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Jewell TI, Petty EM. LGBTQ+ health education for medical students in the United States: a narrative literature review. MEDICAL EDUCATION ONLINE 2024; 29:2312716. [PMID: 38359164 PMCID: PMC10877666 DOI: 10.1080/10872981.2024.2312716] [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: 09/18/2023] [Accepted: 01/26/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION People who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, and other sexual/gender minorities (LGBTQ+) may experience discrimination when seeking healthcare. Medical students should be trained in inclusive and affirming care for LGBTQ+ patients. This narrative literature review explores the landscape of interventions and evaluations related to LGBTQ+ health content taught in medical schools in the USA and suggests strategies for further curriculum development. METHODS PubMed, ERIC, and Education Research Complete databases were systematically searched for peer-reviewed articles on LGBTQ+ health in medical student education in the USA published between 1 January 2011-6 February 2023. Articles were screened for eligibility and data was abstracted from all eligible articles. Data abstraction included the type of intervention or evaluation, sample population and size, and key outcomes. RESULTS One hundred thirty-four articles met inclusion criteria and were reviewed. This includes 6 (4.5%) that evaluate existing curriculum, 77 (57.5%) study the impact of curriculum components and interventions, 36 (26.9%) evaluate student knowledge and learning experiences, and 15 (11.2%) describe the development of broad learning objectives and curriculum. Eight studies identified student knowledge gaps related to gender identity and affirming care and these topics were covered in 34 curriculum interventions. CONCLUSION Medical student education is important to address health disparities faced by the LGBTQ+ community, and has been an increasingly studied topic in the USA. A variety of curriculum interventions at single institutions show promise in enhancing student knowledge and training in LGBTQ+ health. Despite this, multiple studies indicate that students report inadequate education on certain topics with limitations in their knowledge and preparedness to care for LGBTQ+ patients, particularly transgender and gender diverse patients. Additional integration of LGBTQ+ curriculum content in areas of perceived deficits could help better prepare future physicians to care for LGBTQ+ patients and populations.
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Affiliation(s)
- Tess I. Jewell
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Elizabeth M. Petty
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Macedo A, Aurindo M, Febra C. Effectiveness of undergraduate medical students training on LGBTQIA + people health: a systematic review and meta-analysis. BMC MEDICAL EDUCATION 2024; 24:63. [PMID: 38229060 DOI: 10.1186/s12909-024-05041-w] [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: 05/21/2023] [Accepted: 01/06/2024] [Indexed: 01/18/2024]
Abstract
BACKGROUND Adequacy of learning models and their ability to engage students and match session's objectives are critical factors in achieving the desired outcome. In this systematic review and meta-analysis, we assess the methodological approach, content, and effectiveness of training initiatives addressing medical students' knowledge, attitudes, confidence and discrimination perception towards LGBTQIA + people. METHOD PubMed, Web of Science, Medline and Scopus were searched to identify published studies, from 2013 to 2023, on effectiveness of training initiatives addressing medical students' knowledge, attitudes, confidence and discrimination perception towards LGBTQIA + people. The risk of bias of the selected studies was assessed by the Medical Education Research Study Quality Instrument. Overall effect sizes were calculated using a Mantel-Haenszel method, fixed effect meta-analyses. RESULTS A total of 22 studies were included, representing 2,164 medical students. The interventions were highly diverse and included seminars, lectures, videos, real-case discussions, roleplay, and group discussions with people from the LGBTQIA + community. After the interventions, there was a significant improvement in self-confidence and comfort interacting with patients and in the understanding of the unique and specific health concerns experienced by LGBTQIA + patients. CONCLUSION Our findings indicated that the outcomes of interventions training actions for medical students that promote knowledge and equity regarding LGBTQIA + people, regardless of their scope, methodology and duration, result in a considerable increase in students' self-confidence and comfort interacting with LGBTQIA + patients, highlight the need for more actions and programs in this area promoting a more inclusive society and greater equity.
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Affiliation(s)
- Ana Macedo
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Edifício 2 - Ala Norte Campus de Gambelas, Faro, 8005-139, Portugal.
