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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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Jerala N, Petek D. Enhancing LGBT + primary healthcare in Slovenia: A national qualitative study of experiences and expectations of LGBT + people and family doctors. Eur J Gen Pract 2024; 30:2373121. [PMID: 38979662 PMCID: PMC11271072 DOI: 10.1080/13814788.2024.2373121] [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] [Received: 11/25/2023] [Revised: 03/30/2024] [Accepted: 06/11/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Despite growing acceptance of LGBT + individuals, an underlying stigma persists even in healthcare, resulting in substandard care and worse healthcare outcomes for LGBT + individuals. OBJECTIVES To examine and compare the experiences and expectations regarding primary healthcare among LGBT + individuals and general practitioners (GPs) in Slovenia. METHODS We conducted an online national qualitative study using open-ended questions. To reach LGBT + population snowball method of recruitment was employed by sharing the questionnaire through LGBT + organisations, while GPs were invited by email of Association of family doctors in Slovenia. Anonymous data was collected from October to December 2021 and the questionnaires of 25 GPs and 90 LGBT + individuals of various ages, backgrounds, gender identities and sexual orientations were reviewed using thematic analysis. RESULTS Both LGBT + participants and GPs expressed a desire for equal treatment. However, while all GPs claimed to treat all patients equally, LGBT + participants reported more varied experiences. Specific knowledge, especially on LGBT + terminology and healthcare, was perceived as lacking among GPs, leading LGBT + individuals to seek advice from specialists or community counselling. Systemic barriers, including societal stigmatisation and limited formal education on LGBT + issues, were identified, highlighting the need for designated safe spaces and improved GP training. Safety emerged as a central theme, crucial for fostering trust and disclosure between patients and healthcare providers. CONCLUSION The study underscores the significance of a sense of safety in the patient-doctor relationship and highlights the need for improved training and attitudes to provide inclusive and affirming healthcare for LGBT + individuals.
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Affiliation(s)
- Nina Jerala
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Davorina Petek
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Valenti K, Doyon K, Morgan B, Quinn G, Bekelman D. My Partner Is My Family: Engaging and Advocating for Lesbian, Gay, Bisexual, Transgender, Queer+ Patients in Goals of Care Conversations. J Hosp Palliat Nurs 2024; 26:212-218. [PMID: 38683581 DOI: 10.1097/njh.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
In goals of care conversations and through the care trajectory, to avoid insensitive or discriminatory care, it is vital clinicians recognize lesbian, gay, bisexual, transgender, queer+ patients' values and wishes. In clinical settings, implicit bias operating within unconscious awareness may challenge the commitment to equitable care, negatively affecting patient outcomes. In this composite case, during a conversation with a social worker/nurse team, a cisgender woman repeatedly expressed her wishes for her female partner to be her decision maker instead of her biological family. The conversation stalled during the patient's attempts to identify her partner as her most valued and trusted person. Interviewer follow-up responses based on motivational interviewing techniques, which do not include strategies for lesbian, gay, bisexual, transgender, queer+ interactions, inaccurately reflected the patient's needs. Two ethical issues emerged, (1) autonomy and (2) beneficence. Clinicians should approach all patients using nongendered language, and allow patients to self-identify and decide which people are in their support system. Lack of inclusivity training has significant potential to affect the patient experience and decrease clinician/patient trust. Clinicians should not assume the decision maker is a cisgender, heterosexual partner or a biological family member. When patients speak about their partners, it is imperative clinicians use the patient's language and not avoid or redirect responses.
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Handlovsky I, Amato AT, Ferlatte O, Kia H, Gagnon M, Worthington C. Examining the Influence of Pre-HAART Experiences on Older, Self-Identifying Gay Men's Contemporary Constructions of Quality of Life (QOL). JOURNAL OF HOMOSEXUALITY 2024; 71:1880-1899. [PMID: 37192266 DOI: 10.1080/00918369.2023.2212100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Some older gay men (50+) experience diminished quality of life (QOL) due to historical and ongoing discrimination in addition to living through a collective trauma-the pre-HAART era of the HIV/AIDS epidemic-characterized by the absence of treatment and rampant discrimination targeting gay men. A growing body of literature, however, illustrates that older gay men demonstrate remarkable resilience but little is known about how QOL is conceptualized and how these conceptualizations are potentially shaped by pre-HAART experiences. The current study drew on constructivist grounded theory methods to examine how QOL is conceptualized in light of the sociohistorical relevance of pre-HAART. Twenty Canadian based gay men aged 50+ participated in semi-structured interviews via Zoom. Ultimately, QOL is understood as experiencing contentment, which is made possible by the development and implementation of three key processes: (1) developing and cultivating meaningful connections, (2) growing into and embracing identity, and (3) appreciating the capacity to do what brings joy. QOL for this group is greatly informed by a context of disadvantage, and the demonstrated resilience warrants further investigation to meaningfully support the overall well-being of older gay men.
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Affiliation(s)
- Ingrid Handlovsky
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
| | - Anthony T Amato
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Olivier Ferlatte
- École de Santé Publique de l'Université de Montréal, Montreal, Quebec, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Hannah Kia
- UBC School of Social Work, Vancouver, British Columbia, Canada
| | - Marilou Gagnon
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
- Canadian Institute for Substance Use Research, Victoria, British Columbia, Canada
| | - Catherine Worthington
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
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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. [PMID: 38914001 DOI: 10.7326/m24-0636] [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] [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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Burnett C, Boehmer U, Jesdale BM. Perceptions of patient-provider communications with healthcare providers among sexual and gender minority individuals in the United States. PATIENT EDUCATION AND COUNSELING 2024; 127:108347. [PMID: 38968873 DOI: 10.1016/j.pec.2024.108347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/17/2024] [Accepted: 06/06/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVES To identify perceived differences in the key domains of patient-provider communications between sexual and gender minority (SGM) and non-SGM patients. METHODS We reviewed data from the Health Information National Trends Survey (HINTS) to assess patient perspectives on different domains of patient-provider communications in the ideological framework by Epstein and Street (2007) [1]. Between SGM-identified (N = 491) and cisgender, heterosexual respondents (N = 7426), we assessed the proportions of responses to survey questions about the six domains of patient-provider communications and calculated odds ratios (OR) with 95 % confidence intervals (CI) (N = 7917). RESULTS Overall, compared to cisgender, heterosexual individuals, fewer SGM individuals reported always experiencing optimal patient-provider communications across all domains, most notably in areas of emotional support (OR=0.70, 95 % CI: (0.51, 0.97)), patient self-management (OR=0.73, 95 % CI: (0.54, 0.99)), and managing uncertainty (OR=0.68, 95 % CI: (0.49, 0.94)). CONCLUSION Further research on detailed SGM patient perceptions of their relationships with healthcare providers is needed to understand why such differences in communication exist and provide practical recommendations to improve care delivery. PRACTICE IMPLICATIONS SGM patients perceive their current provider communications to be suboptimal, so we must improve emotional management training in future provider-based SGM competency trainings and encourage patient self-management during individual provider encounters.
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Affiliation(s)
- Colin Burnett
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA.
| | - Ulrike Boehmer
- Boston University School of Public Health, Boston, MA, USA
| | - Bill M Jesdale
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
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LeBlanc ME, Trinh MH, Zubizarreta D, Reisner SL. Healthcare stereotype threat, healthcare access, and health outcomes in a probability sample of U.S. transgender and gender diverse adults. Prev Med Rep 2024; 42:102734. [PMID: 38659996 PMCID: PMC11039338 DOI: 10.1016/j.pmedr.2024.102734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
Background Health inequities among transgender and gender diverse (TGD) populations are well-documented and may be partially explained by the complex social power dynamics that lead to stigmatization. Healthcare Stereotype Threat (HCST) refers to the fear and threat of being perceived negatively based on identity-related stereotypes and may influence health and healthcare experiences. Few studies have investigated associations of HCST with healthcare access and health outcomes for TGD individuals. Methods We analyzed the U.S. Transgender Population Health Survey, a cross-sectional national probability sample of 274 TGD adults recruited April 2016-December 2018. Participants self-reported HCST through a 4-item scale. We estimated prevalence ratios (PR) for the association between HCST and binary healthcare access indicators and health outcomes using Poisson models with robust variance. Prevalence ratios (PR) were estimated using negative binomial models for the association between HCST and number of past-month poor physical and mental health days. Models adjusted for sociodemographics and medical gender affirmation. Results The mean age was 34.2 years; 30.9 % identified as transgender men, 37.8 % transgender women, and 31.3 % genderqueer/nonbinary. HCST threat was associated with increased prevalence of not having a personal doctor/healthcare provider (PR = 1.25; 95 %CI = 1.00-1.56) and reporting fair/poor general health vs good/very good/excellent health (PR = 1.92; 95 %CI = 1.37-2.70). Higher HCST was also associated with more frequent past-month poor physical (PR = 1.34; 95 %CI = 1.12-1.59) and mental (PR = 1.49; 95 %CI = 1.33-1.66) health days. Conclusion HCST may contribute to adverse healthcare access and health outcomes in TGD populations, though prospective studies are needed. Multilevel interventions are recommended to create safe, gender-affirming healthcare environments that mitigate HCST.
