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Blaszczak J, Wiener S, Plegue M, Shumer D, Shatzer J, Hernandez A. Evaluating the effectiveness of an online curriculum on caring for transgender and nonbinary patients. MEDICAL EDUCATION ONLINE 2024; 29:2311481. [PMID: 38320110 PMCID: PMC10848997 DOI: 10.1080/10872981.2024.2311481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND AND OBJECTIVES It is well established that provider lack of knowledge in the field of transgender and nonbinary health is as ignificant barrier to care and that training in this area is lacking. This study examined how family medicine residents' self-confidence and medical knowledge in providing gender-affirming care changed after completing a novel, online curriculum on transgender and nonbinary care. METHODS Thirty-nine family medicine residents were invited to complete the curriculum. Change inself-confidence was determined by the difference in scores on a Likert scale on a pre- and post-survey. Change in medical knowledge was assessed by examining the difference between pre- and post-test scores on a novel multiple-choice examination. RESULTS Only 7% of current residents agreed that their current training is adequate in order to provide comprehensive primary care to transgender and nonbinary people. After completion of the curriculum, 100% of participants felt at least somewhat confident providing primary care to transgender and nonbinary people, including hormone therapy. Average medical knowledge post-test scores trended higher than the pre-test results (mean (SD) at pre = 11.2 (1.4) vs post = 14.6 (2.8)). CONCLUSIONS An online, self-directed curriculum on caring for transgender and nonbinary patients in the primary care setting, including management of gender-affirming hormone therapy, has the potential to increase confidence and knowledge in this field, decreasing barriers to care for this population.
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Affiliation(s)
- Julie Blaszczak
- Department of Family Medicine University of Michigan, Ann Arbor, MI, USA
| | - Sara Wiener
- Department of Organizational Learning University of Michigan, Ann Arbor, MI, USA
| | - Melissa Plegue
- Department of Family Medicine University of Michigan, Ann Arbor, MI, USA
| | - Dan Shumer
- Department of Pediatric Endocrinology University of Michigan, Ann Arbor, MI, USA
| | - John Shatzer
- School of Education Johns Hopkins, Baltimore, MD, USA
| | - Anita Hernandez
- Department of Family Medicine University of Michigan, Ann Arbor, MI, USA
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Crowe A, Hogan P, Morrison C, Meads C, Bailey D. Towards inclusive healthcare: evaluating knowledge, confidence and awareness of LGBTQ + health among Internal Medicine Trainees in London. BMC MEDICAL EDUCATION 2024; 24:851. [PMID: 39112977 PMCID: PMC11308546 DOI: 10.1186/s12909-024-05827-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 07/26/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Patients from the lesbian, gay, bisexual, transgender, queer plus (LGBTQ +) community face various health inequalities and report poor healthcare experiences. Little is known about how knowledgeable and confident UK doctors are around LGBTQ + health, and previous research demonstrates that UK medical schools rarely deliver teaching in this area. This research evaluated the level of knowledge, awareness and confidence of LGBTQ + health among Internal Medical Trainees (IMTs) in London. METHODS London IMTs were invited to complete an online questionnaire evaluating knowledge, awareness and confidence in LGBTQ + health. Stratified analysis of results by demographics was performed. RESULTS Three hundred and fifteen surveys were analysed from 796 eligible trainees (40%). Confidence in caring for LGBTQ + patients was variable. Confidence in discussing gender identity was lower than for sexual orientation. Knowledge of health issues affecting LGBTQ + patients varied. Most participants had never received training on LGBTQ + health at undergraduate (n = 201, 64%) or postgraduate level (n = 252, 80%), but the majority of participants felt that training would be useful (n = 233, 74%). Stratified analysis revealed that IMTs who received previous LGBTQ + teaching at undergraduate or postgraduate level were considerably more confident discussing sexual orientation with patients, compared to those who received no previous teaching. CONCLUSIONS There is a clear need for education on LGBTQ + health, given the varied levels of knowledge and confidence identified. A significant majority of IMTs in London have never received teaching on LGBTQ + health, although there exists a strong desire for this. LGBTQ + health topics should be integrated into undergraduate and postgraduate training and examinations for IMTs. This would support IMTs in delivering high quality and inclusive care for all patients, particularly those of sexual orientation and gender identity minorities. There are relatively few published studies exploring competency in LGBTQ + health among doctors, and this is the first among UK Internal Medicine Trainees.
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Affiliation(s)
- Andrew Crowe
- Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK.
| | - Patrick Hogan
- St Pancras Hospital, Central and North West London NHS Foundation Trust, London, UK
| | | | - Catherine Meads
- Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Daniel Bailey
- Kings College Hospital NHS Foundation Trust, London, UK
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3
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Roth LT, Carpenter P, Schwartz A, Lurie B. A National Survey to Assess LGBTQ+ Curricular Needs in Pediatrics Residency Programs. Acad Pediatr 2024:S1876-2859(24)00285-7. [PMID: 39098599 DOI: 10.1016/j.acap.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/23/2024] [Accepted: 07/28/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE Despite incremental increases in lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) health education, there are no uniform training requirements in graduate medical education and the extent to which pediatrics residency programs incorporate LGBTQ+ curricula remains unknown. We aimed to assess the current state of LGBTQ+ health education in pediatrics residency programs. METHODS We surveyed all 202 Accreditation Council for Graduate Medical Education (ACGME)-accredited categorical pediatrics program directors (PDs) in the United States. PDs were contacted via the Association for Pediatrics Program Directors (APPD) listserv with a link to an anonymous electronic survey. RESULTS We had a 53.4% response rate (107/202) with representation from all regions, sizes, and settings. Only 7.5% of programs have robust LGBTQ+ curricula, but many (71%) offer some sessions. About half (54.2%) believe their residents are not at all or somewhat prepared to care for LGBTQ+ patients after training. Many PDs are not at all or somewhat confident their residents learn about gender affirming care (49.5%) or are aware of community resources for LGBTQ+ youth (54.2%). In 91% of programs, 0-25% of faculty educate trainees about LGBTQ+ health. The majority (74.8%) of PDs are very or moderately likely to implement a standardized LGBTQ+ health curriculum. The most prominent barriers were inadequate time (55.1%) and lack of faculty training (51.4%). CONCLUSION Many pediatrics programs have implemented some LGBTQ+ health education; however, PDs lack confidence in residents' abilities to independently care for LGBTQ+ youth after training. An accessible and standardized curriculum is not only needed but desired by programs.
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Affiliation(s)
- Lauren T Roth
- Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 1525 Blondell Ave, Suite 102, Bronx NY 10461.
| | - Pamela Carpenter
- Association of Pediatric Program Directors, Degnon Associates, 6392 S April Meadows Drive, Salt Lake City, UT 84084.
| | - Alan Schwartz
- Department of Medical Education, University of Illinois Chicago, 808 S. Wood Street, MC 591 Chicago, IL 60612.
| | - Brian Lurie
- Department of Pediatrics, The Warren Alpert Medical School of Brown University/Hasbro Children's Hospital, 593 Eddy Street, Providence, RI 02903.
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Serchen J, Hilden DR, Beachy MW. Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority Health Disparities: A Position Paper From the American College of Physicians. Ann Intern Med 2024; 177:1099-1103. [PMID: 38914001 DOI: 10.7326/m24-0636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
Lesbian, gay, bisexual, transgender, queer, or other sexual and gender minorities (LGBTQ+) populations in the United States continue to experience disparities in health and health care. Discrimination in both health care and society at large negatively affects LGBTQ+ health. Although progress has been made in addressing health disparities and reducing social inequality for these populations, new challenges have emerged. There is a pressing need for physicians and other health professionals to take a stance against discriminatory policies as renewed federal and state public policy efforts increasingly impose medically unnecessary restrictions on the provision of gender-affirming care. In this position paper, the American College of Physicians (ACP) reaffirms and updates much of its long-standing policy on LGBTQ+ health to strongly support access to evidence-based, clinically indicated gender-affirming care and oppose political efforts to interfere in the patient-physician relationship. Furthermore, ACP opposes institutional and legal restrictions on undergraduate, graduate, and continuing medical education and training on gender-affirming care and LGBTQ+ health issues. This paper also offers policy recommendations to protect the right of all people to participate in public life free from discrimination on the basis of their gender identity or sexual orientation and encourages the deployment of inclusive, nondiscriminatory, and evidence-based blood donation policies for members of LGBTQ+ communities. Underlying these beliefs is a reaffirmed commitment to promoting equitable access to quality care for all people regardless of their sexual orientation and gender identity.
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Affiliation(s)
- Josh Serchen
- American College of Physicians, Washington, DC (J.S.)
| | | | - Micah W Beachy
- University of Nebraska Medical Center, Omaha, Nebraska (M.W.B.)
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Khalfe N, Stephens M, Albaba D, Gordon MR, Coverdale J. Addressing the Health Needs of LGBTQ Persons in Medical Curricula: A Review of Educational Programs. J Psychiatr Pract 2024; 30:266-272. [PMID: 39058525 DOI: 10.1097/pra.0000000000000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
OBJECTIVE Given the vulnerability of and the importance of caring for the specific health care needs of the growing lesbian, gay, bisexual, transgender, and queer (LGBTQ) population, the authors attempted to identify all educational interventions in psychiatric settings with quantitative outcomes targeting medical students, residents, and physicians in postgraduate settings. To gain insight from other disciplines that have published research in this area, a second objective was to review studies in teaching in those other disciplines. The authors sought to describe the methods of selected studies. METHODS The authors searched the published English-language literature indexed in PubMed, EMBASE, and PsycINFO using key terms for health care education concerning LGBTQ populations. The authors described and critically appraised studies with quantitative outcomes designed to enhance knowledge, skills, and attitudes in treating the LGBTQ community. RESULTS Of the 15 trials identified, 10 included medical students, 4 included internal medicine residents or medical school faculty, and 1 included oncologists. We did not find any randomized controlled trials or controlled nonrandomized trials of curricula dedicated to teaching learners in psychiatry. All of the studies included a presurvey, followed by an educational intervention and then a postsurvey assessment. The educational interventions, outcome measures, and quality of studies varied widely. Four studies enrolled self-identified members of the LGBTQ community as trainers and facilitators of the educational interventions. CONCLUSIONS The lack of high-quality controlled studies indicates the need to develop evidence-based curricula to support the education of the psychiatric workforce to provide for the special needs of LGBTQ persons.
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Affiliation(s)
- Nasim Khalfe
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
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Soto EF, Orantes D, Russo N, Antshel KM. Autism and sexual and gender minority identity in college students: Examination of self-reported rates, functional outcomes, and treatment engagement. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1519-1539. [PMID: 38551171 DOI: 10.1177/13623613241236228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
LAY ABSTRACT Autistic individuals and those who identify with a sexual and/or gender minority are both at risk for various mental health concerns and related impairments. However, the connection between autism and sexual and/or gender minorities and mental health and functional outcomes is not clear. Here, we provide evidence of these connections by analyzing data from a large nationally representative dataset from the American College Health Association-National College Health Assessment III. We found that autistic college students who identify with both sexual and gender minorities reported the highest rates of stress, academic, and mental health concerns including suicidality when compared with autistic college students with or without a sexual and/or gender minority. In addition, college students with at least two identities, such as autism and a sexual minority identity or both a sexual and gender minority identity, reported the next highest rates of concern. These findings affirm the need for mental healthcare providers to consider the intersections of a sexual and gender minority identities in non-autistic and, especially, in autistic college students to develop and provide better support and resources.