- ABC Clinical Reseach Center, Algarve Biomedical Center (ABC), Edifício 2 - Ala Norte Campus de Gambelas, Faro, 8005-139, Portugal.
| | - Maria Aurindo
- National Statistical institute of Portugal, Lisboa, Portugal
| | - Cláudia Febra
- Faculty of Medicine, University of Porto, Porto, Portugal
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Voultsos P, Papana A, Alexandri S, Zymvragou CE. Transgender Attitudes and Beliefs Scale-Greek (TABS-Gr) version: translation and initial evaluation of psychometric properties among medical students. BMC MEDICAL EDUCATION 2023; 23:704. [PMID: 37759217 PMCID: PMC10523621 DOI: 10.1186/s12909-023-04666-7] [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: 03/03/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Transgender people face significantly greater discrimination and health disparities in health care settings than cisgender people. The role of education in eliminating this phenomenon has been increasingly recognized by many medical schools. However, transgender health content is sparse or lacking in the medical curricula of many countries. METHOD This study was designed to validate the Greek version of the Transgender Attitudes and Beliefs Scale (TABS-Gr). The study adopted a cross-sectional, comparative-descriptive research design. Participants (N = 203) were contacted through online recruitment and invited to complete an anonymous web-based survey. The data were collected between December 2022 and February 2023. RESULTS The overall reliability of the TABS-Gr questionnaire was high (Cronbach's α = 0.961, p. from Hotelling's T-squared test < 0.000). High Cronbach's alpha values were estimated for the three subscales, with α = 0.958 for Interpersonal Comfort, α = 0.906 for Gender Beliefs, and α = 0.952 for Human Values. Hotelling's T-squared test confirmed that all items on the scale had the same mean (p < 0.001 for all subgroups). Explanatory factor analysis (EFA) demonstrated adequate fit. Convergent and discriminant validity were validated based on the estimated correlations. The three-factor structure of the Greek TABS version was confirmed. The mean total score was 155.95 (SD = 30.63), indicating that medical students had a moderately positive attitude towards transgender people. Participants showed significantly less biased (more tolerant, positive) attitudes towards transgender people on the Interpersonal Comfort (IC) and Human Value (HV) subscales than on the Sex/Gender Beliefs (SGB) subscale. A demographic comparison was conducted and demonstrated a correlation between scores and sociodemographics, except for place of origin. A statistically significant increase in the total mean score was estimated for women compared to men. CONCLUSION The overall psychometric findings provide some evidence to support the validity of the Greek version of the TABS. However, we call for further validation research in Greek medical schools. Since our claims for validity are based in part on an exploratory factor analysis, a future confirmatory factor analysis (CFA) is part of our call for further validation research. While the results of this study are mostly in line with the results of previous research, some nuances were identified. These results may inform educators, medical school curricula and education policy-makers.
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Affiliation(s)
- Polychronis Voultsos
- Laboratory of Forensic Medicine & Toxicology (Division: Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, Thessaloniki, GR 54124, Greece.
| | - Angeliki Papana
- School of Mathematics, Aristotle University, University Campus, Thessaloniki, GR 54124, Greece
| | - Stella Alexandri
- Laboratory of Forensic Medicine & Toxicology (Division: Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, Thessaloniki, GR 54124, Greece
| | - Christina-Erato Zymvragou
- Laboratory of Forensic Medicine & Toxicology (Division: Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, Thessaloniki, GR 54124, Greece
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Grant W, Adan MA, Samurkas CA, Quigee D, Benitez J, Gray B, Carnevale C, Gordon RJ, Castor D, Zucker J, Sobieszczyk ME. Effect of Participative Web-Based Educational Modules on HIV and Sexually Transmitted Infection Prevention Competency Among Medical Students: Single-Arm Interventional Study. JMIR MEDICAL EDUCATION 2023; 9:e42197. [PMID: 36692921 PMCID: PMC9906317 DOI: 10.2196/42197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/30/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The number of new HIV diagnoses in the United States continues to slowly decline; yet, transgender women and men who have sex with men remain disproportionately affected. Key to improving the quality of prevention services are providers who are comfortable broaching the subjects of sexual health and HIV prevention with people across the spectrum of gender identities and sexual orientations. Preservice training is a critical point to establish HIV prevention and sexual health education practices before providers' practice habits are established. OBJECTIVE The study aimed to develop participative web-based educational modules and test their impact on HIV prevention knowledge and awareness in future providers. METHODS Sexual health providers at an academic hospital, research clinicians, community engagement