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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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Bunting SR, Feinstein BA, Vidyasagar N, Sheth NK, Yu R, Hazra A. Psychiatry and Family Medicine Residents' Likelihood of Prescribing HIV Pre-exposure Prophylaxis to Patients With Mental Illness and HIV Vulnerability. J Acquir Immune Defic Syndr 2024; 96:231-240. [PMID: 38567904 DOI: 10.1097/qai.0000000000003423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/14/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND People living with mental illness (PLMI) experience disproportionately high incidence of and vulnerability to HIV. Pre-exposure prophylaxis (PrEP) is an effective and safe HIV prevention method, but data regarding prescription to PLMI are lacking. Psychiatrists may serve as important points of access for PrEP prescription for PLMI. METHODS We conducted a vignette-based study of residents in psychiatry and family medicine (FM) to assess likelihood of prescribing PrEP and assumptions about the fictional patient. Participants were randomized to one of five vignettes in which the patients' psychiatric diagnosis was varied (schizophrenia on long-acting injectable or oral antipsychotic, bipolar disorder, major depression) or a control vignette without a psychiatric diagnosis. RESULTS A total of 439 residents participated. We found that high percentages of psychiatry (96.8%) and FM (97.4%) residents were aware of PrEP. High percentages of psychiatry (92.0%-98.1%) and FM (80.8%-100%) residents reported that PrEP was indicated for all patient conditions. Family medicine residents were more likely to prescribe PrEP to all experimental conditions than psychiatry residents. There was no difference in likelihood of prescribing to the control condition without a psychiatric diagnosis. The belief that PrEP prescription was out of scope of practice was greater among psychiatry residents. CONCLUSIONS A majority of psychiatry residents responded that PrEP was indicated for an array of patients with psychiatric diagnoses. However, psychiatry residents were broadly less likely to prescribe PrEP to patients with these diagnoses. The high percentage of psychiatry residents who reported that PrEP was indicated for all patients suggests that additional training is needed to facilitate PrEP prescription by psychiatrists.
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Affiliation(s)
- Samuel R Bunting
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine, Chicago, IL
| | - Brian A Feinstein
- Department of Psychology, College of Health Professions, Rosalind Franklin University, North Chicago, IL
| | - Nitin Vidyasagar
- Pritzker School of Medicine, The University of Chicago, Chicago, IL
| | - Neeral K Sheth
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL; and
| | - Roger Yu
- Pritzker School of Medicine, The University of Chicago, Chicago, IL
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, Department of Medicine, The University of Chicago Medicine, Chicago, IL
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Bunting SR, Feinstein BA, Bertram C, Hazra A, Sheth NK, Garber SS. Effects of knowledge and implicit biases on pharmacy students' decision-making regarding pre-exposure prophylaxis for HIV prevention: A vignette-based experimental study. CURRENTS IN PHARMACY TEACHING & LEARNING 2023; 15:139-148. [PMID: 36898891 PMCID: PMC10545445 DOI: 10.1016/j.cptl.2023.02.019] [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: 03/16/2022] [Revised: 10/27/2022] [Accepted: 02/23/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Men who have sex with men (MSM), especially Black MSM, are disproportionately affected by HIV and experience disparate prescription of pre-exposure prophylaxis (PrEP) for HIV prevention compared to White MSM. While pharmacists are essential in efforts to scale-up PrEP, little is known about the role of knowledge and implicit biases in pharmacy students' decision-making regarding PrEP, which may elucidate mechanisms for improving PrEP access and addressing disparities. METHODS A nationwide, cross-sectional study of pharmacy students in the United States was conducted. A fictional White or Black MSM seeking PrEP was presented. Participants completed measures of PrEP/HIV knowledge, implicit racism and heterosexism, assumptions about the patient's behavior (condomless sex, extra-relational sex, adherence to PrEP), and confidence providing PrEP-related care. RESULTS A total of 194 pharmacy students completed the study. Compared to the White patient, the Black patient was assumed to be less adherent to PrEP if prescribed. In contrast, assumptions of sexual risk behaviors if prescribed PrEP and confidence providing PrEP-related care did not differ. Additionally, implicit racism was associated with lower confidence providing PrEP-related care, whereas PrEP/HIV knowledge, implicit sexual orientation bias, and assumed sexual risk behaviors if prescribed PrEP were not associated with confidence. CONCLUSIONS Pharmacists are essential in efforts to scale-up PrEP prescription, making pharmacy education about PrEP for HIV prevention critical. These findings suggest that implicit bias awareness training is needed. This training may reduce the influence of implicit racial bias on confidence providing PrEP-related care and improve knowledge of HIV and PrEP.