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Streed CG, Michals A, Quinn E, Davis JA, Blume K, Dalke KB, Fetterman D, Garcia G, Goldsmith E, Greene RE, Halem J, Hedian HF, Moring I, Navarra M, Potter J, Siegel J, White W, Lunn MR, Obedin-Maliver J. Sexual and gender minority content in undergraduate medical education in the United States and Canada: current state and changes since 2011. BMC MEDICAL EDUCATION 2024; 24:482. [PMID: 38693525 PMCID: PMC11064371 DOI: 10.1186/s12909-024-05469-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/25/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE To characterize current lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI +) health-related undergraduate medical education (UME) curricular content and associated changes since a 2011 study and to determine the frequency and extent of institutional instruction in 17 LGBTQI + health-related topics, strategies for increasing LGBTQI + health-related content, and faculty development opportunities. METHOD Deans of medical education (or equivalent) at 214 allopathic or osteopathic medical schools in Canada and the United States were invited to complete a 36-question, Web-based questionnaire between June 2021 and September 2022. The main outcome measured was reported hours of LGBTQI + health-related curricular content. RESULTS Of 214 schools, 100 (46.7%) responded, of which 85 (85.0%) fully completed the questionnaire. Compared to 5 median hours dedicated to LGBTQI + health-related in a 2011 study, the 2022 median reported time was 11 h (interquartile range [IQR], 6-16 h, p < 0.0001). Two UME institutions (2.4%; 95% CI, 0.0%-5.8%) reported 0 h during the pre-clerkship phase; 21 institutions (24.7%; CI, 15.5%-33.9%) reported 0 h during the clerkship phase; and 1 institution (1.2%; CI, 0%-3.5%) reported 0 h across the curriculum. Median US allopathic clerkship hours were significantly different from US osteopathic clerkship hours (4 h [IQR, 1-6 h] versus 0 h [IQR, 0-0 h]; p = 0.01). Suggested strategies to increase content included more curricular material focusing on LGBTQI + health and health disparities at 55 schools (64.7%; CI, 54.6%-74.9%), more faculty willing and able to teach LGBTQI + -related content at 49 schools (57.7%; CI, 47.1%-68.2%), and more evidence-based research on LGBTQI + health and health disparities at 24 schools (28.2%; CI, 18.7%-37.8%). CONCLUSION Compared to a 2011 study, the median reported time dedicated to LGBTQI + health-related topics in 2022 increased across US and Canadian UME institutions, but the breadth, efficacy, or quality of instruction continued to vary substantially. Despite the increased hours, this still falls short of the number of hours based on recommended LGBTQI + health competencies from the Association of American Medical Colleges. While most deans of medical education reported their institutions' coverage of LGBTQI + health as 'fair,' 'good,' or 'very good,' there continues to be a call from UME leadership to increase curricular content. This requires dedicated training for faculty and students.
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Affiliation(s)
- Carl G Streed
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, 801 Massachusetts Ave., Room 2082, Boston, MA, 02118, USA.
- GenderCare Center, Boston Medical Center, Boston, MA, USA.
| | - Amy Michals
- Biostatistics & Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Emily Quinn
- Biostatistics & Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - John A Davis
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kylie Blume
- Department of Neurology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Katharine B Dalke
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA
| | - David Fetterman
- Fetterman & Associates, Hadley, MA, USA
- Claremont Graduate University, Claremont, CA, USA
| | - Gabriel Garcia
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Elizabeth Goldsmith
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Richard E Greene
- Division of General Internal Medicine, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Jessica Halem
- Eidos LGBTQ+ Health Initiative, University of Pennsylvania, Philadelphia, PA, USA
| | - Helene F Hedian
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Transgender and Gender Expansive Health, Johns Hopkins, Baltimore, MD, USA
| | | | - May Navarra
- GenderCare Center, Boston Medical Center, Boston, MA, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jennifer Siegel
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Transgender Health Program, Massachusetts General Hospital, Boston, MA, USA
| | - William White
- San Francisco Emergency Medical Associates, California Pacific Medical Center, San Francisco, CA, USA
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Mitchell R Lunn
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Juno Obedin-Maliver
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
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Bonomo JA, Luo K, Ramallo JA. LGBTQ+ cardiovascular health equity: a brief review. Front Cardiovasc Med 2024; 11:1350603. [PMID: 38510198 PMCID: PMC10951381 DOI: 10.3389/fcvm.2024.1350603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States. Data shows that social drivers of health (SDOH), including economic stability, racial/cultural identity, and community, have a significant impact on cardiovascular morbidity and mortality. LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and other gender and sexual minority) patients face a variety of unique health risk factors and bear a disproportionate burden of CVD compared to cis-gender, heterosexual peers. There is a paucity of research assessing the etiologies of CVD health disparities within the LGBTQ+ community. Herein, we seek to explore existing literature on LGBTQ+ health disparities with a focus on cardiovascular disease, examine trends impacting LGBTQ+ health equity, and identify strategies and interventions that aim to promote LGBTQ+ cardiovascular health equity on a regional and national level.
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Affiliation(s)
- Jason A. Bonomo
- Inova Scar Heart and Vascular, Inova Health System, Falls Church, VA, United States
| | - Kate Luo
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Jorge A. Ramallo
- Inova Pride Clinic, Inova Health System, Falls Church, VA, United States
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Schafer T, Schnarrs PW, Baldwin A. Two Gender Medicine: Provider-Side Barriers to Caring for Transgender and Gender Diverse Patients. JOURNAL OF HOMOSEXUALITY 2024:1-23. [PMID: 38319650 DOI: 10.1080/00918369.2024.2314030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Experienced and anticipated discrimination during health care visits result in lower health care utilization rates, which contribute to persistent health disparities between transgender and gender diverse (TGD) individuals and the general population. Most strategies for improving health care delivery to TGD patients place the responsibility on providers, overlooking the role of medical systems and institutions in creating the environments where negative health care experiences occur. Relying on the inhabited institutionalism framework, this study explores system- and institutional-level barriers to the provision of quality care to TGD patients identified by health care providers and administrators, including relevant contextual details of, and interactions between, these barriers. Based on interview data from health care providers and administrators from a variety of practices across Texas, we identified two overarching themes and six subthemes. We demonstrate how our interviewees' responses reveal an institutional logic of "two-gender medicine," which creates barriers to health care provision in both formal medical education and training and throughout the managed care model of practice. We also illustrate how health care workers find ways to resist this logic in the course of their practice. Addressing these barriers to delivering competent and compassionate care to TGD patients that providers encounter could make long overdue strides toward addressing health disparities.
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Affiliation(s)
- Tyler Schafer
- Department of Sociology, California State University Stanislaus, Turlock, California, USA
| | - Phillip W Schnarrs
- Department of Population Health, Dell Medical School, University of Texas, Austin, Texas, USA
| | - Aleta Baldwin
- Department of Public Health, California State University Sacramento, Sacramento, California, USA
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Li LX, Lin JS, Tackett S, Bertram A, Sisson SD, Rastegar D, Berkenblit G. Knowledge of Pre- and Postexposure Prophylaxis for HIV Prevention Among Internal Medicine Residents in the United States. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2024; 36:48-59. [PMID: 38349354 DOI: 10.1521/aeap.2024.36.1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Prescription rates of pre-exposure prophylaxis (PrEP) have remained low among noninfectious disease providers in the United States despite almost a decade since their introduction. For future primary care doctors, residency is the optimal time to build practice patterns around HIV prevention. We assessed baseline knowledge of PrEP in specific pre- and post-exposure prophylaxis content areas among internal medicine trainees who completed the Physician Education and Assessment Center HIV learning module between 2013 to 2020 (N = 12,060). Resident baseline PrEP knowledge was universally low; despite rising awareness of antiretroviral therapy for PrEP in successive years following the nadir of 41% in 2014, still only 56% of residents affirmed this means of HIV prevention by 2020. Knowledge remained limited regardless of academic year, local HIV prevalence, or training program type. Online module completion increased competence across all content areas. There is still a deficit in HIV prevention knowledge across U.S. internal medicine residents, suggesting insufficient education and exposure to HIV-related care.
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Affiliation(s)
- Lucy X Li
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessica S Lin
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sean Tackett
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins School of Medicine, Baltimore, Maryland, and Department of Medicine, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amanda Bertram
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen D Sisson
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Darius Rastegar
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gail Berkenblit
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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11
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Ahmad T, Robinson L, Uleryk E, Yu C. Trans health training objectives: A scoping review. CLINICAL TEACHER 2024; 21:e13673. [PMID: 37806669 DOI: 10.1111/tct.13673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 09/04/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Transgender individuals are discriminated against in health care environments and consistently experience poorer health outcomes than their cisgender counterparts. Enhancing physician training in transgender-specific health is critical to closing the transgender health gap. METHODS We conducted a scoping review to identify transgender health training objectives in Internal Medicine and Internal Medicine Subspecialty residency programmes in Canada and the United States. A systematic search was conducted from 1946 to 15 February 2022. Studies were eligible for inclusion if they were written in English, included transgender training objectives, and were aimed at resident physicians in Internal Medicine or Internal Medicine Subspecialty training programmes in Canada or the United States. FINDINGS We found 4048 papers, of which 11 were included for analysis. Transgender health training objectives were synthesised into five themes, including (1) terminology, physiology, and gender presentation, (2) gender-affirming care and communication, (3) hormonal and surgical management, (4) routine health management and maintenance, and (5) equity, diversity, and inclusion in clinical care. The majority of objectives pertained to equity, diversity, and inclusion in clinical care, namely, respectful communication and non-judgemental care of transgender patients. DISCUSSION Our findings provide a comprehensive overview of published transgender health objectives in Canada and the United States and highlight existing gaps in postgraduate medical education for Internal Medicine and Subspecialty programmes. CONCLUSIONS We argue a need for standardisation of transgender-related residency training and suggest that postgraduate Internal Medicine programmes can utilise this review as a framework to begin enhancing transgender health education for their residents.