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Affiliation(s)
- Merrily E. LeBlanc
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, United States
- Department of Sociology and Anthropology, Northeastern University, 900 Renaissance Park, 1135 Tremont St, Boston, MA 02120, United States
| | - Mai-Han Trinh
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
| | - Dougie Zubizarreta
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, United States
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
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Boddu SP, Gill VS, Haglin JM, Brinkman JC, Deckey DG, Bingham JS. Lower Income and Nonheterosexual Orientation Are Associated With Poor Access to Care in Patients With Knee Osteoarthritis. Arthroplast Today 2024; 27:101353. [PMID: 38774403 PMCID: PMC11106826 DOI: 10.1016/j.artd.2024.101353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/20/2024] [Accepted: 02/14/2024] [Indexed: 05/24/2024] Open
Abstract
Background Social determinants of health are implicated in the experience of knee osteoarthritis, a key component of which is access to care and healthcare utilization. The objective of this study was to describe difficulties in access to care and healthcare utilization in the United States knee osteoarthritis population. Methods The publicly available All of Us Database was utilized to conduct a retrospective cohort study. Patients with a diagnosis of knee osteoarthritis were included and matched to a control group who did not have knee osteoarthritis. The association of knee osteoarthritis and patient-specific demographic features with self-reported domains of access to care was analyzed. Results Among 15,718 patients with knee osteoarthritis, 27.6% reported delayed care (n = 4343), 25.6% reported inability to afford care (n = 4015), 12.8% reported skipped medications (n = 2011), and 1.6% reported not seeing a healthcare provider in over 1 year (n = 247). Patients with knee osteoarthritis were more likely to be unable to afford care (odds ratio 1.21, P < .001) or skip medications (odds ratio 1.12, P = .004) in comparison to matched patients without knee osteoarthritis. Among the knee osteoarthritis cohort, low income and nonheterosexual orientation were both associated with increased rates of delayed care and an inability to afford care. Conclusions Patients with knee osteoarthritis report significant challenges with delayed care, affordability of care, and medication adherence. Among patients with knee osteoarthritis, patients who are younger age, female sex, low-income, low-education, nonheterosexual orientation, or have poor physical and mental health are at increased risk of having decreased access to treatment.
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Affiliation(s)
- Sayi P. Boddu
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Vikram S. Gill
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Jack M. Haglin
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | | | - David G. Deckey
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
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Huynh DJ, Paul S, Duong N. Promoting allyship to support and uplift the LGBTQIA+ community. Nat Rev Gastroenterol Hepatol 2024; 21:368-369. [PMID: 38580787 DOI: 10.1038/s41575-024-00928-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
- Daniel J Huynh
- Department of Medicine, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Sonali Paul
- Center for Liver Diseases, University of Chicago Medicine, Chicago, IL, USA
| | - Nikki Duong
- Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA, USA.
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Lo Moro G, Brescia V, Scaioli G, De Angelis A, Siliquini R, Bert F. Mapping research on LGBT+ persons' health: a bibliometric analysis. Perspect Public Health 2024; 144:174-181. [PMID: 38757938 DOI: 10.1177/17579139241247758] [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: 05/18/2024]
Abstract
AIMS Lesbian, gay, bisexual, transgender and other people (LGBT+) individuals may have a greater risk of experiencing mental and physical health issues. In the past years, the predominant theme of research was HIV/AIDS and sexually transmitted infections (STIs). This study aimed to explore the most recent patterns in medical research concerning LGBT+ persons. METHODS A bibliometric analysis using Biblioshiny was conducted. Based on previous studies, years of observation ranged between 2008 and 2021. Web of Science Core Collection was used. RESULTS A total of 31,039 articles were selected. Top journals centered around HIV/AIDS and STIs (n = 6), followed by sexual behaviors/sexuality (n = 2) and LGBT+ health (n = 2). The US led in research output (n = 16,249). Papers were categorized into three main clusters (which showed different evolution across time): one addressing HIV/AIDS, STIs, and sexual behaviors, another focusing on mental health, discrimination, and stigma, and a third, smaller cluster examining transgender, intersex, and gender-diverse health. CONCLUSIONS This article highlighted a growth in LGBT+ health research, uncovering research disparities among countries. While HIV/AIDS and STIs still dominated, a crucial theme concerning mental health, discrimination, and stigma has been rising. Declining interest in gender-diverse health, and disparities in research attention to different LGBT+ subgroups, underscored the need for more comprehensive and inclusive research to address complex health disparities.
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Affiliation(s)
- G Lo Moro
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - V Brescia
- Department of Management, University of Turin, Turin, Italy
| | - G Scaioli
- Department of Public Health and Paediatric Sciences, University of Turin, Via Santena 5 bis, 10126 Turin, Italy
| | - A De Angelis
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - R Siliquini
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
- AOU City of Health and Science of Turin, Turin, Italy
| | - F Bert
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
- Health Local Unit ASL TO3, Turin, Italy
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Jecke L, Zepf FD. Delivering transgender-specific knowledge and skills into health and allied health studies and training: a systematic review. Eur Child Adolesc Psychiatry 2024; 33:1327-1354. [PMID: 37115277 PMCID: PMC11098887 DOI: 10.1007/s00787-023-02195-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/11/2023] [Indexed: 04/29/2023]
Abstract
Many transgender individuals face inequities, discrimination, and sometimes even a lack of transgender-specific knowledge in health care settings. Educational curricula can address such disparities and help future health professionals to become more knowledgeable, confident, and well-prepared for addressing the needs of transgender individuals. This systematic review aims to summarize current training interventions about care of transgender individuals for health and allied health students, and to analyse the effects of the respective intervention. A total of six databases (Pubmed, MEDLINE, Scopus, Web of Science, Embase and SciSearch) were screened for original articles published between 2017 and June 2021. Search terms and eligibility criteria were pre-specified, and after a structured selection process 21 studies were included into further analysis. Extracted data contained information on general study properties, population, design, program format and outcomes of interest. A narrative synthesis was used to summarize detected results. Study quality was assessed for each individual study. A self-developed 18-item checklist combining criteria of two prior published tools was used to assess overall quality of quantitative studies. For qualitative studies a 10-item checklist by Kmet et al. [HTA Initiat, 2004] was applied. Eligible studies were designed for multiple health or allied health profession students, and varied widely regarding program format, duration, content, and assessed outcomes. Almost all (N = 19) interventions indicated improvements in knowledge, attitude, confidence and comfort levels or practical skills concerning care for transgender clients. Major limitations included the lack of long-term data, validated assessment tools, control groups and comparative studies. Training interventions contribute to prepare future health professionals to deliver competent and sensitive care and which may improve the prospective experienced health care reality of transgender individuals. However, currently there is no common consensus about best practice of education. Additionally, little is known about whether detected effects of training interventions translate into noticeable improvements for transgender clients. Further studies are warranted to assess the direct impact of specific interventions in the light of the respective target populations.
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Affiliation(s)
- L Jecke
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - F D Zepf
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany.
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Jena, Germany.
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, Jena, Germany.