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Affiliation(s)
- Samuel R Bunting
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago Medicine, 5841 S. Maryland Avenue, MC 3077, Chicago, IL 60637, United States.
| | - Brian A Feinstein
- Department of Psychology, College of Health Professions, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, United States.
| | - Christie Bertram
- Department of Pharmacy Practice, College of Pharmacy, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, United States.
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, Department of Medicine, The University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637, United States.
| | - Neeral K Sheth
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1620 West Harrison St., Chicago, IL 60612, United States.
| | - Sarah S Garber
- Department of Pharmaceutical Science, College of Pharmacy, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, United States.
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Feinstein BA, Chang CJ, Bunting SR, Bahrke J, Hazra A, Garber SS. Willingness to Prescribe PrEP to Bisexual Men Depends on Genders of Their Past Partners: A Study of Medical Students in the USA. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2535-2547. [PMID: 35689147 DOI: 10.1007/s10508-022-02337-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/23/2022] [Accepted: 04/08/2022] [Indexed: 06/15/2023]
Abstract
Bisexual men are at increased risk for HIV compared to heterosexual men but unlikely to use pre-exposure prophylaxis (PrEP). Given that biases may influence whether bisexual men are prescribed PrEP, we examined whether medical students' decision-making was influenced by the genders of a bisexual male patient's partners. Medical students (N = 718) were randomized to one of nine conditions where they answered questions about a bisexual male patient after reviewing his electronic medical record. We manipulated the gender of his current partner (none, male, female) and the genders of his past partners (male, female, both). Current partners were described as living with HIV and not yet virally suppressed, past partners were described as being of unknown HIV-status, and condom use was described as intermittent with all partners. When the patient was not in a current relationship, perceived HIV risk and likelihood of prescribing PrEP were lowest if he only had female partners in the past. When he was in a current relationship, perceived HIV risk and likelihood of prescribing PrEP did not differ based on current or past partners' genders. In addition, identification as a PrEP candidate, perceived likelihood of adherence, and perceived likelihood of engaging in condomless sex if prescribed were lower when the patient was not in a current relationship. Medical students appropriately prioritized the status of the partner living with HIV, but their decision-making was influenced by past partner genders when the patient was not in a current relationship. Medical students may require additional education to ensure they understand PrEP eligibility criteria and make decisions based on patients' individual presentations.
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Affiliation(s)
- Brian A Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd., North Chicago, IL, 60064, USA.
| | - Cindy J Chang
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA
| | - Samuel R Bunting
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine, Chicago, IL, USA
| | - Jesse Bahrke
- Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd., North Chicago, IL, 60064, USA
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Sarah S Garber
- College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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Pharmacy-Based Interventions to Increase Use of HIV Pre-exposure Prophylaxis in the United States: A Scoping Review. AIDS Behav 2022; 26:1377-1392. [PMID: 34669062 PMCID: PMC8527816 DOI: 10.1007/s10461-021-03494-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 12/15/2022]
Abstract
HIV pre-exposure prophylaxis (PrEP) remains underutilized in the U.S. Since greater than 85% of PrEP prescriptions are filled at commercial pharmacies, pharmacists are uniquely positioned to increase PrEP use. This scoping review explores pharmacy-based initiatives to increase PrEP use. We searched PubMed, PsycINFO, CINAHL, and Scopus for peer-reviewed studies on pharmacist-led interventions to increase PrEP use or pharmacy-based PrEP initiatives. Forty-nine articles were included in this review. Overall, studies demonstrated that patients expressed strong support for pharmacist prescription of PrEP. Three intervention designs compared changes in PrEP initiation or knowledge pre- and post-intervention. Commentary/review studies recommended PrEP training for pharmacists, policy changes to support pharmacist screening for HIV and PrEP prescription, and telemedicine to increase prescriptions. Pharmacists could play key roles in improving PrEP use in the U.S. Studies that assess improvements in PrEP use after interventions such as PrEP prescription, PrEP-specific training, and adherence monitoring by pharmacists are needed.
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Bunting SR, Feinstein BA, Hazra A, Garber SS. Effects of Patient Sexual Orientation and Gender Identity on Medical Students' Decision Making Regarding Preexposure Prophylaxis for Human Immunodeficiency Virus Prevention: A Vignette-Based Study. Sex Transm Dis 2021; 48:959-966. [PMID: 34050098 PMCID: PMC8595697 DOI: 10.1097/olq.0000000000001488] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Preexposure prophylaxis (PrEP) is a pillar of our national strategy to end the human immunodeficiency virus (HIV) epidemic. However, one of the largest obstacles to realizing the effectiveness of PrEP is expansion of prescription to all patients at risk for HIV. In this vignette-based study, we sought to investigate medical students' decision making regarding PrEP by presenting fictional patients, all of whom had HIV risk factors based on sexual behavior. METHODS We systematically varied patients' sexual orientation or gender identity (heterosexual female, gay male, bisexual male, transgender male, transgender female, gender nonbinary person). We assessed the medical students' willingness to prescribe PrEP to the patients, as well as their perceptions of the patients' HIV risk and behavior. RESULTS A total of 670 US medical students completed the study. The heterosexual female patient was least frequently identified as a PrEP candidate, was viewed as least likely to adhere to PrEP, and the most likely to engage in condomless sex if prescribed PrEP; however, was considered at lower overall HIV risk. Lower perceived HIV risk and anticipated PrEP adherence were both associated with lower willingness to prescribe PrEP. Willingness to prescribe PrEP was highest for the gay male patient and lowest for the heterosexual female. CONCLUSIONS These analyses suggest that assumptions about epidemiological risk based on patients' gender identity or sexual orientation may reduce willingness to prescribe PrEP to heterosexual women, ultimately hindering uptake in this critical population.