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Affiliation(s)
- Tehmina Ahmad
- Department of Medicine, Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada
| | - Lilian Robinson
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Uleryk
- Medical Information Sciences, E.M. Consulting, Mississauga, Ontario, Canada
| | - Catherine Yu
- Department of Medicine, Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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12
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Liu M, Grasso C, Kim HH, Mayer KH, Keuroghlian AS. Advancing Pediatric Sexual Orientation and Gender Identity Data Collection. Am J Public Health 2024; 114:17-20. [PMID: 37856729 PMCID: PMC10726944 DOI: 10.2105/ajph.2023.307448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Affiliation(s)
- Michael Liu
- Michael Liu is with Harvard Medical School, Boston, MA. Chris Grasso, Kenneth H. Mayer, and Alex S. Keuroghlian are with the Fenway Institute at Fenway Health, Boston. Hyun-Hee Kim is with the Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston
| | - Chris Grasso
- Michael Liu is with Harvard Medical School, Boston, MA. Chris Grasso, Kenneth H. Mayer, and Alex S. Keuroghlian are with the Fenway Institute at Fenway Health, Boston. Hyun-Hee Kim is with the Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston
| | - Hyun-Hee Kim
- Michael Liu is with Harvard Medical School, Boston, MA. Chris Grasso, Kenneth H. Mayer, and Alex S. Keuroghlian are with the Fenway Institute at Fenway Health, Boston. Hyun-Hee Kim is with the Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston
| | - Kenneth H Mayer
- Michael Liu is with Harvard Medical School, Boston, MA. Chris Grasso, Kenneth H. Mayer, and Alex S. Keuroghlian are with the Fenway Institute at Fenway Health, Boston. Hyun-Hee Kim is with the Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston
| | - Alex S Keuroghlian
- Michael Liu is with Harvard Medical School, Boston, MA. Chris Grasso, Kenneth H. Mayer, and Alex S. Keuroghlian are with the Fenway Institute at Fenway Health, Boston. Hyun-Hee Kim is with the Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston
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Rhodes A, Barbati Z, Tybor D, Louis JS. Knowledge and perceived competence with sexual and gender minority healthcare topics among medical students and medical school faculty. BMC MEDICAL EDUCATION 2023; 23:928. [PMID: 38066533 PMCID: PMC10709858 DOI: 10.1186/s12909-023-04849-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Despite changes in social attitudes in the United States over the last decade, sexual and gender minority (SGM) individuals continue to face significant health disparities, driven partly by disproportionately higher rates of self-reported discrimination and harassment when seeking healthcare. Historically, physicians have received little to no required training on how to provide sensitive, competent care to SGM patients, and continue to demonstrate poor competency with SGM topics despite calls for increased education and published guidelines to promote competency. The present study aimed to investigate competency with SGM topics among both faculty and medical students at one institution. METHODS The authors distributed an anonymous online survey (2020-2021) to medical students and student-facing faculty at one allopathic medical school in the United States. The objective of the study was to evaluate knowledge, clinical skills, and self-reported competence with SGM topics. RESULTS Of survey respondents, 223 medical students and 111 faculty were included in final analysis. On average, medical students were significantly more likely to answer General Knowledge questions correctly (97.2%) compared to faculty (89.9%). There were no significant differences in responses to Clinical Knowledge questions between medical students and faculty. however medical students were significantly more likely to report competence with eliciting a thorough sexual history, and faculty were significantly more likely to report receiving adequate clinical training and supervision to work with lesbian, gay, and bisexual patients. CONCLUSIONS Medical students demonstrated significantly higher general knowledge about SGM topics compared to faculty. Medical students and faculty demonstrated similarly low average clinical knowledge, with percent correct 65.6% for students and 62.7% for faculty. Despite significant differences in general knowledge and low clinical knowledge, medical students and faculty self-reported similar levels of competence with these topics. This indicates insufficient curricular preparation to achieve the AAMC competencies necessary to care for SGM patients.
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Affiliation(s)
- Allison Rhodes
- Department of Psychiatry, Tufts Medical Center, Boston, MA, USA
| | - Zachary Barbati
- Departments of Pathology and Laboratory Medicine, University of California - San Francisco, San Francisco, CA, USA
| | - David Tybor
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Joshua St Louis
- Department of Family Medicine, Tufts University School of Medicine, core faculty, Lawrence Family Medicine residency, Lawrence, MA, USA.
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14
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Amidon J, Taylor SS, Hinton S. Practice Impact of a Dedicated LGBTQ+ Clinical Exposure During Residency. PRIMER (LEAWOOD, KAN.) 2023; 7:24. [PMID: 37791052 PMCID: PMC10544642 DOI: 10.22454/primer.2023.329607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background and Objectives An increased focus on lesbian, gay, bisexual, transgender, queer (LGBTQ+) care in graduate medical education is needed to address health disparities in this patient population. This study assessed practice confidence and practice intentions of residents who rotated through an LGBTQ+ clinic during their residency. Methods Residents completed three to eight half-day sessions in a dedicated LGBTQ+ clinic focusing on primary care, pre-exposure prophylaxis (PrEP), and gender-affirming care from 2019 to 2022. Prior to this clinical experience, they were provided background reading materials, care guidelines, and clinical cases. Residents were electronically surveyed at two time points after completing this clinical experience to retrospectively assess their pre-and postcurricular confidence. Results Seventeen out of 18 (94%) residents who completed the curricular experience responded to the initial survey, which showed statistically significant differences between reported pre- and postcurricular confidence in providing primary care, PrEP, and gender affirmation care. Eight-eight percent of residents reported that they planned to or have already incorporated this care into their practice. In a follow-up survey 1 year later, 15 out of 18 (83%) responded, reporting consistent skills confidence. Seventy-one percent of participants reported currently providing LGBTQ+ care. We noted no statistical difference between the initial postconfidence survey and the follow-up survey. Conclusion This study demonstrated positive associations between a focused curricular experience in LGBTQ+ care and both confidence providing LGBTQ+ care and planned and actual postgraduation practice patterns.
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Affiliation(s)
- Joel Amidon
- Prisma Health, University of South Carolina, School of Medicine Greenville, Department of Family Medicine, Greenville, SC
| | - Shannon Stark Taylor
- Prisma Health, University of South Carolina, School of Medicine Greenville, Department of Family Medicine, Greenville, SC | Clemson University School of Health Research, Clemson, SC
| | - Sarah Hinton
- Prisma Health, University of South Carolina, School of Medicine Greenville, Department of Internal Medicine and Pediatrics, Greenville, SC
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15
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Carvajal N, Lopez J, Ahmad TR, Maru J, Ramanathan S, Seitzman GD, Padmanabhan S, Parikh N. Health Disparity Curricula for Ophthalmology Residents: Current Landscape, Barriers, and Needs. JOURNAL OF ACADEMIC OPHTHALMOLOGY (2017) 2023; 15:e162-e171. [PMID: 37564161 PMCID: PMC10411222 DOI: 10.1055/s-0043-1771356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/28/2023] [Indexed: 08/12/2023]
Abstract
Background Social determinants of health play a critical role in visual health outcomes. Yet, there exists no structured curriculum for ophthalmology residents to identify and address health disparities relevant to eye care or no a standard assessment of health disparities education within ophthalmology residency programs. This study aims to characterize current health disparity curricula in ophthalmology residency programs in the United States, determine resident confidence in addressing health disparities in the clinical setting, and identify perceived barriers and needs of program directors (PDs) and residents in this area. Design This was a cross-sectional survey study. Methods A closed-ended questionnaire with comments was distributed to the Accreditation Council for Graduate Medical Education-accredited ophthalmology residency PDs and residents in April 2021 and May 2022. The questionnaire solicited characteristics of any existing health disparity curricula, PD and resident perceptions of these curricula, and residents' experience with and confidence in addressing health disparities in the delivery of patient care. Results In total, 29 PDs and 96 residents responded. Sixty-six percent of PDs stated their program had a formal curriculum compared to fifty-three percent of residents. Forty-one percent of PDs and forty-one percent of residents stated their program places residents in underserved care settings for more than 50% of their training. Most residents (72%) were confident in recognizing health disparities. Sixty-six percent were confident in managing care in the face of disparities and fifty-nine percent felt they know how to utilize available resources. Residents were most concerned with the lack of access to resources to help patients. Forty-five percent of PDs felt the amount of time dedicated to health disparities education was adequate. Forty-nine percent of residents reported they felt the amount of training they received on health disparities to be adequate. The top barrier to curriculum development identified by PDs was the availability of trained faculty to teach. Time in the curriculum was a major barrier identified by residents. Conclusions Roughly half of ophthalmology residency programs who responded had a health disparity curriculum; however, both PDs and residents felt inadequate time is dedicated to such education. National guidance on structured health disparity curricula for ophthalmology residents may be warranted as a next step.
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Affiliation(s)
- Nicole Carvajal
- University of California San Francisco School of Medicine, San Francisco, California
| | - Justin Lopez
- University of California San Francisco School of Medicine, San Francisco, California
| | - Tessnim R. Ahmad
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Johsias Maru
- University of California San Francisco School of Medicine, San Francisco, California
| | - Saras Ramanathan
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Gerami D. Seitzman
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Sriranjani Padmanabhan
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Neeti Parikh
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
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16
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Reilly GR, Russell NG, McIltrot K, Sisson SD, Scott AW. Nurse Practitioner Students' Knowledge Assessment and Perceived Preparedness to Triage Ophthalmology Complaints in a Primary Care Setting: An Educational Intervention. JOURNAL OF ACADEMIC OPHTHALMOLOGY (2017) 2023; 15:e232-e236. [PMID: 37795384 PMCID: PMC10547544 DOI: 10.1055/s-0043-1771355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/28/2023] [Indexed: 10/06/2023]
Abstract
Purpose In this proof-of-concept pilot study, we aimed to increase nurse practitioner (NP) student knowledge of ophthalmology to prepare NPs for encounters in primary care settings. The Association of University Professors of Ophthalmology (AUPO) and the American Academy of Ophthalmology (AAO) endorse core knowledge that medical students should achieve. We assess the effectiveness of an innovative ophthalmologist-led curriculum based on these competencies tailored to issues NPs encounter in primary care. Methods Johns Hopkins University NP students enrolled in a pre-post-cohort study and educational intervention. The didactic program was developed according to AUPO and AAO core ophthalmology content for medical students and was taught in-person by an ophthalmologist. Pre-post-assessments evaluated students' perceived readiness to encounter ophthalmic issues in the clinic and baseline knowledge of core competencies of ophthalmology. Results A total of 42 NP students were included in the analysis. NP students improved in core knowledge and readiness to encounter ophthalmology issues. After the educational event, there was a statistically significant improvement in students' ratings of preparedness to obtain a focused history, exam, perform initial management and decide the urgency of a referral for acute painless vision loss ( p < 0.001), chronic vision loss ( p < 0.001), or a patient with a red/painful eye ( p < 0.001). Students showed a statistically significant improvement in postdidactic event core ophthalmology knowledge assessment scores ( p = 0.002). Conclusion Primary care NPs are increasingly the initial point of contact for patients with ophthalmic complaints, and thus, high-quality and thorough education regarding ophthalmology triage and referral for NPs is necessary. NP student comfort with and knowledge of ophthalmic complaints and triage may be improved by a brief educational intervention taught by an ophthalmologist early in the NP curriculum.
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Affiliation(s)
- Grace R. Reilly
- Drexel University College of Medicine, Philadelphia, Pennsylvania
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Stephen D. Sisson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adrienne W. Scott
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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17
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Hrynyk N, Peel JK, Grace D, Lajoie J, Ng-Kamstra J, Kuper A, Carter M, Lorello GR. Queer(ing) medical spaces: queer theory as a framework for transformative social change in anesthesiology and critical care medicine. Can J Anaesth 2023; 70:950-962. [PMID: 37217735 DOI: 10.1007/s12630-023-02449-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 08/02/2022] [Accepted: 09/15/2022] [Indexed: 05/24/2023] Open
Abstract
Queer theory is a disruptive lens that can be adopted by researchers, educators, clinicians, and administrators to effect transformative social change. It offers opportunities for anesthesiologists, critical care physicians, and medical practitioners to more broadly understand what it means to think queerly and how queering anesthesiology and critical care medicine spaces improves workplace culture and patient outcomes. This article grapples with the cis-heteronormative medical gaze and queer people's apprehensions of violence in medical settings to offer new ways of thinking about structural changes needed in medicine, medical language, and the dehumanizing application of medical modes of care. Using a series of clinical vignettes, this article outlines the historical context underlying queer peoples' distrust of medicine, a primer in queer theory, and an understanding of how to begin to "queer" medical spaces using this critical framework.