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Jones Q, Batchelder H, Sanchez M, Rolls J. An Analysis of Lesbian, Gay, Bisexual, Transgender, and Queer Curricula Inclusion: A National Study of Physician Assistant Programs. J Physician Assist Educ 2024:01367895-990000000-00138. [PMID: 38684096 DOI: 10.1097/jpa.0000000000000584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
INTRODUCTION The health professions education literature shows an increased focus on inclusion of lesbian, gay, bisexual, transgender, and queer (LGBTQ) content in curricula; however, it does not address hours of content or methods for content delivery. The purpose of this study was to describe the delivery of LGBTQ content in physician assistant (PA) education through a national survey of PA programs. METHODS In 2021, a national program survey was sent to all US-accredited PA Programs (n = 284) and had a completion rate of 71.8% (n = 204). Descriptive statistics were conducted to describe trends and make comparisons in the delivery of LGBTQ content. RESULTS Most PA programs are incorporating LGBTQ content into preclinical phases of PA education (81%) and describe that LGBTQ curricula align with institutional values (82%). Most report 1 to 3 hours of preclinical education for all LGBTQ population groups and cite medical interviewing courses as the most frequently used course to address LGTBQ care. Many programs (43%) do not provide instructional hours on LGBTQ content in the clinical phase, and the majority do not offer clinical rotations focused on this care. The results show variability in the level of preparedness that programs report on their students caring for LGBTQ populations. DISCUSSION Physician assistant programs are generally integrating the content throughout their didactic curricula; however, few offer clinical experiences focused on caring for patients who are LGBTQ. Offering clinical experiences and assessing student competencies are areas of growth in health professions education as related to LGBTQ health.
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Affiliation(s)
- Quinnette Jones
- Quinnette Jones, MSW, LCSW, MHS, PA-C, is an associate professor in the Department of Family Medicine and Community Health, Duke University, PA Program, Durham, North Carolina
- Heather Batchelder, MA, LPA, HSP-PA, is a research program leader in the Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
- Mara Sanchez, MMS, RD, PA-C, is a consulting faculty in the Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
- Joanne Rolls, MEHP, MPAS, PA-C, is an associate professor (Clinical) in the Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Heather Batchelder
- Quinnette Jones, MSW, LCSW, MHS, PA-C, is an associate professor in the Department of Family Medicine and Community Health, Duke University, PA Program, Durham, North Carolina
- Heather Batchelder, MA, LPA, HSP-PA, is a research program leader in the Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
- Mara Sanchez, MMS, RD, PA-C, is a consulting faculty in the Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
- Joanne Rolls, MEHP, MPAS, PA-C, is an associate professor (Clinical) in the Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Mara Sanchez
- Quinnette Jones, MSW, LCSW, MHS, PA-C, is an associate professor in the Department of Family Medicine and Community Health, Duke University, PA Program, Durham, North Carolina
- Heather Batchelder, MA, LPA, HSP-PA, is a research program leader in the Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
- Mara Sanchez, MMS, RD, PA-C, is a consulting faculty in the Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
- Joanne Rolls, MEHP, MPAS, PA-C, is an associate professor (Clinical) in the Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Joanne Rolls
- Quinnette Jones, MSW, LCSW, MHS, PA-C, is an associate professor in the Department of Family Medicine and Community Health, Duke University, PA Program, Durham, North Carolina
- Heather Batchelder, MA, LPA, HSP-PA, is a research program leader in the Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
- Mara Sanchez, MMS, RD, PA-C, is a consulting faculty in the Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
- Joanne Rolls, MEHP, MPAS, PA-C, is an associate professor (Clinical) in the Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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Muschialli L, Coduri-Fulford S, Garbett Z, Connolly DJ. Twelve tips for LGBT+-inclusive undergraduate and postgraduate medical education. MEDICAL TEACHER 2024:1-7. [PMID: 38652880 DOI: 10.1080/0142159x.2024.2344617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
Sexual and gender minority (LGBT+) populations continue to experience worse health outcomes and reduced healthcare access compared to their cisgender, heterosexual counterparts, perpetuated by a lack of sufficient LGBT+-specific healthcare education within medical schools. Developing educational material that encourages self-reflective, proactive, and affirmative practice has been identified as a mechanism for increasing the quality of doctor-patient relationships and breaking down barriers in healthcare access for LGBT + communities. In this article, we provide twelve tips for those designing and delivering undergraduate and postgraduate medical curricula. We summarise evidence-based approaches to inclusive care, key overarching concepts that curricula should include and common issues to be avoided. We hope these tips provide a standard against which existing curricula and teaching practices can be appraised and form the basis of future educational material.
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Affiliation(s)
- Luke Muschialli
- University of Cambridge, Cambridge, United Kingdom
- UCL Medical School, UCL, London, United Kingdom
| | | | - Zoë Garbett
- North Central London Integrated Care Board, London, United Kingdom
| | - Dean J Connolly
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Ortiz-Paredes D, Chanady T, Wassef K, Knight R, Ferlatte O. 'I created my own access:' understanding mental healthcare access experiences among LGTBQ + youth who use cannabis in Canada. CULTURE, HEALTH & SEXUALITY 2024:1-20. [PMID: 38639032 DOI: 10.1080/13691058.2024.2340090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/03/2024] [Indexed: 04/20/2024]
Abstract
In North America, LGBTQ+ youth have high rates of cannabis use and face mental health issues. We conducted a photovoice study to describe the perspectives, needs, and motivations of forty-six LGBTQ+ youth who use cannabis as they access mental healthcare services. Participants' photographs were discussed in individual semi-structured interviews conducted by peer researchers. Following a thematic analysis of the interview transcripts, we first found that, beyond medication, LGBTQ+ youth sought mental health services facilitating introspection to better understand their sexual and gender identities and mental health. Second, participants sought affirming health professionals but often felt judged by providers. Third, access to desired services was often described as uncertain and taxing, which impacted their mental health. Fourth, participants' agency was determined by their experience with mental health services, which translated into resilience to tackle access challenges and cannabis use to mitigate their mental health struggles. Our findings point to the need for mental healthcare delivery that goes beyond medication provision but which in addition foster therapeutic processes based on a holistic understanding of mental health. A trusting dynamic between health professionals and LGBTQ+ youth is imperative to counteract the feelings of stigma experienced by LGBTQ+ youth using cannabis in Canada.
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Affiliation(s)
- David Ortiz-Paredes
- École de Santé Publique de l'Université de Montréal, Montréal, QC, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Tara Chanady
- École de Santé Publique de l'Université de Montréal, Montréal, QC, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Kinda Wassef
- École de Santé Publique de l'Université de Montréal, Montréal, QC, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Rod Knight
- École de Santé Publique de l'Université de Montréal, Montréal, QC, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Olivier Ferlatte
- École de Santé Publique de l'Université de Montréal, Montréal, QC, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
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Ruprecht KA, Dunlop WA, Wah E, Phillips C, Martin SJ. Intergroup Contact Improves Medical Student Attitudes and Skill in Transgender Health Care. Transgend Health 2024; 9:162-173. [PMID: 38585241 PMCID: PMC10998020 DOI: 10.1089/trgh.2021.0203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Purpose Poorer health outcomes for transgender and gender diverse (TGD) individuals have been associated with lack of health care provider knowledge and personal bias. Training at all levels of medical education has been positioned as one strategy to combat these inequities. This study sought to characterize preclinical medical student attitude, skill, and knowledge pre- and post-teaching with TGD community volunteers. Methods This matched pre- and post-test study was conducted from July 2020 to August 2021 capturing two preclinical medical student cohorts exposed to the same teaching intervention. Students completed the Transgender Attitudes and Beliefs Scale (TABS) and the Transgender Development of Clinical Skills Scale (T-DOCSS) at baseline, 1 week, and 1 month after the clinical skills session. Tutors' attitudes to TGD health were measured before facilitating teaching, using the Attitudes Toward Transgender Patients and Beliefs and Knowledge about Treating Transgender Patients scales. Results Fifty-nine students completed questionnaires at three time points and were included in this study. Total TABS and T-DOCCS scores increased from preintervention to 1-week follow-up, maintained at 1 month, with significant changes in Interpersonal Comfort and Sex and Gender Beliefs subscales. Scores on the Human Value subscale did not change, remaining consistently high. Postintervention knowledge-question scores were high. Nine of 13 tutors completed surveys, demonstrating overall positive attitudes toward gender diversity and TGD health. Conclusion This study demonstrates improvement in preclinical medical student attitudes and self-reported skill toward gender health care sustained at 1 month after small-group teaching with TGD community volunteers.
