had little exposure to SGM health-related topics. If we expect future dermatologists to provide culturally and clinically competent care to SGM individuals, we must consider graduate medical education training a critical period to prepare dermatologists to address SGM health.

Barriers to Care Among Sexual and Gender Minority Individuals With Chronic Inflammatory Skin Diseases in the US

“…19 Dermatology residency programs should work to close gaps in SGM education in their curriculum and provide trainees with best practices for caring for SGM patients with CISDs (eg, the use of patient-preferred language, offering treatment options for CISDs that are consistent with the gender-affirming goals of SGM patients who may be transitioning). [20][21][22] Our finding that non-Hispanic White SGM women with CISDs, but not non-Hispanic Black or Hispanic/Latino non-SGM women, were significantly more likely than non-Hispanic White non-SGM women to report not always being treated with respect by health care practitioners could reflect how SGM status is not outwardly apparent to practitioners like race and ethnicity may be; this finding underscores the need for the routine collection and reassessment of sexual orientation, gender identity, and pronoun information in addition to racial and ethnic identity data. 23 By universally collecting this demographic information from all patients and taking the time to better understand the unique background, values, and goals of each of their patients, dermatologists can be better prepared to provide culturally responsive care to SGM patients with CISDs.…”

“…A 2020 survey of US dermatology residency programs showed that 46% of programs have 0 hours of SGM education in their curriculum . Dermatology residency programs should work to close gaps in SGM education in their curriculum and provide trainees with best practices for caring for SGM patients with CISDs (eg, the use of patient-preferred language, offering treatment options for CISDs that are consistent with the gender-affirming goals of SGM patients who may be transitioning) …”

Evaluating Participation in Gender-Affirming Care: Cross-Sectional Analysis of Dermatology Program Websites in the United States

“…Dermatologists play a pivotal role addressing these needs and providing services for gender-affirming care (GAC), such as laser hair removal, management of androgenetic alopecia, injectable neurotoxins, or soft tissue augmentation. To ensure culturally competent care, dermatology residency programs should provide/promote didactic and experiential training tailored to the health needs of TGD patients [ 2 ]. Additionally, prospective residents may benefit from being able to ascertain whether certain programs are involved in GAC, including education and research.…”