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Affiliation(s)
- Nicholas Hrynyk
- Department of Philosophy, History, and Politics, Thompson Rivers University, Kamloops, BC, Canada
| | - John K Peel
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jason Lajoie
- Department of English, University of Waterloo, Waterloo, ON, Canada
| | - Joshua Ng-Kamstra
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
- Department of Surgery, The Queen's Medical Center, Honolulu, HI, USA
| | - Ayelet Kuper
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, University of Toronto, Toronto General Hospital, Toronto, ON, Canada
| | - Mic Carter
- The Creative School, Toronto Metropolitan University, Toronto, ON, Canada
| | - Gianni R Lorello
- The Wilson Centre, University Health Network - University of Toronto, Toronto, ON, Canada.
- Department of Anesthesia and Pain Management, University Health Network - Toronto Western Hospital, Toronto, ON, Canada.
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
- University Health Network-Toronto Western Hospital, 399 Bathurst Avenue, McL 2-405, Toronto, ON, M5T 2S8, Canada.
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18
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Wallisch A, Boyd BA, Hall JP, Kurth NK, Streed Jr CG, Mulcahy A, McMaughan DJ, Batza K. Health Care Disparities Among Autistic LGBTQ+ People. AUTISM IN ADULTHOOD 2023; 5:165-174. [PMID: 37346996 PMCID: PMC10280185 DOI: 10.1089/aut.2022.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Background Lesbian, gay, bisexual, transgender, or queer (LGBTQ+) people and disabled people experience disparities in access to health care compared with others. However, we have yet to understand how health care disparities may be further exacerbated at the intersection of disability and LGBTQ+ identity, particularly among autistic people. Objectives The primary goals of this study were to (1) examine differences in unmet health care needs and health status between LGBTQ+ autistic people and straight/cisgender autistic people and (2) explore how state policies and demographics predict the unmet health care needs of the autistic LGBTQ+ people. Methods We conducted a cross-sectional analysis using data from the 2019 National Survey on Health and Disability that included a subsample of autistic participants, with 62 LGBTQ+ adults and 58 straight/cisgender adults. To address our first study goal, we used an independent samples t-test, and to address our second study goal, we used Poisson regression. Results The LGBTQ+ group reported significantly more days of poor physical and mental health, more co-occurring diagnoses, and more unmet health care needs than the straight/cisgender group. For LGBTQ+ people, protective state health care laws and a lower income resulted in significantly more health care needs being met. Conclusions Findings from this study suggest that the intersection of an LGBTQ+ identity and autism is associated with greater disparities in physical and mental health as well as unmet health care needs; however, state policies prohibiting discrimination of LGBTQ+ people may act as a protective factor and result in fewer unmet health care needs. Future research should examine additional structural factors that may mitigate health inequities for autistic LGBTQ+ people.
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Affiliation(s)
- Anna Wallisch
- Juniper Gardens Children's Project, University of Kansas, Kansas City, Kansas, USA
| | - Brian A. Boyd
- School of Education, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jean P. Hall
- Institute for Health and Disability Policy Studies, University of Kansas, Lawrence, Kansas, USA
| | - Noelle K. Kurth
- Institute for Health and Disability Policy Studies, University of Kansas, Lawrence, Kansas, USA
| | - Carl G. Streed Jr
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Abigail Mulcahy
- Center to Improve Veteran Involvement in Care, Portland VA Healthcare System, Portland, Oregon, USA
| | - Darcy Jones McMaughan
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Katie Batza
- Women, Gender and Sexuality Studies, University of Kansas, Lawrence, Kansas, USA
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19
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Marr MC, Bunting SR, Blansky BA, Dickson L, Gabrani A, Sanchez NF. Graduate Medical Education Curriculum Regarding the Health and Healthcare of Older Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Adults. JOURNAL OF GAY & LESBIAN SOCIAL SERVICES 2023; 35:420-433. [PMID: 38107508 PMCID: PMC10723790 DOI: 10.1080/10538720.2023.2172122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) adults experience a wide variety of unique challenges accessing healthcare. These barriers may be exacerbated among older LGBTQ+ people due to intersecting, marginalized identities. To prepare physicians to address the healthcare needs of older LGBTQ+ adults, graduate medical education (GME) must include training about the specific needs of this population. Prior studies demonstrate a lack of LGBTQ+ training in GME curricula. Here, we investigated the presence of LGBTQ+ curricula in internal medicine residencies and geriatrics fellowships through a national survey. Over 62.0% of internal medicine (n = 49) and 65.6% (n = 21) of geriatric medicine fellowship program directors, responding to the survey, reported content relevant to the health of older LGBTQ+ adults. Education about LGBTQ+ health in internal medicine residencies and geriatrics fellowships is vital for the provision of culturally-competent healthcare and to create an inclusive environment for older LGBTQ+ patients.
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Affiliation(s)
- Mollie C Marr
- Oregon Health & Science University, Portland, OR, USA
| | - Samuel R Bunting
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Bradley A Blansky
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Lexi Dickson
- School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Aayush Gabrani
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nelson F Sanchez
- Associate Professor of Medicine, Weill Cornell Medicine & Memorial Sloan Kettering Cancer Center, New York, NY, USA
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20
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Sports Medicine Physicians Comfort and Competence in Caring for Transgender and Gender Nonconforming Patients and Athletes. Clin J Sport Med 2023; 33:33-44. [PMID: 36111996 DOI: 10.1097/jsm.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/29/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to explore primary care sports medicine physicians' comfort, competence, education, and scope of training in caring for transgender and gender nonconforming (TGNC) patients/athletes. DESIGN Mixed-methods, cross-sectional survey. SETTING Online. PATIENTS OR PARTICIPANTS In total, 4300 e-mails were successfully sent with 252 eligible responses received from the American Medical Society for Sports Medicine members. INDEPENDENT VARIABLES Previous relationships with TGNC persons; previous relationships with TGNC patients/athletes; frequency of care for TGNC patients/athletes. MAIN OUTCOME MEASURES The participants completed a 38-item tool used to assess perceived comfort and competence treating TGNC patients/athletes. Physicians defined "transgender" and described their thoughts on unfair competitive advantage of transgender athletes. RESULTS Most participants had worked with a TGNC patient (70.2%, n = 177), but far fewer worked with a TGNC athlete (n = 26.6%, n = 67). Among the participants who provided a definition of transgender (n = 183), only 28.4% (n = 52) of participants were able to correctly define the term, whereas most were able to partially (57.9%, n = 106) characterize the term. The most common mechanisms identified for learning about TGNC patients were reading peer-reviewed journal articles (44.8%, n = 113) and CME (41.3%, n = 104). Those with previous TGNC friend/family, patient, and athlete relationships had a significantly different level of comfort and competence treating TGNC patients/athletes. CONCLUSIONS Previous care relationships with TGNC strongly influences comfort and perceived competence of primary care sports medicine physicians. Training, from unbiased peer-reviewed sources of data, is critical to improve care for TGNC patients/athletes.
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21
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Streed CG, Navarra M, Klein J. Advancing undergraduate medical education regarding the care of transgender and gender Diverse persons and communities. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:306-308. [PMID: 36435909 PMCID: PMC9743931 DOI: 10.1007/s40037-022-00732-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Carl G Streed
- Center for Transgender Medicine & Surgery, Boston Medical Center, 02118, Boston, MA, USA.
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 02118, Boston, MA, USA.
| | - May Navarra
- Center for Transgender Medicine & Surgery, Boston Medical Center, 02118, Boston, MA, USA
| | - Jorden Klein
- Division of Emergency Medicine, Department of Medicine, University of Toronto, M5S 1A1, Toronto, Ontario, Canada
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22
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Cook SC. LGBTQ+ in Cardiology: Breaking Down the Closet Door. JACC Case Rep 2022; 4:1453-1455. [PMID: 36388716 PMCID: PMC9663978 DOI: 10.1016/j.jaccas.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Stephen C. Cook
- Address for correspondence: Dr Stephen C. Cook, Adult Congenital Heart Disease Program, Indiana University School of Medicine, Professional Center 2, 1801 North Senate Boulevard, Suite 4000, Indianapolis, Indiana 46202, USA. @stephencookmd
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23
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Suarez S, Lupez E, Demers L, Streed CG, Siegel J. Gender and Sexual Diverse Health Education: A Needs Assessment Among Internal Medicine Residents. LGBT Health 2022; 9:589-594. [PMID: 35905057 DOI: 10.1089/lgbt.2022.0058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose: The purpose of this study was to assess perception of competency and comfort level of internal medicine (IM) residents in caring for gender and sexual diverse (GSD) patients, and to identify residents' preferred educational modalities and perceived facilitators and barriers to GSD curriculum implementation. Methods: A survey was distributed among IM residents during a mandatory didactic session between November 9 and December 18, 2020. Categorical variables were analyzed using Fisher's exact test. Open-ended questions were analyzed using content and theme analysis. Results: Of 138 residents, 89 (64%) completed the survey. Residents had varying levels of comfort and perceived competence. Small group (n = 61, 69%) and case-based learning (n = 58, 66%) formats were preferred. Content and theme analysis resulted in four major themes on facilitators and three major themes on barriers to GSD curricular implementation. Conclusion: This study provides unique insight to facilitate implementation of a learner-centered and developmentally appropriate curricular approach to GSD health education.
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Affiliation(s)
- Sebastian Suarez
- Internal Medicine Residency Program, Boston University Medical Center, Boston, Massachusetts, USA
| | - Emily Lupez
- Internal Medicine Residency Program, Boston University Medical Center, Boston, Massachusetts, USA
| | - Lindsay Demers
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Education Evaluation Core, Boston University School of Medicine, Boston, Massachusetts, USA.,Health Sciences Education MS Program, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Carl G Streed
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Center for Transgender Medicine and Surgery, Boston University Medical Center, Boston, Massachusetts, USA
| | - Jennifer Siegel
- Internal Medicine Residency Program, Boston University Medical Center, Boston, Massachusetts, USA.,Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Center for Transgender Medicine and Surgery, Boston University Medical Center, Boston, Massachusetts, USA
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24
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van Heesewijk J, Kent A, van de Grift TC, Harleman A, Muntinga M. Transgender health content in medical education: a theory-guided systematic review of current training practices and implementation barriers & facilitators. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:817-846. [PMID: 35412095 PMCID: PMC9374605 DOI: 10.1007/s10459-022-10112-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 03/19/2022] [Indexed: 06/14/2023]
Abstract
Health disparities faced by transgender people are partly explained by barriers to trans-inclusive healthcare, which in turn are linked to a lack of transgender health education in medical school curricula. We carried out a theory-driven systematic review with the aim to (1) provide an overview of key characteristics of training initiatives and pedagogical features, and (2) analyze barriers and facilitators to implementing this training in medical education. We used queer theory to contextualize our findings. We searched the PubMed/Ovid MEDLINE database (October 2009 to December 2021) for original studies that reported on transgender content within medical schools and residency programs (N = 46). We performed a thematic analysis to identify training characteristics, pedagogical features, barriers and facilitators. Most training consisted of single-session interventions, with varying modes of delivery. Most interventions were facilitated by instructors with a range of professional experience and half covered general LGBT+-content. Thematic analysis highlighted barriers including lack of educational materials, lack of faculty expertise, time/costs constraints, and challenges in recruiting and compensating transgender guest speakers. Facilitators included scaffolding learning throughout the curriculum, drawing on expertise of transgender people and engaging learners in skills-based training. Sustainable implementation of transgender-health objectives in medical education faces persistent institutional barriers. These barriers are rooted in normative biases inherent to biomedical knowledge production, and an understanding of categories of sex and gender as uncomplicated. Medical schools should facilitate trans-inclusive educational strategies to combat transgender-health inequities, which should include a critical stance toward binary conceptualizations of sex and gender throughout the curriculum.