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Affiliation(s)
- Ky A. Ruprecht
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - William A. Dunlop
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Estee Wah
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Christine Phillips
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Sarah J. Martin
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
- Canberra Sexual Health Centre, Canberra Health Services, Garran, Australia
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Maihle C, Anderson AM, von Sadovszky V. Evidence-Based Education on Care of LGBTQ Patients: Improving Knowledge and Attitudes Among Pediatric Nurses. J Contin Educ Nurs 2024; 55:181-186. [PMID: 38108812 DOI: 10.3928/00220124-20231211-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND Due to stigma and mistreatment, lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients and their families often face barriers to accessing and receiving equitable health care. Pediatric settings are not immune to this health inequity, yet there is limited literature to address it with pediatric nurses. METHOD An evidence-based education program on the care of LGBTQ patients was delivered electronically to pediatric nurses. Using a pre- and posttest design, knowledge and attitudes regarding care of LGBTQ patients were collected via online questionnaires. RESULTS Knowledge significantly increased from pre- to posttest (p = .02). Attitudes related to LGBTQ concepts either remained consistently positive or shifted in the positive direction. CONCLUSION Providing education regarding LGBTQ patients to pediatric nurses can improve related knowledge and attitudes. Expansion of evidence-based LGBTQ education to pediatric nurses is likely to contribute to lessening the health care barriers and inequities faced by these patients and their families. [J Contin Educ Nurs. 2024;55(4):181-186.].
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Berk AL, Pickett A, Kusters IS, Gregory ME. Healthcare Experiences of Black Patients During and After Pregnancy: a Needs Assessment for Provider Training to Improve Quality of Care. J Racial Ethn Health Disparities 2024; 11:992-1004. [PMID: 37010801 DOI: 10.1007/s40615-023-01579-5] [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] [Received: 02/16/2023] [Revised: 02/16/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Black patients are at a higher risk of experiencing less safe and lower quality care during pregnancy and childbirth, compared to their White counterparts. Behaviors that healthcare professionals engage in that can facilitate or hinder high-quality care for this population are underexplored. We sought to explore Black patients' experiences with healthcare professionals during and after pregnancy, as a needs assessment to inform the development of training for healthcare professionals. METHODS We conducted semi-structured interviews of Black patients who were in their third trimester of pregnancy or within 18 months of giving birth. Questions focused on experiences with healthcare professionals during pregnancy-related healthcare, including quality of care and discrimination. Thematic analysis was conducted using a combined deductive-inductive approach. Findings were considered in the context of the Institute of Medicine's Six Domains of Quality (equitable, patient-centered, timely, safe, effective, efficient). RESULTS We interviewed 8 participants who received care from various clinics and institutions. Over half (62%) described experiencing discrimination or microaggressions during their pregnancy-related healthcare. Participants most commonly reflected upon experiences within the patient-centered care domain, regarding whether care was in alignment with their preferences, positive and negative interpersonal interactions, and varied experiences with patient education/shared decision-making. CONCLUSIONS Black patients commonly report experiencing discrimination from healthcare professionals during pregnancy-related healthcare. Reducing microaggressions and improving patient-centered care is a key focus for healthcare professionals who serve this group. Training needs include addressing implicit bias, educating on common microaggressions, improving communication, and promoting an inclusive workplace.
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Affiliation(s)
- Abigail L Berk
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Isabelle S Kusters
- Department of Clinical, Health, and Applied Sciences, University of Houston-Clear Lake, Houston, TX, USA
| | - Megan E Gregory
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, USA.
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Kruse MI, Bigham BL, Phillips SP. A novel online training program for sexual and gender minority health increases allyship in cisgender, heterosexual paramedics. AEM EDUCATION AND TRAINING 2024; 8:e10958. [PMID: 38516255 PMCID: PMC10951873 DOI: 10.1002/aet2.10958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 01/02/2024] [Accepted: 01/18/2024] [Indexed: 03/23/2024]
Abstract
Introduction Sexual and gender minorities (SGM) make up 4% of the Canadian population. Due to existing barriers to care in the community, SGM patients may seek more help and be sicker at presentation to hospital. Paramedics occupy a unique role and can remove or decrease these barriers. There are no existing evaluations of training programs in SGM health for prehospital providers. A training program to develop better allyship in paramedics toward SGM populations was developed and assessed. Methods A 70- to 90-min mandatory, asynchronous, online training module in SGM health in the prehospital environment was developed and delivered via the emergency medical service (EMS) system's learning management system. A before-and-after study of cisgender, heterosexual, frontline paramedics was performed to measure the impact of the training module on the care of SGM patients. The validated Ally Identity Measure (AIM) tool was used to identify success of training and includes subscales of knowledge and skills, openness and support, and oppression awareness. Demographics and satisfaction scores were collected in the posttraining survey. Matched and unmatched pairs of surveys and demographic associations were analyzed using nonparametric statistics. Results Of 609 paramedics, 571 completed the training, and 239 surveys were completed before and 105 (n = 344) surveys after the training; 60 surveys were paired. Overall AIM scores of matched pairs (n = 60) improved by 12% (p < 0.001), with knowledge and skills accounting for most of the increase (21%, p < 0.001). Unmatched pairs (n = 344) were similar in demographics and scores. Rural paramedics also had significantly lower pretraining oppression awareness scores and had lower posttraining AIM scores compared to suburban paramedics (6% difference). Satisfaction scores rated the training as relevant and applicable (87% and 82%, respectively). Conclusions A novel prehospital training program in the care of SGM patients resulted in a statistically significant increase in allyship in cisgender, heterosexual-identified frontline paramedics.
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Affiliation(s)
- Michael I. Kruse
- Department of Family MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Blair L. Bigham
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Susan P. Phillips
- Department of Family MedicineQueen's UniversityKingstonOntarioCanada
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Rahman E, Rao P, Webb WR, Philipp-Dormston WG, Sayed K, Almeida ART, Mosahebi A, Carruthers JDA, Carruthers A. Embracing Spectrum: Celebrating LGBTQIA+ Journeys in Aesthetic Medicine: A Kaleidoscope of Identity. Aesthetic Plast Surg 2024:10.1007/s00266-024-03923-4. [PMID: 38499877 DOI: 10.1007/s00266-024-03923-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/09/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE This synaptic systemised review critically examines the provision of aesthetic medical care to LGBTQIA+ (lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more) individuals, assessing both the clinical practices and the educational frameworks that guide interactions with LGBTQIA+ patients in aesthetic settings. METHODS Following PRISMA-S guidelines, a comprehensive review was conducted, initially identifying 159 potentially relevant articles. Upon stringent full-text review, 33 studies met the inclusion criteria and were subject to an in-depth thematic analysis. The scope encompassed qualitative studies, quantitative analyses, and a cross section of interdisciplinary research, predominantly from Western settings. RESULTS The analysis distilled four principal themes: the imperative of identity affirmation in aesthetic interventions, substantial barriers to inclusive and empathetic care, the critical need for patient empowerment, and the existing deficiencies within medical education regarding LGBTQIA+ care. These themes highlight a complex interplay between the clinical aspirations of LGBTQIA+ individuals and the current capacity of aesthetic medicine to cater to this diversity. CONCLUSIONS There is a pressing need for a paradigmatic shift towards more inclusive, competent, and sensitive aesthetic medical care for LGBTQIA+ patients. It underscores the necessity of reform in medical education and advocates for policy changes that promote a more equitable healthcare environment. This research serves as a call to action, emphasizing the ethical imperative to integrate comprehensive LGBTQIA+ care competencies into aesthetic medicine curricula and practice. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Eqram Rahman
- Research and Innovation Hub, Innovation Aesthetics, London, WC2H 9JQ, UK.
