Improving the Health Care of the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community through Medical Education

By Kristen Eckstrand

Ten years ago, at age 18, I went to the doctor to discuss recent struggles with depression. She listened intently and nodded her head in understanding as I characterized my persistent feelings of sadness, guilt, and inadequacy. She asked questions, yet I felt separated from her because I was holding back. Wanting her to understand the entirety of my situation, I confided in her my secret: I am gay. My doctor grew cold and silent, and as she stiffened in her chair she suggested I seek religious — not medical — care. As I left the office without receiving the care every patient deserves, I became part of the majority within sexual and gender minorities: those who have been discriminated against by the health care system.

The health disparities and unique health needs of the lesbian, gay, bisexual, and transgender (LGBT) community have commanded the attention of national medical organizations. Yet as the need for comprehensive provider knowledge, skills, and attitudes surrounding LGBT health is becoming increasingly clear, so is the need for curricular development.

The concealed nature of sexual orientation and gender identity can make the LGBT community a “hidden minority.” Omitting LGBT content from medical curricula parallels that societal invisibility. We are excluding by not including, and patients are suffering as a result. Numerous barriers exist: limited instructional time, a lack of educator comfort and professional development, and no validated teaching tools. But understanding these barriers as hurdles to be overcome can help channel our energy into specific areas for curricular improvement.

Integrating LGBT Content into Medical Curricula

The addition of new material to an already-dense curriculum may seem cumbersome, but LGBT patient care can be directly improved with even small educational initiatives. Medical schools tackle LGBT content integration via three routes: full curriculum inclusion, an extracurricular elective, and/or an independent certificate program. While no recommendations exist on what content should be included, at minimum curricula should reflect the health topics that disproportionately affect, and the clinical skills required to care for, the LGBT population. These can be easily integrated as epidemiology and health outcomes information into existing lectures, and the Fenway Institute teaching modules can be used for content-specific lectures. Sexual orientation, gender identity, and any appropriate counseling should be included in patient cases to provide valuable clinical experience.

Teaching the Teachers

Faculty play a vital role in teaching the knowledge, skills, and attitudes required of future physicians, yet many feel unprepared to teach the core aspects of LGBT health. Like medical curricula, there are no models for faculty development in LGBT health, but in addition to the key LGBT health disparities, programs should focus on the language and attitudes necessary to disseminate LGBT information. Such content is available, and institutions should consider partnering with field experts and national LGBT education organizations to ensure content inclusion.

Program Development and Evaluation

Validated teaching tools for trainees and faculty in LGBT health are currently unavailable and in high demand. Research on implemented educational initiatives must evaluate program impact on preparing medical professionals to care for LGBT patients. Given the infancy of the field, all programs are valuable; supporting student participation in research increases the pace of successful program development. Indeed, students have been the driving force behind the integration of LGBT content into curriculum at several medical schools.

Despite the blame and isolation I experienced a decade ago, I am lucky. Unlike others in my community, I have access to health care. I don’t delay or avoid care for fear of bias and discrimination. I understand the unique needs of the LGBT population and can advocate for my care. My life will not be cut short as a result of the disproportionate health outcomes in my community. And I hope that, through education across the medical system, we can improve LGBT patient care so that I am again one of the majority within sexual and gender minorities: those who experience high-quality and comprehensive health care.

—Kristen Eckstrand is an MD/PhD Candidate, 2016, at the Vanderbilt University School of Medicine. She can be reached at kristen.l.eckstrand@vanderbilt.edu.

The AAMC is leading an initiative to identify key competencies and educational best practices to ensure medical students master the knowledge, skills, and attitudes necessary to provide excellent, comprehensive care for Lesbian, Gay, Bisexual, Transgender, and Intersex (LGBTI) patients. To this end, the AAMC is convening an LGBTI Patient Care Advisory Committee to support and advise its efforts to identify, publish, and disseminate best practices in communications training, faculty development strategies, and curricular content on the specific health needs of LGBTI populations. Stay tuned for more up-to-date information regarding this initiative.

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2 Responses to Improving the Health Care of the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community through Medical Education

  1. Tracey Rickards RN PhD (c) says:

    I am really pleased to see this blog. I am the only ‘out’ lesbian in the Faculty of Nursing at the University of New Brunswick, Fredericton Campus in Canada. I make it a point to include some element of LBGT education in whichever course I am teaching, regardless of whether it is a theory or clinical focus. I think that it is immensely important that we bring this material into class, it helps to normalize the need for appropriate healthcare for ALL regardless of whatever label is attached to the client/patient. It is not always easy to get some of the very innocent and frequently unaware students to take a minute and consider the challenges faced by populations who have experienced stigma and marginalization. The rewards though are great. When a student comes to me and thanks me for including that content in the lecture or when I see the positive impact of this information being put into practice I know that my efforts are not going unnoticed. Keep it up!

  2. Juan says:

    Mosaic DaveDavey, I feel almost trite sainyg this but your post, today, holds great significance for me. I realise what a poor fit my corporate job is for my life and vice versa. I’ve always believed (and continue to do so) that God will provide. I love the idea of actually codifying what I agree to do and what I believe He will provide me. Thank you for this.What I will do:I will build my practice as a personal coach and counsellor. I will help people to get in touch with their values, beliefs, goals and dreams and to design your lives in ways that honour those things. I will touch the hearts and souls of however many people I can with my voice and the beautiful music that so many great composers have given me. I will live my life on purpose and with intention.What the universe will do:Keep food in my fridge, medicine in my cabinet, gas in my tank and a roof over my head.

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