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Affiliation(s)
- Jason van Heesewijk
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1131, 1081 HX, Amsterdam, The Netherlands.
| | - Alex Kent
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Tim C van de Grift
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1131, 1081 HX, Amsterdam, The Netherlands
- Departments of Plastic, Reconstructive and Hand Surgery and of Psychosomatic Gynecology and Sexology, Amsterdam University Medical Center, Location VUmc and AMC, Amsterdam, The Netherlands
| | - Alex Harleman
- Centre for Sexual Health, GGD Amsterdam, Amsterdam, The Netherlands
| | - Maaike Muntinga
- Department of Ethics, Law and Humanities, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
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25
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Affiliation(s)
- Michael Liu
- From Harvard Medical School (M.L., S.S., A.S.K.), the Fenway Institute, Fenway Health (A.S.K.), and the Department of Psychiatry, Massachusetts General Hospital (A.S.K.) - all in Boston
| | - Sahil Sandhu
- From Harvard Medical School (M.L., S.S., A.S.K.), the Fenway Institute, Fenway Health (A.S.K.), and the Department of Psychiatry, Massachusetts General Hospital (A.S.K.) - all in Boston
| | - Alex S Keuroghlian
- From Harvard Medical School (M.L., S.S., A.S.K.), the Fenway Institute, Fenway Health (A.S.K.), and the Department of Psychiatry, Massachusetts General Hospital (A.S.K.) - all in Boston
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26
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The current state of lesbian, gay, bisexual, and transgender cultural competency among U.S. dermatology residents. Int J Womens Dermatol 2022; 8:e030. [PMID: 35822191 PMCID: PMC9270600 DOI: 10.1097/jw9.0000000000000030] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
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Feroe AG, Hutchinson LE, Miller PE, Samora JB, Kocher MS. Knowledge, Attitudes, and Practices in the Orthopaedic Care of Sexual and Gender Minority Youth: A Survey of Two Pediatric Academic Hospitals. Clin Orthop Relat Res 2022; 480:1313-1328. [PMID: 35167510 PMCID: PMC9191605 DOI: 10.1097/corr.0000000000002143] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/27/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, and queer (LGBTQ) children and adolescents continue to experience unmet healthcare needs, partly because of clinician biases, discrimination, and inadequate education. Although clinician attitudes and knowledge related to sexual and gender minority health have been well studied in other medical specialties, these have been scarcely studied in orthopaedics. QUESTIONS/PURPOSES (1) What are pediatric orthopaedic healthcare professionals' attitudes (perceived importance, openness, comfort, and confidence) toward caring for sexual and gender minority youth? (2) What do pediatric orthopaedic healthcare professionals know about caring for this patient population? (3) What factors are associated with clinician attitude and/or knowledge? (4) What existing initiatives to improve orthopaedic care for this population are clinicians aware of at their home institutions? METHODS All 123 orthopaedic healthcare professionals at two pediatric academic hospitals in the Midwestern and Northeastern United States were sent a 34-question, internet-based, anonymous survey. The survey queried respondent demographics, attitudes, knowledge, and practice behaviors at their home institutions related to the care of sexual and gender minority youth. Respondent attitudes were queried using the Attitudes Summary Measure, which is a survey instrument that was previously validated to assess clinicians' attitudes regarding sexual and gender minority patients. Items used to assess knowledge and practice behaviors were developed by content experts in LGBTQ health and/or survey design, as well as orthopaedic surgeons to improve face validity and to mitigate push-polling. Attitude and knowledge items used a 5-point Likert scale. Sixty-six percent (81 of 123) of clinicians completed the survey. Of those, 47% (38 of 81) were physicians, 73% (59 of 81) were licensed for fewer than 20 years, 63% (51 of 81) were women, and 53% (43 of 81) described themselves as liberal-leaning. The response proportions were 73% (38 of 52) among eligible physicians specifically and 61% (43 of 71) among other clinicians (nurse practitioners, physician assistants, and registered nurses). To assess potential nonresponse bias, we compared early responders (within 2 weeks) with late responders (after 2 weeks) and found no differences in responder demographics or in questionnaire responses (all p > 0.05). The main outcome measures included responses to the attitude and knowledge questionnaire, as well as the existing practices questionnaire. To answer our research questions regarding clinician attitudes knowledge and awareness of institutional initiatives, we compared participant responses using chi-square tests, the Student t-test, and the McNemar tests, as appropriate. To answer our research question on factors associated with questionnaire responses, we reported data for each question, stratified by hospital, years since licensure, and political leaning. Comparisons were conducted across strata using chi-square tests for Likert response items and ANOVA for continuous response items. All p values less than 0.05 were considered significant. RESULTS Of the respondents who reported feeling comfortable treating lesbian, gay, and bisexual (sexual minority) youth, a small proportion reported feeling confident in their knowledge about these patients' health needs (99% [80 of 81] versus 63% [51 of 80], 36% reduction [95% confidence interval 23% to 47%]; p < 0.001). Similarly, of those who reported feeling comfortable treating transgender (gender minority) youth, a smaller proportion reported feeling confident in their knowledge of their health needs (94% [76 of 81] versus 49% [37 of 76], 45% reduction [95% CI 31% to 59%]; p < 0.001). There was substantial interest in receiving more education regarding the health concerns of LGBTQ people (81% [66 of 81]) and being listed as an LGBTQ-friendly clinician (90% [73 of 81]). Factors that were associated with select attitude and knowledge items were duration of licensure and political leaning; gender identity, institutional affiliation, educational degree, or having LGBTQ friends and family were not associated. Many respondents were aware of the use of clinic intake forms and the electronic medical record to collect and provide patient gender identity and sexual orientation data at their practice, as well as signage and symbols (for example, rainbow posters) to cultivate LGBTQ-welcoming clinic spaces. CONCLUSION There were varying degrees of confidence and knowledge regarding the health needs of sexual and gender minority youth among pediatric orthopaedic healthcare professionals. There was considerable interest in more focused training and better use of medical technologies to improve care for this population. CLINICAL RELEVANCE The study findings support the further investment in clinician training opportunities by healthcare administrators and orthopaedic associations related to the care of sexual and gender minority patients, as well as in the expansion of medical documentation to record and report important patient information such as pronouns and gender identity. Simultaneously, based on these findings, clinicians should engage with the increasing number of educational opportunities, explore their personal biases, and implement changes into their own practices, with the ultimate goal of providing equitable and informed orthopaedic care.
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Affiliation(s)
- Aliya G. Feroe
- Harvard Medical School, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Lauren E. Hutchinson
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Patricia E. Miller
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Julie Balch Samora
- Department of Orthopaedic Surgery, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Mininder S. Kocher
- Harvard Medical School, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA, USA
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Cooper RL, Ramesh A, Radix AE, Reuben JS, Juarez PD, Holder CL, Belton AS, Brown KY, Mena LA, Matthews-Juarez P. Affirming and Inclusive Care Training for Medical Students and Residents to Reducing Health Disparities Experienced by Sexual and Gender Minorities: A Systematic Review. Transgend Health 2022. [PMID: 37525832 PMCID: PMC10387161 DOI: 10.1089/trgh.2021.0148] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose Providing inclusive and comprehensive gender-affirming care is critical to reducing health disparities (gaps in care) experienced by sexual and gender minorities (SGM). Currently, little is known about how medical students and residents are being trained to address the health needs of SGM persons or of the most effective methods. Methods We conducted a systematic review of the research literature from 2000 to 2020 on the effectiveness of teaching medical students and residents on knowledge, attitudes, and skills in addressing the health of SGM persons and the strength of the research sample, design, and methods used. Results We identified a total of 36 articles that assessed the impact of medical student and resident education on knowledge, comfort, attitudes, confidence, and skills in working with SGM patients. All studies utilized quasi-experimental designs, and found efficacious results. No study examined the impact of training on patient outcomes. Conclusion Future studies will need to be powered and designed to assess the impact of training on patient outcomes.
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Affiliation(s)
- Robert Lyle Cooper
- Department of Family and Community Medicine, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, Tennessee, USA
| | - Aramandla Ramesh
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, Tennessee, USA
- National Center for Medical Education Development and Research, Meharry Medical College, Nashville, Tennessee, USA
| | - Asa E. Radix
- Callen-Lorde Community Health Center in New York, New York, New York, USA
| | - Jayne S. Reuben
- Department of Biomedical Sciences, Texas Agricultural and Mechanical University College of Dentistry, Dallas, Texas, USA
| | - Paul D. Juarez
- Department of Family and Community Medicine, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, Tennessee, USA
- National Center for Medical Education Development and Research, Meharry Medical College, Nashville, Tennessee, USA
| | - Cheryl L. Holder
- Department of Family Medicine at Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Allyson S. Belton
- Satcher Health Leadership Institute at Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Katherine Y. Brown
- Department of Family and Community Medicine, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, Tennessee, USA
- National Center for Medical Education Development and Research, Meharry Medical College, Nashville, Tennessee, USA
| | - Leandro A. Mena
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Patricia Matthews-Juarez
- Department of Family and Community Medicine, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, Tennessee, USA
- National Center for Medical Education Development and Research, Meharry Medical College, Nashville, Tennessee, USA
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Atkinson RB, Khubchandani JA, Chun MBJ, Reidy E, Ortega G, Bain PA, Demko C, Barreiro-Rosado J, Kent TS, Smink DS. Cultural Competency Curricula in US Graduate Medical Education: A Scoping Review. J Grad Med Educ 2022; 14:37-52. [PMID: 35222820 PMCID: PMC8848887 DOI: 10.4300/jgme-d-21-00414.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/19/2021] [Accepted: 09/21/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Cultural competency training provides participants with knowledge and skills to improve cross-cultural communication and is required for all graduate medical education (GME) training programs. OBJECTIVE The authors sought to determine what cultural competency curricula exist specifically in GME. METHODS In April 2020, the authors performed a scoping review of the literature using a multidatabase (PubMed, Ovid, MedEdPORTAL) search strategy that included keywords relevant to GME and cultural competency. The authors extracted descriptive data about the structure, implementation, and analysis of cultural competency curricula and analyzed these data for trends. RESULTS Sixty-seven articles met criteria for inclusion, of which 61 (91%) were focused exclusively on residents. The most commonly included specialties were psychiatry (n=19, 28.4%), internal medicine (n=16, 23.9%), and pediatrics (n=15, 22.4%). The shortest intervention was a 30-minute online module, while the longest contained didactics, electives, and mentoring programs that spanned the entirety of residency training (4 years). The sample sizes of included studies ranged from 6 to 833 participants. Eight (11.9%) studies utilized OSCEs as assessment tools, while 17 (25.4%) conducted semi-structured interviews or focus groups. Four common themes were unique interventions, retention of learning, trainee evaluation of curricula, and resources required for implementation. CONCLUSIONS Wide variation exists in the design, implementation, and evaluation of cultural competency curricula for residents and fellows.