| | - Parinitha Rao
- Aesthetic Dermatology Practice, The Skin Address, Bangalore, India
| | | | | | - Karim Sayed
- Nomi Clinic, Oslo, Norway
- University of South East Norway, Notodden, Norway
| | - Ada R T Almeida
- Dermatologic Clinic, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | | | - Jean D A Carruthers
- Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada
| | - Alastair Carruthers
- Department of Dermatology, University of British Columbia, Vancouver, BC, Canada
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Clare CA, Woodland MB, Buery-Joyner S, Whetstone S, Ogunyemi D, Sims SM, Moxley M, Baecher-Lind LE, Hampton BS, Pradhan A, Katz NT. Educational guidelines on sexual orientation, gender identity and expression, and sex characteristics biases in medical education. Am J Obstet Gynecol 2024:S0002-9378(24)00422-8. [PMID: 38432411 DOI: 10.1016/j.ajog.2024.02.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
A commitment to diversity, equity, inclusion, and belonging in medical education requires addressing both explicit and implicit biases based on sexual orientation, gender identity and expression, and sex characteristics and the intersectionality with other identities. Heterosexism and heteronormative attitudes contribute to health and healthcare disparities for lesbian, gay, bisexual, transgender and queer or questioning, intersex, asexual individuals. Student, trainee, and faculty competencies in medical education curricula regarding the care of lesbian, gay, bisexual, transgender and queer or questioning, intersex, asexual patients and those who are gender nonconforming or born with differences of sex development allow for better understanding and belonging within the clinical learning environment of lesbian, gay, bisexual, transgender and queer/questioning, intersex, asexual learners and educators. The Association of Professors of Gynecology and Obstetrics issued a call to action to achieve a future free from racism and bias through inclusivity in obstetrics and gynecology education and healthcare, which led to the creation of the Association of Professors of Gynecology and Obstetrics Diversity, Equity, and Inclusion Guidelines Task Force. The task force initially addressed racism, racial- and ethnicity-based bias, and discrimination in medical education and additionally identified other groups that are subject to bias and discrimination, including sexual orientation, gender identity and expression, and sex characteristic identities, persons with disabilities, and individuals with various religious and spiritual practices. In this scholarly perspective, the authors expand on previously developed guidelines to address sexual orientation, gender identity and expression, and sex characteristics bias, heterosexism, and heteronormative attitudes in obstetrics and gynecology educational products, materials, and clinical learning environments to improve access and equitable care to vulnerable individuals of the lesbian, gay, bisexual, transgender and queer or questioning, intersex, asexual community.
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Affiliation(s)
- Camille A Clare
- Department of Obstetrics and Gynecology, Downstate Health Sciences University College of Medicine and Department of Health Policy and Management, School of Public Health, Brooklyn, NY.
| | - Mark B Woodland
- Department of OBGYN, Drexel University College of Medicine, Philadelphia, PA
| | - Samantha Buery-Joyner
- Department Ob/Gyn, Inova Fairfax Medical Campus, Division of Medical Education, University of Virginia School of Medicine, Inova Campus, Fairfax, VA
| | - Sara Whetstone
- Division of Obstetrics, Gynecology, and Gynecologic Surgery, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - Dotun Ogunyemi
- Division of Graduate Medical Education, Department of Obstetrics & Gynecology, Charles Drew University of Medicine and Science, Los Angeles, CA
| | - Shireen Madani Sims
- Department of Obstetrics & Gynecology, University of Florida College of Medicine, Gainesville, FL
| | - Michael Moxley
- Department of Obstetrics/Gynecology, Roper St. Francis Healthcare, Division of Diversity, Inclusion and Health Equity, Georgetown University School of Medicine, Washington, DC
| | - Laura E Baecher-Lind
- Division of Educational Affairs, Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA
| | - B Star Hampton
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Archana Pradhan
- Rutgers Robert Wood Johnson Medical School, Department of Obstetrics, Gynecology and Reproductive Sciences, General Division, New Brunswick, NJ
| | - Nadine T Katz
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
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Lamba S, Jones KT, Grozdanic T, Moy E. Differences by Sexual Orientation in Patient-Centered Care Outcomes for Veterans Utilizing Primary Care Services at the Veterans Health Administration. LGBT Health 2024. [PMID: 38837356 DOI: 10.1089/lgbt.2023.0224] [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: 06/07/2024] Open
Abstract
Purpose: This study examined the differences by sexual orientation in patient-centered care outcomes (including health care experiences and health-related screening) of veterans utilizing Veterans Health Administration (VHA) primary care. Methods: VHA's adapted version of the Consumer Assessment of Healthcare Providers and Systems was used to compare the health care experience of primary care services among sexual minority (SM) and heterosexual veterans. Health care experience measures were dichotomized to "always" versus "less" and stratified by SM status. Health-related screening measures were dichotomous. Survey data were weighted using provided sample weights. Descriptive statistics were performed on sociodemographic characteristics. Logistic regression coefficients were represented as adjusted odds ratios (aORs). A total of 66,348 veterans were included in the analytic sample, of which 2.9% (n = 1,935) identified as SM. Sexual orientation was ascertained by self-report measures by veterans. Results: SM veterans were significantly younger (56.95 years vs. 63.43 years, p < 0.001), were less likely to report that their provider showed respect for what they had to say (aOR: 0.76; 95% confidence interval [CI]: 0.61-0.95), that they were asked about difficulties taking care of their health (aOR: 0.81; 95% CI: 0.67-0.96), and their provider listened carefully to them (aOR: 0.71; 95% CI: 0.57-0.87) compared to heterosexual veterans. Conclusion: Health care experiences differed between SM and heterosexual veterans who sought VHA primary care, suggesting the need to increase provider trainings, which may improve cultural competency and promote a more welcoming and inclusive environment.
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Affiliation(s)
- Shane Lamba
- VA Office of Health Equity, Veterans Health Administration, Washington, District of Columbia, USA
| | - Kenneth T Jones
- VA Office of Health Equity, Veterans Health Administration, Washington, District of Columbia, USA
| | - Tamara Grozdanic
- VA Office of Health Equity, Veterans Health Administration, Washington, District of Columbia, USA
| | - Ernest Moy
- VA Office of Health Equity, Veterans Health Administration, Washington, District of Columbia, USA
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Nowaskie DZ, Dauterman JW, Dauterman LC, Menez O. U.S. Pediatric Residents' Preparedness, Attitudes, and Knowledge in LGBTQ+ Health Care. J Pediatr Health Care 2024; 38:140-147. [PMID: 38429026 DOI: 10.1016/j.pedhc.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION The objective of this study was to evaluate pediatric residents' lesbian, gay, bisexual, transgender, queer, and all sexual and gender diverse (LGBTQ+) care. METHOD In June 2022, U.S. pediatric residents completed an anonymous online survey including the Lesbian, Gay, Bisexual, and Transgender-Development of Clinical Skills Scale (LGBT-DOCSS). RESULTS Pediatric residents (n = 78) reported low-to-moderate annual amounts of LGBT curricular hours (3.32 ± 3.17) and LGBT patients (13.84 ± 15.11) as well as low-to-moderate clinical preparedness and knowledge and high positive attitudes. They were significantly less likely to report receiving adequate training and supervision, having experience, and feeling competent in transgender care compared with lesbian, gay, and bisexual care. In general, pediatric residents who reported more LGBT education and LGBT patients also reported higher LGBT-DOCSS scores. DISCUSSION Pediatric residents in this study had substantial shortcomings in LGBTQ+ care. Pediatric programs must increase LGBTQ+ education and LGBTQ+ patient exposure.
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Carmichael TN, Copel LC, McDermott-Levy R. Effect of an Education Intervention on Nursing Students' Knowledge of and Attitudes Toward Caring for Transgender and Nonbinary People. Nurse Educ 2024:00006223-990000000-00396. [PMID: 38235809 DOI: 10.1097/nne.0000000000001600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Transgender and nonbinary (TGNB) people experience inequities in health care access, quality, and outcomes. Health care professionals' lack of knowledge and biased attitudes toward gender minorities contribute to inequitable care. PURPOSE This study examined the effect of TGNB health education on nursing students' knowledge and attitudes about caring for TGNB clients. METHODS A quasi-experimental study using a one-group pretest/posttest design was conducted with 46 nursing students at 2 private baccalaureate nursing programs. RESULTS A paired-samples t test found a significant increase in knowledge about caring for TGNB clients at posttest (P = .02). Attitudes toward caring for TGNB clients showed a significant improvement in the Sex and Gender Beliefs subscale at posttest (P = .014). CONCLUSIONS The findings suggest that TGNB health education is effective for inclusion in nursing curricula to better prepare nurses to care for gender-diverse clients.