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Affiliation(s)
- Samuel R. Bunting
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL, USA
| | - Brian A. Feinstein
- Department of Psychology, College of Health Professions, Rosalind Franklin University, North Chicago, IL, USA
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Sarah S. Garber
- College of Pharmacy, Rosalind Franklin University, North Chicago, IL, USA
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Bunting SR, Feinstein BA, Hazra A, Sheth NK, Garber SS. Knowledge of HIV and HIV pre-exposure prophylaxis among medical and pharmacy students: A national, multi-site, cross-sectional study. Prev Med Rep 2021; 24:101590. [PMID: 34976649 PMCID: PMC8683973 DOI: 10.1016/j.pmedr.2021.101590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/27/2021] [Accepted: 10/03/2021] [Indexed: 01/19/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) is a highly effective strategy for preventing HIV. However, prescription of PrEP has not reached the scale that is necessary to meet the public health need of reducing HIV incidence. A factor contributing to this slow scale-up is limited healthcare practitioners' knowledge of PrEP, making PrEP education a priority. We conducted a national, cross-sectional study of medical (allopathic and osteopathic) and pharmacy students regarding knowledge of PrEP and HIV between October 2020 and February 2021. We included 28 items in our knowledge assessment. Analysis sought to identify gaps in knowledge as well as academic and demographic correlates of knowledge. A total of 2,353 students participated in the study (response rate = 17.0%). The overall mean HIV knowledge score was 79.6% correct. Regarding specific items, 68.7% of participants believed HIV treatment was difficult because it required many pills, and 61.1% incorrectly indicated a person with an undetectable HIV viral load could transmit the virus to their sexual partners. Overall mean PrEP knowledge was 84.1%. Approximately one-third of participants did not identify HIV-negative status as a requirement to be a PrEP candidate. Gay/lesbian participants and those who were in the late-phase of training reported higher knowledge of both HIV and PrEP than did heterosexual participants and those in the early-phase of training. This study identifies specific gaps in training on HIV prevention with PrEP that must be improved in health professions education to ensure PrEP reaches its full potential in ending the HIV epidemic.
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Affiliation(s)
- Samuel R Bunting
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago Medical Center, Chicago, IL, USA
| | - Brian A Feinstein
- Department of Psychology, College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, Department of Medicine, The University of Chicago Medical Center, Chicago, IL, USA
| | - Neeral K Sheth
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sarah S Garber
- College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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Bunting SR, Calabrese SK, Garber SS, Ritchie TD, Batteson TJ. Where Do Health Professions Students Learn About Pre-exposure Prophylaxis (PrEP) for HIV Prevention? MEDICAL SCIENCE EDUCATOR 2021; 31:423-427. [PMID: 34457900 PMCID: PMC8368481 DOI: 10.1007/s40670-021-01265-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 05/14/2023]
Abstract
UNLABELLED HIV pre-exposure prophylaxis (PrEP) is critical for ending the HIV epidemic, and a necessary part of health professions education. We present data from a US survey study (N = 2085) about educational experiences (coursework and extracurricular), in which medical, physician assistant, nursing, and pharmacy students received training about HIV risk factors and PrEP. We found a discrepancy between the percentage of courses covering HIV risk factors (84.7%) compared to PrEP (54.6%) for all students (P < .001), and specifically among final-year students (92.0% vs. 59.7%; P < .001). Pharmacology courses were the most common exposure to PrEP (46.0%), and 61.3% of students were introduced to PrEP through an extracurricular experience. Health professions education must present HIV risk factors in conjunction with PrEP. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-021-01265-3.
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Affiliation(s)
- Samuel R. Bunting
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, 60064 IL USA
| | - Sarah K. Calabrese
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Sarah S. Garber
- Department of Pharmaceutical Sciences, College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, IL USA
| | | | - Tamzin J. Batteson
- DeWitt C. Baldwin Institute for Interprofessional Education, Rosalind Franklin University of Medicine and Science, North Chicago, IL USA
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