The prevalence of lesbian, gay, bisexual, and transgender health education and training in emergency medicine residency programs: Where are we now?

Abstract

Background: Despite identified inequities and disparities in lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) health, past studies have shown little or no education at the medical school or residency level for emergency physicians. With increased focus on health inequities and disparities, we sought to reexamine the status of sexual and gender minority health education in U.S. emergency medicine (EM) residencies. Objectives: Our primary objective was to determine how many EM residencies offer education on LGBTQ+ health. Secondary objectives included the number of actual versus preferred hours of LGBTQ+ training, identification of barriers to providing education, and correlation of education with program demographics. Finally, we compared our current data with past results of our 2013 study. Methods: The initial survey that sought to examine LGBTQ+ training in 2013 was used and sent in 2020 via email to EM programs accredited by the American Council for Graduate Medical Education who had at least one full class of residents in 2019. Reminder emails and a reminder post on the Council of Residency Directors in Emergency Medicine listserv were used to increase participation. Results: A total of 229 programs were eligible, with a 49.3% response rate (113/229).The majority (75%) offered education content on LGBTQ+ health, for a median (IQR) of 2 (1-3) hours and a range of 0 to 22 hours. Respondents preferred more hours of education than offered (median desired hours = 4, IQR = 2-5 hours; p < 0.001). The largest barrier identified was lack of time in curriculum (63%). The majority of programs had known LGBTQ+ faculty and residents. Inclusion and amount of education hours positively correlated with presence of LGBTQ+ faculty or residents; university-and county-based programs were more likely to deliver education content than private groups (p = 0.03). Awareness of known LGBTQ+ residents but not faculty differed by region, but there was no significant difference in actual or preferred content by region. Conclusion:The majority of respondents offer education in sexual and gender minority health, although there remains a gap between actual and preferred hours. This is

Transgender health content in medical education: a theory-guided systematic review of current training practices and implementation barriers & facilitators

“…And while we found that involvement of transgender perspectives in developing and delivering content was beneficial for student learning and part of necessary advocacy work, some authors warn of overburdening people with lived experiences (including transgender students), in particular when experiential knowledge cannot be properly compensated (Bi et al, 2020 ; Biro et al, 2021 ). Finally, there is concern about how to optimize learner gain; currently, no conclusive evidence exists as to which timing, modality, and method of implementation effectively contributes to student learning and clinical outcomes (Altneu et al, 2020 ), while the everyday conditions of graduate, undergraduate and residency programs hinder initial implementation of curricula (Donovan et al, 2021 ; Moll et al, 2021 ). All of this suggests that currently, medical curricula are lagging to take a key role as intervention sites for reducing and eliminating transgender health inequities (Giffort & Underman, 2016 ; Pregnall et al, 2021 ).…”

Experiences of Transgender and Gender Expansive Physicians

“…Despite recent efforts to increase LGBTQIA+ health care training, these endeavors are insufficient—the pathologizing of being TGE and conflation of gender diversity with mental illness were commonly reported by our participants. 17 , 18 , 19 In line with prior literature, educational interventions should target transphobia rather than simply provide informational and/or clinical knowledge. 20 Training programs and institutions should partner with transgender-led organizations that facilitate this education, and the training should span all career stages.…”

Emergency care of LGBTQIA+ patients requires more than understanding the acronym

“…Formal education on the care of LGBTQIA+ persons is inadequate at both the undergraduate medical education level (median 5 h of curriculum) and EM residency level (median 2 h per academic year). [9][10][11] A survey of EM residents reported that 24.6% found it challenging to do a history and physical on LGB patients, and 42.6% on transgender patients. 12 In that same survey, 6% of residents did not agree that…”