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Affiliation(s)
- Rachel B. Atkinson
- Rachel B. Atkinson, MD, is a Resident, Department of Surgery, and Research Fellow, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School
| | - Jasmine A. Khubchandani
- Jasmine A. Khubchandani, MD, is a Resident, Department of Surgery, and Research Fellow, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School
| | - Maria B. J. Chun
- Maria B. J. Chun, PhD, is a Specialist and Associate Chair in Administration and Finance, Department of Surgery, John A. Burns School of Medicine, University of Hawaii
| | - Emma Reidy
- Emma Reidy, MPH, is Senior Project Manager, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School
| | - Gezzer Ortega
- Gezzer Ortega, MD, MPH, is Lead Faculty for Research and Innovation for Equitable Surgical Care, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical
| | - Paul A. Bain
- Paul A. Bain, PhD, is Reference and Instruction Librarian, Countway Library of Medicine, Harvard Medical School
| | - Caroline Demko
- Caroline Demko, is a First-Year Masters Student, Goldman School of Public Policy, University of California, Berkeley
| | - Jeenn Barreiro-Rosado
- Jeenn Barreiro-Rosado, is a Research Assistant, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School
| | - Tara S. Kent
- Tara S. Kent, MD, MS, is Associate Professor of Surgery, Vice Chair for Education, and Program Director, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Douglas S. Smink
- Douglas S. Smink, MD, MPH, is Chief of Surgery, Brigham and Women's Faulkner Hospital, Associate Chair of Education and Associate Professor of Surgery, and Core Faculty, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School
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Goetz TG, Nieman CL, Chaiet SR, Morrison SD, Cabrera-Muffly C, Lustig LR. Sexual and Gender Minority Curriculum Within Otolaryngology Residency Programs. Transgend Health 2022; 6:267-274. [PMID: 34993299 DOI: 10.1089/trgh.2020.0105] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Otolaryngologists are uniquely situated to provide sexual and gender minority (SGM) care, including gender-affirmation (voice/communication, facial surgery) and HIV/AIDS-related conditions. Yet, no research has characterized otolaryngology residency program directors' attitudes toward SGM-related curricula, nor opportunities for supporting training in SGM-related care. Methods: An anonymous cross-sectional e-mail survey was disseminated to 116 otolaryngology residency program directors in July-September 2019. Information collected included current/future curriculum in and attitudes toward SGM care, and program demographics. Data were categorical and analysis utilized chi-square test. Results: The 65 complete responses (56% rate) were nationally representative. Overall, 17% of programs include no SGM-related education. Subjective importance of SGM training ranged from not important at all (3%) to absolutely essential (11%), with mode of average importance (47%); this varied significantly by program geographic setting and population, and program size. The mean percentage of curriculum dedicated to SGM care was 1.0% for didactics and 0.7% for clinical. Curricula include HIV/AIDS-related conditions (58%), facial gender-affirming procedures (50%), culturally informed care (42%), changes with gender-affirming hormones (voice/communication: 48%, facial: 22%), and cancer in SGM patients (42%). Frequently reported barriers were insufficient experienced faculty (52%) and time (42%). Program directors deemed visiting expert lectures (66%), small-group discussion (39%), and online modules (27%) the best ways to incorporate SGM education. Conclusions: More than 80% of otolaryngology residency curricula in a representative national survey include SGM-related education, which represents a limited portion of total curriculum. These results highlight the opportunity for expert lectures and discussion-based and online tool development to facilitate standardized SGM education in otolaryngology residencies.
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Affiliation(s)
- Teddy G Goetz
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Carrie L Nieman
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Scott R Chaiet
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Cristina Cabrera-Muffly
- Department of Otolaryngology Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lawrence R Lustig
- Department of Otolaryngology Head and Neck Surgery, Columbia University, New York, New York, USA
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Scheim AI, Baker KE, Restar AJ, Sell RL. Health and Health Care Among Transgender Adults in the United States. Annu Rev Public Health 2021; 43:503-523. [PMID: 34882432 DOI: 10.1146/annurev-publhealth-052620-100313] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Transgender (trans) communities in the USA and globally have long organized for health and social equity but have only recently gained increased visibility within public health. In this review, we synthesize evidence demonstrating that trans adults in the USA are affected by disparities in physical and mental health and in access to health care, relative to cisgender (nontrans) persons. We draw on theory and data to situate these disparities in their social contexts, explicating the roles of gender affirmation, multilevel and intersectional stigmas, and public policies in reproducing or ameliorating trans health disparities. Until recently, trans health disparities were largely made invisible by exclusionary data collection practices. We highlight the importance of, and methodological considerations for, collecting inclusive sex and gender data. Moving forward, we recommend routine collection of gender identity data, an emphasis on intervention research to achieve trans health equity, public policy advocacy, and investment in supporting gender-diverse public health leadership. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Ayden I Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA; .,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kellan E Baker
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Whitman-Walker Institute, Whitman-Walker Health, Washington, DC, USA
| | - Arjee J Restar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington 98195, USA
| | - Randall L Sell
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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Assessment of Cardiovascular Risk in Transgender Patients Presenting for Gender-Affirming Care. Am J Med 2021; 134:1002-1008. [PMID: 33895118 DOI: 10.1016/j.amjmed.2021.02.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND The transgender population is rapidly growing in the United States and abroad. Transgender men and women are marginalized as a result of their transgender status, with resultant health repercussions. This and other factors such as increased substance use, mental health disorders, violence, and chronic stress may place transgender individuals at higher risk for cardiovascular disease. Additionally, many transgender patients pursue gender-affirming hormone therapy, which has been linked to increased rates of some cardiovascular events such as metabolic syndrome, venous thromboembolism, and stroke. Despite the likelihood of elevated cardiovascular risk in this population, there is a paucity of published data about the cardiovascular risk of this population. METHODS We present baseline cardiovascular data from a transgender population at a large tertiary care center prior to the initiation of hormone therapy. RESULTS The described transgender population had much higher rates of mental health disorders and substance use than the general population. Furthermore, there were high rates of undiagnosed and untreated comorbidities, such as hypertension and dyslipidemia, that increase risk for cardiovascular disease. Baseline risk assessment using the ASCVD (Atherosclerotic Cardiovascular Disease) and QRISK3 calculators showed higher-than-expected cardiovascular risk, particularly given the young age of our patient population. CONCLUSIONS Transgender individuals are at high baseline cardiovascular risk. These data help fill some important knowledge gaps in this patient subgroup, and provide us with much-needed data to help guide our management and counseling of individuals seeking this type of care.
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Roth LT, Garcia M, Soren K, Catallozzi M. An unmet need for paediatric LGBTQ training. CLINICAL TEACHER 2021; 18:547-551. [PMID: 34327832 DOI: 10.1111/tct.13407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) youth have increased health risks, exacerbated by discrimination and lack of provider training. Currently, no graduate medical education requirements address the need for LGBTQ health training, particularly for paediatric providers. We aimed to perform a needs assessment of provider knowledge, comfort and awareness of community resources regarding LGBTQ youth. METHODS We administered two anonymous surveys from May to October 2017. The first survey of 73 residents assessed awareness of community resources and comfort providing referrals. A second survey of 110 trainees and faculty assessed comfort and knowledge regarding paediatric LGBTQ health. RESULTS In the first survey of residents regarding community resources (n = 30, 41% response rate), most did not know where to refer LGBTQ patients for mental health care (67%), transgender care (73%), support groups (87%), emergency shelters (86%) or family resources (87%). Ninety-seven per cent would refer to the social worker. In the second survey of trainees and faculty (n = 78, 71% response rate), most had little or no knowledge regarding pre-exposure prophylaxis (60%), post-exposure prophylaxis (54%), strategies for coming out (68%), homelessness/environmental risks (59%), gender dysphoria (63%), puberty blockade (77%), hormonal (78%) and surgical (81%) transitioning, domestic violence (58%), EMR logistics (89%) and community resources (80%). Only 33% felt very comfortable eliciting a history about sexual orientation, 13% about gender identity and 14% about sexual practices. CONCLUSION There is a clear need and desire for dedicated paediatric LGBTQ health training in graduate medical education. Residents and faculty need resources and training to better care for LGBTQ youth.
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Affiliation(s)
- Lauren T Roth
- Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Marco Garcia
- Department of Pediatrics, New York University Grossman School of Medicine, New York City, New York, USA
| | - Karen Soren
- Department of Pediatrics, Columbia University Irving Medical Center, New York City, New York, USA
| | - Marina Catallozzi
- Department of Pediatrics, Population and Family Health, Columbia University Irving Medical Center, New York City, New York, USA
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Schreiber M, Ahmad T, Scott M, Imrie K, Razack S. Arguments en faveur d’une norme canadienne pour l’intégration des enjeux 2SLGBTQIA+ dans les études de médecine. CMAJ 2021; 193:E937-E941. [PMID: 34860696 PMCID: PMC8248460 DOI: 10.1503/cmaj.202642-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Miranda Schreiber
- Université de Toronto (Schreiber); Division d'endocrinologie et de métabolisme (Ahmad), Division d'hématologie (Scott, Imrie), Faculté de médecine, Centre de cancérologie Odette et Centre des sciences de la santé Sunnybrook (Imrie), Université de Toronto, Ont.; Département de pédiatrie et Institut d'éducation en sciences de la santé (Razack), Université McGill, Montréal, Qc
| | - Tehmina Ahmad
- Université de Toronto (Schreiber); Division d'endocrinologie et de métabolisme (Ahmad), Division d'hématologie (Scott, Imrie), Faculté de médecine, Centre de cancérologie Odette et Centre des sciences de la santé Sunnybrook (Imrie), Université de Toronto, Ont.; Département de pédiatrie et Institut d'éducation en sciences de la santé (Razack), Université McGill, Montréal, Qc.
| | - Michael Scott
- Université de Toronto (Schreiber); Division d'endocrinologie et de métabolisme (Ahmad), Division d'hématologie (Scott, Imrie), Faculté de médecine, Centre de cancérologie Odette et Centre des sciences de la santé Sunnybrook (Imrie), Université de Toronto, Ont.; Département de pédiatrie et Institut d'éducation en sciences de la santé (Razack), Université McGill, Montréal, Qc
| | - Kevin Imrie
- Université de Toronto (Schreiber); Division d'endocrinologie et de métabolisme (Ahmad), Division d'hématologie (Scott, Imrie), Faculté de médecine, Centre de cancérologie Odette et Centre des sciences de la santé Sunnybrook (Imrie), Université de Toronto, Ont.; Département de pédiatrie et Institut d'éducation en sciences de la santé (Razack), Université McGill, Montréal, Qc
| | - Saleem Razack
- Université de Toronto (Schreiber); Division d'endocrinologie et de métabolisme (Ahmad), Division d'hématologie (Scott, Imrie), Faculté de médecine, Centre de cancérologie Odette et Centre des sciences de la santé Sunnybrook (Imrie), Université de Toronto, Ont.; Département de pédiatrie et Institut d'éducation en sciences de la santé (Razack), Université McGill, Montréal, Qc
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Pregnall AM, Churchwell AL, Ehrenfeld JM. A Call for LGBTQ Content in Graduate Medical Education Program Requirements. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:828-835. [PMID: 34031304 DOI: 10.1097/acm.0000000000003581] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A well-developed body of literature demonstrates that lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals experience poorer health outcomes and report worse health care experiences than straight/cisgender individuals. Many reforms since 2010 have addressed the LGBTQ-related education of future health care professionals at the undergraduate medical education (UME) level; however, reforms at the graduate medical education (GME) level are lagging, and new literature suggests that didactic education at the UME level is not enough to prepare future physicians to properly and compassionately care for LGBTQ patients. Recently, the Accreditation Council for Graduate Medical Education (ACGME) implemented a major revision of its Common Program Requirements that requires residents to demonstrate, as a competence, respect and responsiveness to diverse populations. Given these revisions and the ongoing failure of many GME training programs to adequately prepare future physicians to care for LGBTQ patients, the authors argue that now is the time for the ACGME to develop and implement LGBTQ health-related residency requirements. In addition, the authors outline a path by which the academic medical community may develop and implement these requirements.