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Affiliation(s)
- Tanya N Carmichael
- Author Affiliations: Assistant Professor (Dr Carmichael), School of Nursing, Widener University, Chester, Pennsylvania; and Professor (Drs Copel and McDermott-Levy), M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania
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Tyrie D, Oliva A, Llorin H, Zayhowski K. Transgender and gender diverse individuals' perspectives on discussions of fetal sex chromosomes in obstetrics care. J Genet Couns 2024. [PMID: 38198055 DOI: 10.1002/jgc4.1842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/26/2023] [Accepted: 12/27/2023] [Indexed: 01/11/2024]
Abstract
In the past decade, prenatal cell-free DNA screening (cfDNA) has become ubiquitous as a screening tool for fetal aneuploidy and sex chromosomes. Healthcare provider (HCP) discussions and public perceptions of sex and gender uniquely impact transgender and gender diverse (TGD) individuals, and existing cfDNA guidelines lack recommendations regarding how to discuss sex and gender prenatally. The aim of this exploratory qualitative study was to examine TGD individuals' opinions regarding fetal sex chromosome disclosure sessions. Twelve semi-structured virtual interviews were conducted with TGD individuals regarding their perspectives on the discussion of fetal sex chromosomes by HCPs within the prenatal setting. Interviews were coded and analyzed using a reflexive thematic approach, generating four major themes: (1) Current practices in prenatal care exclude gender diverse people; (2) HCPs' responsibility to de-gender discussions of sex chromosomes in prenatal care; (3) HCPs' responsibility to acknowledge gender diversity; and (4) HCPs' influence on societal perceptions of sex and gender. More guidance is needed from professional societies regarding best practices for HCP discussions of sex chromosomes, sex, and gender. Participants recommended HCPs educate patients about sex chromosomes and their relevance to health while avoiding the conflation of sex and gender terms. Additionally, there is an acute need for trans-inclusive prenatal healthcare. Ultimately, HCPs' and organizations are in a prime position to deconstruct rigid gender binaries and promote societal inclusion of TGD people.
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Affiliation(s)
- Dana Tyrie
- Joan H. Marks Graduate Program in Human Genetics, Sarah Lawrence College, Bronxville, New York, USA
| | - Alejandra Oliva
- Joan H. Marks Graduate Program in Human Genetics, Sarah Lawrence College, Bronxville, New York, USA
| | | | - Kimberly Zayhowski
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota, USA
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Jeffrey S, Ashton L, Ferfolja T, Armour M. Transgender and gender diverse people with endometriosis: A perspective on affirming gynaecological care. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241251974. [PMID: 38742674 PMCID: PMC11095187 DOI: 10.1177/17455057241251974] [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: 11/30/2023] [Revised: 03/29/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024]
Abstract
Transgender and gender diverse people presumed female at birth experience gynaecological conditions, such as chronic pelvic pain at elevated rates, estimated to impact between 51% and 72% of this population, compared to rates of up to 26.6% in cisgender women. The negative impact of these conditions is likely amplified due to limited access to safe and affirming healthcare. Despite this high prevalence rate, there is limited research investigating the prevalence, presentation or management options for trans and gender diverse people with endometriosis. Cisgender women with endometriosis report barriers to accessing care, with lengthy times to diagnosis and limited treatment options available. However, barriers for trans and gender diverse individuals are enhanced by physician bias and lack of education in gender-affirming care. This is reflected in stories of discrimination and denial of basic healthcare. A healthcare environment built on the presumption that gynaecological patients are women, others trans and gender diverse patients, which can result in avoidance of needed medical care. A lack of knowledge of gender-affirming care alongside healthcare provider bias highlights a need for gender-affirming care and bias reduction training in undergraduate healthcare provider curricula. Research to date assessing current curriculum in Australia and Aotearoa (New Zealand) shows limited inclusion of lesbian, gay, bisexual, trans, queer, intersex, asexual and other related identities content as a whole with gender-affirming care being among the least-frequently addressed topics. This review will detail barriers to accessing gender-affirming healthcare specific to gynaecology, interweaving the experiences of a non-binary individual seeking access to gender-affirming endometriosis care.
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Affiliation(s)
- Sam Jeffrey
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | | | - Tania Ferfolja
- School of Education, Western Sydney University, Penrith, NSW, Australia
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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Handlovsky I, Wonsiak T, Amato AT. Older, self-identifying gay men's conceptualisations of psychological well-being (PWB): A Canadian perspective. Nurs Philos 2024; 25:e12466. [PMID: 37828850 DOI: 10.1111/nup.12466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023]
Abstract
Many older gay men experience diminished psychological well-being (PWB) due to unique circumstances including discrimination, living with HIV, and aging through the HIV/AIDS crisis. However, there remains ambiguity as to how older gay men define and understand PWB. Our team interviewed and analyzed the accounts of 26 older (50+) self-identifying English-speaking men living in southwestern British Columbia, Canada. We drew on tenets of constructivist grounded theory and intersectionality to account for unique contextual considerations and power relations. Semi-structured Zoom interviews were conducted from August-October 2022. Interview transcripts were compared to generate high-order conceptual findings underpinned by processes understood as central to PWB. Three PWB temporal processes highlighted interlocking social and contextual circumstances intersecting with power and maturation: (1) being emotionally balanced, (2) living gratitude (3) and fully embracing self-acceptance. Being emotionally balanced supported the affective and sustainable state of contentment, living gratitude drew from the wisdom of accrued experiences to cultivate a positive affective state inclusive to recognising social location privileges, whilst fully embracing self-acceptance redressed the harms of anti-gay discourses that men endured throughout their lives. The knowledge is relevant to service and resource development to deliver tailored PWB supports to older gay men.
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Affiliation(s)
- Ingrid Handlovsky
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
| | - Tessa Wonsiak
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Anthony T Amato
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
- Community-Based Research Centre, Vancouver, British Columbia, Canada
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Maka P, Rosander A, Sato D, Elkbuli A. Letter re: Achieving Equitable Representation For Minorities and Underrepresented Members of the Surgical Community. Am Surg 2024; 90:170-171. [PMID: 36031884 DOI: 10.1177/00031348221124326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Affiliation(s)
- Piueti Maka
- John A. Burns School of Medicine, Honolulu, HI, USA
| | - Abigail Rosander
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
| | | | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
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Hughes TL, Bochicchio L, Drabble L, Muntinga M, Jukema JS, Veldhuis CB, Bruck S, Bos H. Health disparities in one of the world's most progressive countries: a scoping review of mental health and substance use among sexual and gender minority people in the Netherlands. BMC Public Health 2023; 23:2533. [PMID: 38110908 PMCID: PMC10729573 DOI: 10.1186/s12889-023-17466-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Evidence from many parts of the world shows that sexual and gender minority (SGM) people have poorer health than their cisgender heterosexual counterparts. Minority stressors, particularly stigma and discrimination, have been identified as major contributors to sexual orientation- and gender identity-related health disparities, particularly negative mental health and behavioral health outcomes. To better understand factors that contribute to these disparities, we conducted a scoping review of SGM mental health and substance use research in the Netherlands-a country with a long-standing reputation as a pioneer in SGM equality. METHODS Using Joanna Briggs Institute guidelines and the PRISMA-ScR protocol, we searched seven databases to identify studies published between 2010 and 2022 that focused on substance use and/or mental health of SGM youth and adults in the Netherlands. RESULTS Although there was some evidence that SGM people in the Netherlands report fewer substance use and mental health concerns than those in less progressive countries, with very few exceptions studies found poorer outcomes among SGM participants than cisgender, heterosexual participants. However, this observation must be considered cautiously given major gaps in the literature. For example, only one study focused exclusively on adult sexual minority women, two focused on older SGM adults, and very little attention was given to nonbinary individuals. Most studies used non-probability samples that were quite homogenous. Many studies, especially those with youth, assessed sexual orientation based on sexual attraction; some studies of adults operationalized SGM status as having a same-sex partner. Importantly, we found no studies that directly assessed associations between structural-level stigma and health outcomes. Studies were mostly focused at the individual level and on health problems; very little attention was given to strengths or resilience. CONCLUSIONS Findings of persistent health disparities-despite the relatively long history of SGM supportive policies in the Netherlands-highlight the need for more research and greater attention to population groups that have been underrepresented. Such research would not only provide guidance on strategies to improve the health of SGM people in the Netherlands, but also in other countries that are seeking to reduce health inequities. Addressing SGM health disparities in the Netherlands and elsewhere is complex and requires a multifaceted approach that addresses individual, interpersonal and structural factors.
