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 firstname.lastname@example.org.