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Affiliation(s)
- Andrew M Pregnall
- A.M. Pregnall is LGBTQ health intern, Vanderbilt Program for LGBTQ Health, Vanderbilt University Medical Center, Nashville, Tennessee; ORCID: https://orcid.org/0000-0001-9629-0636
| | - André L Churchwell
- A.L. Churchwell is professor of medicine (cardiology), professor of radiology and radiological sciences, professor of biomedical engineering, and senior associate dean, Diversity Affairs, Vanderbilt University School of Medicine, and chief diversity officer, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jesse M Ehrenfeld
- J.M. Ehrenfeld is senior associate dean and director, Advancing a Healthier Wisconsin Endowment, the Medical College of Wisconsin, Milwaukee, Wisconsin
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Streed CG, Lunn MR, Siegel J, Obedin-Maliver J. Meeting the Patient Care, Education, and Research Missions: Academic Medical Centers Must Comprehensively Address Sexual and Gender Minority Health. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:822-827. [PMID: 32852319 DOI: 10.1097/acm.0000000000003703] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
While sociopolitical advances have improved the rights of sexual and gender minorities (i.e., lesbian, gay, bisexual, transgender, queer [LGBTQ+] persons), they continue to face a health system that discriminates against them and does not provide competent, comprehensive care. Despite calls for advancing research, there remains limited sexual and gender minority health research funding, mentorship, and institutional support. Academic medical centers are best suited to systematically tackle disparities and improve care for all sexual and gender minority people through their tripartite missions of patient care, education, and research. In this article, the authors outline discrimination experienced by LGBTQ+ persons and highlight the unique disparities they experience across access and outcomes. The authors posit that by systematically improving clinical care of, incorporating education and training about, and research with LGBTQ+ people into their core missions, academic medical centers can dramatically change the health care landscape. Academic medical centers can eliminate health disparities, expand necessary research endeavors about sexual and gender minorities, and prepare the health care workforce to address the unique needs of these overlooked populations.
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Affiliation(s)
- Carl G Streed
- C.G. Streed Jr is assistant professor of medicine, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, and research lead, Center for Transgender Medicine & Surgery, Boston Medical Center, Boston, Massachusetts; ORCID: http://orcid.org/0000-0003-3075-253X
| | - Mitchell R Lunn
- M.R. Lunn is assistant professor of medicine, Division of Nephrology, Department of Medicine, Stanford University School of Medicine, and co-director, The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California; ORCID: http://orcid.org/0000-0002-0068-0814
| | - Jennifer Siegel
- J. Siegel is assistant professor of medicine, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, associate program director, Internal Medicine Residency Program, Boston Medical Center, and medical director, Center for Transgender Medicine & Surgery, Boston Medical Center, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-5517-8004
| | - Juno Obedin-Maliver
- J. Obedin-Maliver is assistant professor, Department of Obstetrics and Gynecology, Stanford University School of Medicine, and co-director, The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California; ORCID: http://orcid.org/0000-0002-0945-2842
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Schreiber M, Ahmad T, Scott M, Imrie K, Razack S. The case for a Canadian standard for 2SLGBTQIA+ medical education. CMAJ 2021; 193:E562-E565. [PMID: 33875462 PMCID: PMC8084556 DOI: 10.1503/cmaj.202642] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Miranda Schreiber
- University of Toronto (Schreiber); Divisions of Endocrinology & Metabolism (Ahmad) and Hematology (Scott, Imrie), Department of Medicine, and Odette Cancer Centre (Imrie), and Sunnybrook Health Sciences Centre (Imrie), University of Toronto, Ont.; Department of Pediatrics and Institute for Health Sciences Education (Razack), McGill University, Montréal, Que
| | - Tehmina Ahmad
- University of Toronto (Schreiber); Divisions of Endocrinology & Metabolism (Ahmad) and Hematology (Scott, Imrie), Department of Medicine, and Odette Cancer Centre (Imrie), and Sunnybrook Health Sciences Centre (Imrie), University of Toronto, Ont.; Department of Pediatrics and Institute for Health Sciences Education (Razack), McGill University, Montréal, Que.
| | - Michael Scott
- University of Toronto (Schreiber); Divisions of Endocrinology & Metabolism (Ahmad) and Hematology (Scott, Imrie), Department of Medicine, and Odette Cancer Centre (Imrie), and Sunnybrook Health Sciences Centre (Imrie), University of Toronto, Ont.; Department of Pediatrics and Institute for Health Sciences Education (Razack), McGill University, Montréal, Que
| | - Kevin Imrie
- University of Toronto (Schreiber); Divisions of Endocrinology & Metabolism (Ahmad) and Hematology (Scott, Imrie), Department of Medicine, and Odette Cancer Centre (Imrie), and Sunnybrook Health Sciences Centre (Imrie), University of Toronto, Ont.; Department of Pediatrics and Institute for Health Sciences Education (Razack), McGill University, Montréal, Que
| | - Saleem Razack
- University of Toronto (Schreiber); Divisions of Endocrinology & Metabolism (Ahmad) and Hematology (Scott, Imrie), Department of Medicine, and Odette Cancer Centre (Imrie), and Sunnybrook Health Sciences Centre (Imrie), University of Toronto, Ont.; Department of Pediatrics and Institute for Health Sciences Education (Razack), McGill University, Montréal, Que
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Grova MM, Donohue SJ, Bahnson M, Meyers MO, Bahnson EM. Allyship in Surgical Residents: Evidence for LGBTQ Competency Training in Surgical Education. J Surg Res 2020; 260:169-176. [PMID: 33341680 DOI: 10.1016/j.jss.2020.11.072] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/06/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Studies have shown poorer health outcomes for people who identify as sexual and/or gender minority (LGBTQ+) compared to heterosexual peers. Our goal was to establish baseline levels of LGBTQ Ally Identity Measure (AIM) scores: (1) Knowledge and Skills, (2) Openness and Support, and (3) Awareness of Oppression of the LGBTQ+ in surgical trainees, and implement a pilot training in LGBTQ + cultural competency. MATERIALS AND METHODS General surgery residents from a single academic medical center participated in a 2-h educational training developed from the existing Health Care Safe Zone training at our institution. Utilizing the previously validated LGBTQ Ally Identity Measure (AIM), residents responded to 19 items on Likert-type scales from 1 to 5 pretraining and 6 wk posttraining. The residents' perceptions of the utility of the training were also assessed. Data were analyzed by MANOVA, repeated measures MANOVA, and subsequent univariate analysis. RESULTS 27 residents responded to the pretraining survey (52%), 22 residents participated in the training, and 10 responded at 6 wk posttraining (19%). The average baseline scores were Knowledge and Skills 19.38 ± 4.64, Openness and Support 25.96 ± 4.31, and Awareness of Oppression 17.15 ± 2.20. Participants who identified as women scored 4.46 (95% CI 0.77-8.15) points higher in Openness and Support compared to males. Of those respondents who completed pretraining and posttraining surveys (n = 10), training had a significant effect on AIM scores with an improvement in Knowledge and Skills (P = 0.024) and Openness and Support (P = 0.042). Residents found the training relevant to surgery patient care (71%), increased their competency in LGBTQ + patient care (86%), and all participants indicated they were better LGBTQ allies following the training. CONCLUSIONS Assessing LGBTQ + allyship in surgical residents, we found that training improved AIM scores over time with significant improvement in the Knowledge and Skills, and Openness and Support scales, suggesting a viable and valuable curriculum focused on sexual and gender identity-related competencies within the graduate medical education for surgical trainees.
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Affiliation(s)
- Monica M Grova
- Department of Surgery, UNC Chapel Hill, Chapel Hill, North Carolina
| | - Sean J Donohue
- School of Medicine, UNC Chapel Hill, Chapel Hill, North Carolina
| | - Matthew Bahnson
- Department of Psychology, North Carolina State University, Raleigh, North Carolina
| | - Michael O Meyers
- Department of Surgery, UNC Chapel Hill, Chapel Hill, North Carolina
| | - Edward M Bahnson
- Division of Vascular Surgery, Department of Surgery, and Center of Nanotechnology in Drug Delivery, UNC Chapel Hill, Chapel Hill, North Carolina.
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Katabi LJ, Ng HH, Streed CG, Arora KS. Ethical Considerations of Fertility Preservation for Transmasculine and Nonbinary Youth. Transgend Health 2020; 5:201-204. [PMID: 33381649 DOI: 10.1089/trgh.2020.0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
An increasing number of young adolescents who identify as transgender or nonbinary are presenting to the health care system for gender affirmation therapy before the full progression of puberty. Gender-affirming therapy may impair future fertility, but options exist for fertility preservation. This perspective reviews these options for transmasculine and nonbinary youth, and explores related ethical considerations. The authors support the right of transgender and nonbinary youth to utilize available reproductive technologies, provide recommendations for treating health professionals, and advocate for increased research efforts and tools to aid patient decision making.
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Affiliation(s)
- Leila J Katabi
- Department of Bioethics, Case Western Reserve University, Cleveland, Ohio, USA.,School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Henry H Ng
- Center for LGBT Health, Cleveland Clinic Foundation, Cleveland, Ohio, USA.,Public Health and Science Department, Baldwin Wallace University, Berea, Ohio, USA
| | - Carl G Streed
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Kavita S Arora
- Department of Bioethics, Case Western Reserve University, Cleveland, Ohio, USA.,Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio, USA
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40
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Greene RE, Blasdel G, Cook TE, Gillespie C. How Do OSCE Cases Activate Learners About Transgender Health? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:S156-S162. [PMID: 32889930 DOI: 10.1097/acm.0000000000003704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To describe the effect of transgender health-related objective structured clinical examination (THOSCE) case exposure on learner activation regarding gender-affirming care. METHOD A modified grounded theory approach was applied to identify the educational value of THOSCE cases. Focus groups with current and former primary care internal medicine residents who participated in THOSCE cases were conducted in 2018-2019. Transcripts were analyzed and coded until saturation to identify themes. RESULTS Eighteen (72%) eligible learners participated in the focus groups. Themes were identified relating to gender-affirming care, and modified grounded theory analysis was used as a framework to organize the themes into 4 stages of learner activation: (1) believing the learner role is important, (2) having the confidence and knowledge necessary to take action, (3) taking action to maintain and improve one's skills, and (4) staying the course even under stress. CONCLUSIONS Residents were grateful for the opportunity to practice the skills involved in transgender health in a simulation. Many felt unprepared and were concerned about how they were perceived by the standardized patient and faculty. Residents identified feeling more comfortable with gender-affirming language in the inpatient setting, which may provide an opportunity for learning in the future. Residents identified the psychosocial skills of gender-affirming care as more directly relevant while biomedical aspects of gender-affirming care seemed less accessible to residents, given the lack of outpatient experience. The authors propose a staged approach to teaching the skills of gender-affirming care using simulation to address learners of all levels.