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Affiliation(s)
- Tonda L Hughes
- School of Nursing, Department of Psychiatry, Columbia University Irving Medical School, Center for Sexual and Gender Minority Health Research, 560 West 168 Street, New York, NY, USA.
| | - Lauren Bochicchio
- Columbia University School of Nursing Center for Sexual and Gender Minority Health Research, 560 West 168th Street, New York, NY, USA
| | - Laurie Drabble
- College of Health and Human Sciences, San Jose State University, One Washington Square, San Jose, CA, USA
| | - Maaike Muntinga
- Department of Ethics, Law and Humanities, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam, 1081 HZ, Netherlands
| | - Jan S Jukema
- School of Health, Saxion University of Applied Sciences, M. H. Tromplaan 28, Enschede, 7513 AB, Netherlands
| | - Cindy B Veldhuis
- Departments of Medical Social Sciences, Psychology, Psychiatry, and Obstetrics & Gynecology, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, USA
| | - Sunčica Bruck
- Kohnstamm Instituut, Keizer Karelplein 1, Amstelveen, 1185 HL, Netherlands
| | - Henny Bos
- Research Institute Child Development and Education, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, 1012 WX, Netherlands
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Teoh KRH, Dunning A, Taylor AK, Gopfert A, Chew-Graham CA, Spiers J, Appleby L, Van Hove M, Buszewicz M, Riley R. Working conditions, psychological distress and suicidal ideation: cross-sectional survey study of UK junior doctors. BJPsych Open 2023; 10:e14. [PMID: 38099399 PMCID: PMC10755551 DOI: 10.1192/bjo.2023.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/01/2023] [Accepted: 11/01/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Evidence attests a link between junior doctors' working conditions and psychological distress. Despite increasing concerns around suicidality among junior doctors, little is known about its relationship to their working conditions. AIMS To (a) establish the prevalence of suicidal ideation among junior doctors in the National Health Service; (b) examine the relationships between perceived working conditions and suicidal ideation; and (c) explore whether psychological distress (e.g. symptoms of depression and anxiety) mediates these relationships. METHOD Junior doctors were recruited between March 2020 and January 2021, for a cross-sectional online survey. We used the Health and Safety Executive's Management Standards Tool; Depression, Anxiety and Stress Scale 21; and Paykel Suicidality Scale to assess working conditions, psychological distress and suicidality, respectively. RESULTS Of the 424 participants, 50.2% reported suicidal ideation, including 6.1% who had made an attempt on their own life. Participants who identified as LGBTQ+ (odds ratio 2.18, 95% CI 1.15-4.12) or reported depression symptoms (odds ratio 1.10, 95% CI 1.07-1.14) were more likely to report suicidal ideation. No direct relationships were reported between working conditions (i.e. control, support, role clarity, strained relationships, demand and change) and suicidal ideation. However, depression symptoms mediated all six relationships. CONCLUSIONS This sample of junior doctors reported alarming levels of suicidal ideation. There may be an indirect relationship between working conditions and suicidal ideation via depressive symptoms. Clearer research exploring the experience of suicidality in junior doctors is needed, including those who identify as LGBTQ+. Systematic interventions addressing working environment are needed to support junior doctors' mental health.
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Affiliation(s)
- Kevin Rui-Han Teoh
- Department of Organizational Psychology, Birkbeck, University of London, UK
| | - Alice Dunning
- School of Health and Related Research, University of Sheffield, UK
| | - Anna Kathryn Taylor
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, UK
| | - Anya Gopfert
- Department of Sports Sciences and Public Health, University of Exeter, UK
| | | | | | - Louis Appleby
- Division of Psychology and Mental Health, School of Medicine, University of Manchester, UK
| | - Maria Van Hove
- Department of Health and Community Sciences, University of Exeter, UK
| | - Marta Buszewicz
- UCL Great Ormand Street Institute of Child Health, University College London, UK
| | - Ruth Riley
- School of Health Sciences, University of Surrey, UK
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Lewis BE, Naik AR. A scoping review to identify and organize literature trends of bias research within medical student and resident education. BMC MEDICAL EDUCATION 2023; 23:919. [PMID: 38053172 DOI: 10.1186/s12909-023-04829-6] [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: 11/01/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Physician bias refers to the unconscious negative perceptions that physicians have of patients or their conditions. Medical schools and residency programs often incorporate training to reduce biases among their trainees. In order to assess trends and organize available literature, we conducted a scoping review with a goal to categorize different biases that are studied within medical student (MS), resident (Res) and mixed populations (MS and Res). We also characterized these studies based on their research goal as either documenting evidence of bias (EOB), bias intervention (BI) or both. These findings will provide data which can be used to identify gaps and inform future work across these criteria. METHODS Online databases (PubMed, PsycINFO, WebofScience) were searched for articles published between 1980 and 2021. All references were imported into Covidence for independent screening against inclusion criteria. Conflicts were resolved by deliberation. Studies were sorted by goal: 'evidence of bias' and/or 'bias intervention', and by population (MS or Res or mixed) andinto descriptive categories of bias. RESULTS Of the initial 806 unique papers identified, a total of 139 articles fit the inclusion criteria for data extraction. The included studies were sorted into 11 categories of bias and showed that bias against race/ethnicity, specific diseases/conditions, and weight were the most researched topics. Of the studies included, there was a higher ratio of EOB:BI studies at the MS level. While at the Res level, a lower ratio of EOB:BI was found. CONCLUSIONS This study will be of interest to institutions, program directors and medical educators who wish to specifically address a category of bias and identify where there is a dearth of research. This study also underscores the need to introduce bias interventions at the MS level.
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Affiliation(s)
- Brianne E Lewis
- Department of Foundational Sciences, Central Michigan University College of Medicine, Mt. Pleasant, MI, 48859, USA
| | - Akshata R Naik
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI, 48309, USA.
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Byrne M, Borzalski C. Analysis of Inclusive Gender, Sexuality and Sexual Orientation Data Elements in Academic Electronic Health Records. Comput Inform Nurs 2023; 41:975-982. [PMID: 37607730 DOI: 10.1097/cin.0000000000001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Findings from an analysis of three vended academic electronic health records used in health science education are presented in this article. The quality assurance project examined the lexical and semantic fit and content coverage of gender, sexuality, and sexual orientation data elements within the academic electronic health records. A semantic comparative content analysis using a cognitive walkthrough was conducted as a means of comparing the ideal set of gender, sexuality, and sexual orientation data elements with those found in the three vended academic electronic health records. The results indicated a need for alignment to the research literature, expert consensus, and technical standards similar to what is expected for electronic health records used in clinical practice because of a lack of ideal state data elements. The findings align with ongoing issues with bias and disparities seen in the care of the lesbian, gay, bisexual, and transgender population and a lack of diverse, inclusive media and teaching technologies in health science education. The quality project and findings can inform academic electronic health record vendors on how they can create more inclusive systems and bring awareness to healthcare educators about the potential for implicit and explicit bias in their teaching technologies.
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Affiliation(s)
- Matthew Byrne
- Author Affiliations : Saint Catherine University, School of Nursing, St Paul, MN
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Blanchard E, Evans R, Abdullatif H, Brown M, Carter T, LaChenaye J. Beliefs and Intentions of Anesthesia Physicians Toward Providing Culturally Competent Care to Transgender Patients. Transgend Health 2023; 8:542-549. [PMID: 38130981 PMCID: PMC10732157 DOI: 10.1089/trgh.2022.0041] [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: 11/13/2022] Open
Abstract
Purpose Anesthesiologists have limited relationships with their patients before delivering care and have little time for patient interactions. Yet, they should possess the knowledge and skills to treat all patients in an equitable, culturally competent manner, including transgender patients. The study's purpose was to determine behavioral factors influencing culturally competent care by anesthesia physicians with transgender patients. Methods A two-phase design was utilized in 2020 to examine the attitudes, subjective norms, and perceived behavioral control of anesthesia physicians, both in training and practicing independently. Phase 1 allowed exploration of themes related to facilitators and barriers of the provision of culturally competent care to transgender patients. Phase 2 involved the creation and deployment of a 51-question survey informed by phase 1 to 100 anesthesia physicians at a single academic medical center in the southeastern United States. Results Thematic analysis was performed on results from the phase 1 elicitation survey, which informed the creation of the survey for phase 2. One hundred phase 2 surveys were distributed, with a 70% response rate. Analyses were conducted to determine the largest influence of intent to interact with transgender patients in a culturally competent manner, as well as to establish the reliability of the tool. Conclusion Attitude followed by subjective norms were positive influencers of intent, while lack of knowledge was a negative influencer. Strengthening attitudes and subjective norms, while implementing programs to increase knowledge, competence, and humility, would be goals for future studies and actions toward improving healthcare of transgender individuals.