professionals, and New York City community members were consulted to develop 7 web-based educational modules, which were then piloted among medical students. We assessed knowledge of HIV and sexually transmitted infection prevention and comfort assessing the prevention needs of various patients via web-based questionnaires administered before and after our educational intervention. We conducted exploratory factor analysis of the items in the questionnaire. RESULTS Pre- and postmodule surveys were completed by 125 students and 89 students, respectively, from all 4 years of training. Before the intervention, the majority of students had heard of HIV pre-exposure prophylaxis (122/123, 99.2%) and postexposure prophylaxis (114/123, 92.7%). Before the training, 30.9% (38/123) of the students agreed that they could confidently identify a patient who is a candidate for pre-exposure prophylaxis or postexposure prophylaxis; this increased to 91% (81/89) after the intervention. CONCLUSIONS Our findings highlight a need for increased HIV and sexually transmitted infection prevention training in medical school curricula to enable future providers to identify and care for diverse at-risk populations. Participative web-based modules offer an effective way to teach these concepts.
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Affiliation(s)
- William Grant
- Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Matthew A Adan
- Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, United States
| | - Christina A Samurkas
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Daniela Quigee
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Jorge Benitez
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Brett Gray
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Caroline Carnevale
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Rachel J Gordon
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Delivette Castor
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Jason Zucker
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Magdalena E Sobieszczyk
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY, United States
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Brandt G, Stobrawe J, Korte S, Prüll L, Laskowski NM, Halbeisen G, Paslakis G. Medical Students' Perspectives on LGBTQI+ Healthcare and Education in Germany: Results of a Nationwide Online Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10010. [PMID: 36011644 PMCID: PMC9408586 DOI: 10.3390/ijerph191610010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/30/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
The healthcare needs of lesbian, gay, bisexual, trans*, queer, and intersex (LGBTQI+) persons are often overlooked, prompting national and international calls to include diversity-related competencies into medical students' training. However, LGBTQI+-focused healthcare education targets remain elusive, as surveys reveal considerable variability across national student populations. To generate empirical data and vocalize recommendations for medical education, we conducted the first nationwide online survey among 670 German medical students from 33 universities. Overall, most respondents reported low confidence regarding their medical training preparing them for LGBTQI+ patients, stated that LGBTQI+ themes were not covered during training, and agreed that the inclusion of such themes is urgently needed. In addition, we found gender and LGBTQI+ community member status to be key variables. Men scored lower in knowledge than women, while community members scored higher than non-community members. Similarly, community members reported higher comfort levels. Non-community men showed the highest levels of prejudice and efficacy beliefs, while at the same time had the lowest scores in contacts and the perceived importance of LGBTQI+-related teaching. Keeping subgroup differences in mind, we recommend that educational training should include LGBTQI+ healthcare aspects and address self-efficacy beliefs in future medical professionals to overcome LGBTQI+ healthcare disparities.
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Affiliation(s)
- Gerrit Brandt
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Virchowstr. 65, 32312 Luebbecke, Germany
| | - Jule Stobrawe
- German Medical Students’ Association (BVMD e.V.), Standing Committee on Sexual and Reproductive Health and Rights including HIV and AIDS (SCORA), 10115 Berlin, Germany
| | - Sophia Korte
- German Medical Students’ Association (BVMD e.V.), Standing Committee on Sexual and Reproductive Health and Rights including HIV and AIDS (SCORA), 10115 Berlin, Germany
| | - Livia Prüll
- Institute of Functional and Clinical Anatomy, University Medical Center Mainz, 55131 Mainz, Germany
| | - Nora M. Laskowski
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Virchowstr. 65, 32312 Luebbecke, Germany
| | - Georg Halbeisen
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Virchowstr. 65, 32312 Luebbecke, Germany
| | - Georgios Paslakis
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Virchowstr. 65, 32312 Luebbecke, Germany
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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: 33] [Impact Index Per Article: 16.5] [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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