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Affiliation(s)
- Richard E Greene
- R.E. Greene is associate professor of internal medicine and director, Health Disparities Education, Office of Diversity Affairs, New York University Grossman School of Medicine, New York, New York; ORCID: https://orcid.org/0000-0001-8618-7723
| | - Gaines Blasdel
- G. Blasdel is research associate, Department of Urology, New York University Grossman School of Medicine, New York, New York; ORCID: https://orcid.org/0000-0002-5431-6540
| | - Tiffany E Cook
- T.E. Cook is program manager, Training and Professional Development, Office of Diversity Affairs, New York University Grossman School of Medicine, New York, New York
| | - Colleen Gillespie
- C. Gillespie is associate professor, Department of Medicine, and director, Division of Educational Quality, Institute for Innovations in Medical Education, New York University Grossman School of Medicine, New York, New York
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Caceres BA, Streed CG, Corliss HL, Lloyd-Jones DM, Matthews PA, Mukherjee M, Poteat T, Rosendale N, Ross LM. Assessing and Addressing Cardiovascular Health in LGBTQ Adults: A Scientific Statement From the American Heart Association. Circulation 2020; 142:e321-e332. [PMID: 33028085 DOI: 10.1161/cir.0000000000000914] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There is mounting evidence that lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) adults experience disparities across several cardiovascular risk factors compared with their cisgender heterosexual peers. These disparities are posited to be driven primarily by exposure to psychosocial stressors across the life span. This American Heart Association scientific statement reviews the extant literature on the cardiovascular health of LGBTQ adults. Informed by the minority stress and social ecological models, the objectives of this statement were (1) to present a conceptual model to elucidate potential mechanisms underlying cardiovascular health disparities in LGBTQ adults, (2) to identify research gaps, and (3) to provide suggestions for improving cardiovascular research and care of LGBTQ people. Despite the identified methodological limitations, there is evidence that LGBTQ adults (particularly lesbian, bisexual, and transgender women) experience disparities across several cardiovascular health metrics. These disparities vary by race, sex, sexual orientation, and gender identity. Future research in this area should incorporate longitudinal designs, elucidate physiological mechanisms, assess social and clinical determinants of cardiovascular health, and identify potential targets for behavioral interventions. There is a need to develop and test interventions that address multilevel stressors that affect the cardiovascular health of LGBTQ adults. Content on LGBTQ health should be integrated into health professions curricula and continuing education for practicing clinicians. Advancing the cardiovascular health of LGBTQ adults requires a multifaceted approach that includes stakeholders from multiple sectors to integrate best practices into health promotion and cardiovascular care of this population.
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Dupras DM, Wieland ML, Halvorsen AJ, Maldonado M, Willett LL, Harris L. Assessment of Training in Health Disparities in US Internal Medicine Residency Programs. JAMA Netw Open 2020; 3:e2012757. [PMID: 32777061 PMCID: PMC7417967 DOI: 10.1001/jamanetworkopen.2020.12757] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Health disparities continue to exist despite the call to increase education of health care practitioners. An assessment of health disparities education has not been previously studied in a national cohort. OBJECTIVE To describe and compare the curriculum on health disparities from the perspective of program directors and perceptions of training among internal medicine residents. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional survey study used a survey of US internal medicine program directors, the 2015 Association of Program Directors in Internal Medicine annual survey, which included questions about health disparities curriculum, and a 1-time survey of US internal medicine residents that asked questions related to their training in health disparities on the American College of Physicians 2015 Internal Medicine In-Training Examination. All internal medicine program directors who were members of Association of Program Directors in Internal Medicine (368 of 396 accredited programs), and internal medicine residents who took the Internal Medicine In-Training Examination were eligible. Final analysis of the merged data set was completed in 2018. EXPOSURES Questions were included on the annual Association of Program Directors in Internal Medicine survey and the Internal Medicine In-Training Examination. MAIN OUTCOMES AND MEASURES Program directors reported on presence of health disparities curriculum, educational methods, quality, barriers and challenges to curriculum, and Clinical Learning Environment Review. Residents reported whether they received training and quality of the training in health disparities. RESULTS A total of 227 program directors (response rate, 61.7%) and 22 723 residents (response rate, 87.2%) responded to the surveys. A total of 90 program directors (39.6%) reported a curriculum in health disparities, but among these, only 16 program directors (17.8%) felt quality of their education was very good or excellent. In more than half of the programs (52 programs [55.9%]), outcomes of the curriculum were not measured. After merging, the combined data set included 18 883 residents from 366 APDIM member programs with 225 program director responses. Among these, 13 251 residents (70.2%) reported some training in caring for patients at risk for health disparities. Of residents who reported receiving training, 10 494 (79.2%) rated the quality as very good or excellent. CONCLUSIONS AND RELEVANCE These findings suggest that that despite the Clinical Learning Environment Review mandate and Accreditation Council for Graduate Medical Education required competencies for training in health disparities, relatively few internal medicine programs in the US provided educational curriculum. Additionally, the existence of health disparities curricula in internal medicine training programs was not associated with resident's perception of training or its quality.
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Affiliation(s)
- Denise M. Dupras
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Mark L. Wieland
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | | | | | | | - Linda Harris
- Research Center, American College of Physicians, Philadelphia, Pennsylvania
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Nowaskie D. A national survey of U.S. psychiatry residents’ LGBT cultural competency: The importance of LGBT patient exposure and formal education. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2020. [DOI: 10.1080/19359705.2020.1774848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Dustin Nowaskie
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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Affiliation(s)
- Tina Q Tan
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University.,Division of Infectious Diseases, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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45
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Sternhell-Blackwell K, Mansh M, Peebles JK. Residency Education on Sexual and Gender Minority Health. JAMA Dermatol 2020; 156:497-499. [DOI: 10.1001/jamadermatol.2020.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kara Sternhell-Blackwell
- Division of Dermatology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Matthew Mansh
- Department of Dermatology, University of Minnesota, Minneapolis
| | - J. Klint Peebles
- Department of Dermatology, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
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46
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Fakhoury JW, Daveluy S. Incorporating Lesbian, Gay, Bisexual, and Transgender Training into a Residency Program. Dermatol Clin 2019; 38:285-292. [PMID: 32115139 DOI: 10.1016/j.det.2019.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Lesbian, gay, bisexual, and transgender (LGBT) patients experience vast health care disparities. Numerous government and professional organizations have attempted to address these disparities by calling for improvement in LGBT health and increased research endeavors. Despite these initiatives, residents still receive inadequate education and training in LGBT health. Here, the authors review these shortcomings and provide a framework for how to improve resident education and training in LGBT health. They describe methods of curricular enhancements and departmental/institutional climate optimization to improve resident competency. Finally, they discuss how LGBT-competent physicians can publicize their expertise and improve overall LGBT health care delivery.
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Affiliation(s)
- Joseph W Fakhoury
- Department of Dermatology, Wayne State University School of Medicine, 18100 Oakwood Boulevard, Suite 300, Dearborn, MI 48214, USA
| | - Steven Daveluy
- Department of Dermatology, Wayne State University School of Medicine, 18100 Oakwood Boulevard, Suite 300, Dearborn, MI 48214, USA.
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47
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Ko M, Dorri A. Primary Care Clinician and Clinic Director Experiences of Professional Bias, Harassment, and Discrimination in an Underserved Agricultural Region of California. JAMA Netw Open 2019; 2:e1913535. [PMID: 31642925 PMCID: PMC6820031 DOI: 10.1001/jamanetworkopen.2019.13535] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Many rural and agricultural communities experience hardship from a shortage of clinicians. The aging of the clinician population threatens future supply in these areas. Developing policies to build a sustainable workforce requires the understanding of experiences from those currently in medical practice. Previous research about rural clinicians has primarily sampled non-Latinx white men, and to a lesser extent, non-Latinx white women; to date, no study has examined differences by race/ethnicity, sexual orientation, or gender identity. OBJECTIVE To describe the professional experiences of a diverse group of primary care clinicians and clinic directors in an underserved rural and agricultural region of California. DESIGN, SETTING, AND PARTICIPANTS In this qualitative study, semistructured in-depth qualitative interviews were performed with clinicians and clinic directors from December 1, 2017, to December 31, 2018, with a present or recent medical practice in the central San Joaquin Valley region of California. Participants (N = 26) consisted of physicians, nurse practitioners, and clinic directors practicing in primary care settings. Settings included solo and group private practice, academic training programs, community health centers, and rural health clinics. MAIN OUTCOMES AND MEASURES Personal experiences as primary care clinicians and clinic directors, and perceived associations with gender, race/ethnicity, sexual orientation, and gender identity. RESULTS Of 26 primary care clinicians and clinic directors interviewed, 16 (62%) identified as female, 12 (46%) identified as non-Latinx white, and 3 (12%) identified as a member of a sexual and gender minority group. Participants who self-identified as female, nonwhite, and of certain sexual orientation and gender identity minority groups described burnout from bias, harassment, and hostility in their professional relationships with colleagues and health care staff. These experiences intensified their feelings of community isolation and professional isolation. Harassment and institutional discrimination were factors in the decision of participants to change practices or exit the region entirely. Discriminatory acts against members of sexual and gender minority groups were the most severe, including threats to licensure and denial of hospital admitting privileges. In contrast to the minority group participants, the remaining participants expressed little to no awareness of these negative experiences, or the association between these experiences and retention. CONCLUSIONS AND RELEVANCE Professional harassment and discrimination may hamper efforts to improve clinician and clinic director recruitment and retention in underserved rural and agricultural areas and may pose barriers to addressing health disparities within those communities. Additional investigation appears to be needed to assess the extent to which professional harassment and discrimination affect clinicians and clinic directors in similar communities across the United States.
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Affiliation(s)
- Michelle Ko
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis
| | - Armin Dorri
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis
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48
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Dimant OE, Cook TE, Greene RE, Radix AE. Experiences of Transgender and Gender Nonbinary Medical Students and Physicians. Transgend Health 2019; 4:209-216. [PMID: 31552292 PMCID: PMC6757240 DOI: 10.1089/trgh.2019.0021] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To explore the experiences of transgender and gender nonbinary (TGNB) medical students and physicians in the United States. Methods: The authors conducted a 79-item online survey using Likert-type and open-ended questions to assess the experiences of TGNB-identified U.S. medical students and physicians. Variables included demographic data, disclosure of TGNB status, exposure to transphobia, and descriptions of educational and professional experiences. Recruitment was conducted using snowball sampling through Lesbian, Gay, Bisexual, Transgender, Queer professional groups, list-servs, and social media. The survey was open from June 2017 through November 2017. Results: Respondents included 21 students and 15 physicians (10 transgender women, 10 transgender men, and 16 nonbinary participants). Half (50%; 18) of the participants and 60% (9) of physicians had not disclosed their TGNB identity to their medical school or residency program, respectively. Respondents faced barriers on the basis of gender identity/expression when applying to medical school (22%; 11) and residency (43%; 6). More than three-quarters (78%; 28) of participants censored speech and/or mannerisms half of the time or more at work/school to avoid unintentional disclosure of their TGNB status. More than two-thirds (69%; 25) heard derogatory comments about TGNB individuals at medical school, in residency, or in practice, while 33% (12) witnessed discriminatory care of a TGNB patient. Conclusion: TGNB medical students and physicians faced significant barriers during medical training, including having to hide their identities and witnessing anti-TGNB stigma and discrimination. This study, the first to exclusively assess experiences of TGNB medical students and physicians, reveals that significant disparities still exist on the basis of gender identity.
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Affiliation(s)
- Oscar E Dimant
- Department of Medicine, Staten Island University Hospital, Northwell Health, New York, New York
| | - Tiffany E Cook
- Office of Diversity Affairs, NYU School of Medicine, New York, New York
| | - Richard E Greene
- Department of Medicine, NYU School of Medicine, New York, New York
| | - Asa E Radix
- Department of Medicine, NYU School of Medicine, New York, New York.,Department of Medicine, Callen-Lorde Community Health Center, New York, New York
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