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Affiliation(s)
- Erin Blanchard
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Retta Evans
- Department of Community Health & Human Services, School of Education, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hussein Abdullatif
- Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michelle Brown
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tekuila Carter
- Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jenna LaChenaye
- Department of Human Studies, School of Education, University of Alabama at Birmingham, Birmingham, Alabama, USA
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O’Hara CA, Foon XL, Ng JCK, Wong CS, Wang FYC, Tan CYR, Cheah YT, Griva K, Yoong JSY, Tan RKJ. Lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) healthcare in Singapore: perspectives of non-governmental organisations and clinical year medical students. MEDICAL EDUCATION ONLINE 2023; 28:2172744. [PMID: 36744296 PMCID: PMC9904294 DOI: 10.1080/10872981.2023.2172744] [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: 10/18/2022] [Revised: 01/12/2023] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE International studies document that lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) patients face significant health disparities. Studies exploring the attitudes, knowledge, preparedness and comfort levels of healthcare students towards LGBTQI+ health have been conducted in the United States, United Kingdom and Malaysia. This study aims to investigate stigma in healthcare for LGBTQI+ patients in Singapore, and possible upstream factors within medical education. METHODS This mixed-methods study adopts a convergent parallel design. The Health Stigma and Discrimination Framework was referenced to devise in-depth interviews with representatives from 13 LGBTQI-affirming non-governmental organisations, analysed through thematic analysis. 320 clinical medical students were surveyed about attitudes, knowledge, comfort, preparedness, and perceived importance of/towards LGBTQI+ health, analysed via descriptive statistics and multivariate regression. RESULTS Prevailing stigma in Singaporean society against LGBTQI+ individuals is exacerbated in healthcare settings. Doctors were cited as unfamiliar or uncomfortable with LGBTQI+ health, possibly from lack of training. Among medical students surveyed, the median composite attitudes, comfort and preparedness index was 3.30 (Interquartile Range (IQR) = 0.50), 3.17 (IQR = 0.83), 2.50 (IQR = 1.00) respectively. Only 12.19% of students answered all 11 true-false questions about LGBTQI+ health correctly. CONCLUSION Medical students in Singapore have scored sub-optimally in their knowledge and preparedness towards LGBTQI+ health, while interpersonal and structural stigma in healthcare towards LGBTQI+ people in Singapore negatively affects health and wellbeing. These findings are an impetus to improve medical training in this area. High scores among medical students in attitudes, comfort and perceived importance of LGBTQI+ topics demonstrate that there is space for LGBTQI+ health in the local medical education curriculum. Curricular interventions can prioritise content knowledge, communication skills and sensitivity.
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Affiliation(s)
- Caitlin A O’Hara
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xiang Lin Foon
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jared CK Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chen Seong Wong
- National Center for Infectious Diseases, National University of Singapore, Singapore
| | - Francine YC Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Clara YR Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yi Ting Cheah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Konstadina Griva
- Office of Research, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Joanne SY Yoong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Research for Impact, Singapore
| | - Rayner KJ Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- University of North Carolina Project-China, Guangzhou, China
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Doughty J, Macdonald ME, Muirhead V, Freeman R. Oral health-related stigma: Describing and defining a ubiquitous phenomenon. Community Dent Oral Epidemiol 2023; 51:1078-1083. [PMID: 37462247 DOI: 10.1111/cdoe.12893] [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] [Received: 02/21/2023] [Revised: 06/19/2023] [Accepted: 07/07/2023] [Indexed: 11/15/2023]
Abstract
This paper is the fourth of a series of narrative reviews to critically rethink underexplored concepts in oral health research. The series commenced with an initial commissioned framework of Inclusion Oral Health, which spawned further exploration into the social forces that undergird social exclusion and othering. The second review challenged unidimensional interpretations of the causes of inequality by bringing intersectionality theory to oral health. The third exposed how language, specifically labels, can perpetuate and (re)produce vulnerability by eclipsing the agency and power of vulnerabilised populations. In this fourth review, we revisit othering, depicted in the concept of stigma. We specifically define and conceptualize oral health-related stigma, bringing together prior work on stigma to advance the robustness and utility of this theory for oral health research.
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Affiliation(s)
- J Doughty
- NIHR Clinical Lecturer, School of Dentistry, University of Liverpool, Liverpool, UK
| | - M E Macdonald
- Clinical Reader and Honorary Consultant in Dental Public Health, Centre for Dental Public Health and Primary Care, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - V Muirhead
- J&W Murphy Foundation Endowed Chair in Palliative Care Research. Professor, Division of Palliative Medicine. Nova Scotia Health Affiliate Scientist (Research). Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - R Freeman
- Past co-director Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee, UK
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O'Leary A, Willis LA, Henny KD, Madden M, Koenig LJ. Development of a Video-Delivered Serial Drama Designed to Reduce Community Homophobia and HIV Stigma, Decrease Sexual Risk Behavior, and Increase HIV Testing Among Black Youth. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:439-451. [PMID: 38096457 PMCID: PMC10877481 DOI: 10.1521/aeap.2023.35.6.439] [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: 12/18/2023]
Abstract
This article describes the development of a video serial drama intervention that was designed to address factors that influence HIV in the United States among Black youth. These include HIV testing, sexual behaviors not protected by condoms, negative attitudes towards sexual minorities, and HIV stigma. Behavior-change principles (social learning theory and education-entertainment) and input from members of the priority audience formed the basis of this 27-episode (3 minutes each) drama for dissemination on multiple platforms, including in public spaces or privately online. The developmental process, specifically involving members of the population of interest and use of behavioral theory, enriched the narrative elements and likely ensured intervention acceptability, enhancing effectiveness. Public health practitioners and prevention programmers may want to consider using this intervention and/or the narrative communication approach when intervening to change behavior.
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Affiliation(s)
| | - Leigh A Willis
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kirk D Henny
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Linda J Koenig
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Kenner C, Cherry J, Mizock L, DiStefano A, Tosh J, Gurse C. Reimagining sexual and reproductive healthcare for LGBTQ communities. CULTURE, HEALTH & SEXUALITY 2023; 25:1419-1432. [PMID: 36592957 DOI: 10.1080/13691058.2022.2159066] [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: 07/26/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Qualitative interviews were conducted with nine individuals identifying as LGBTQ to identify recommendations for improving sexual and reproductive healthcare at a local clinic on the California Central Coast. Interviewees were recruited at local Pride events. Grounded theory methodology revealed several themes related to participants' desires for a LGBTQ-affirmative sexual and reproductive healthcare setting. Themes identified included: Beyond Enacted Inclusivity (avoiding a performative demonstration of LGBTQ-affirming care); Anti-Institutional Care (a political and visual challenge to what the healthcare setting should look like), a One-Stop-Shop (encompassing several types of care under one roof); Constrained Visibility (where LGBTQ identities are reflected but not exposed); and Community and Social Wellness (to be in community with other LGBTQ-serving organisations and one another in mutual support and celebration). Research implications and clinical recommendations are described at the local and system levels.
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Affiliation(s)
- Catelynn Kenner
- Catelynn Kenner Consulting Collective, San Luis Obispo, CA, USA
| | - Jennifer Cherry
- School of Psychology, Fielding Graduate University, Santa Barbara, CA, USA
| | - Lauren Mizock
- School of Psychology, Fielding Graduate University, Santa Barbara, CA, USA
| | - Anna DiStefano
- School of Leadership Studies, Fielding Graduate University, Santa Barbara, CA, USA
| | - Jenna Tosh
- Planned Parenthood California Central Coast, Santa Barbara, CA, USA
| | - Cheri Gurse
- Independent Consultant, Santa Barbara, CA, USA
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Ferrero EM, Yunker AG, Cuffe S, Gautam S, Mendoza K, Bhupathiraju SN, Mattei J. Nutrition and Health in the Lesbian, Gay, Bisexual, Transgender, Queer/Questioning Community: A Narrative Review. Adv Nutr 2023; 14:1297-1306. [PMID: 37536566 PMCID: PMC10721458 DOI: 10.1016/j.advnut.2023.07.009] [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] [Received: 02/12/2023] [Revised: 07/16/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023] Open
Abstract
Sexual and gender minorities have a higher risk for health and nutrition-related disparities across the life course compared to the heterosexual or cisgender population. Experiences of stigmatization and discrimination are associated with diminished mental health quality and psychological distress, which are risk factors for developing various eating disorders. Other nutrition disparities include increased risk for food insecurity, body dissatisfaction, and weight complications, such as those experienced by the transgender population in association with gender-affirming hormone therapies. Despite the need for tailored nutrition recommendations that address the unique needs of the lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) community, there are currently no such guidelines in North America. The purpose of this review is to summarize major LGBTQ+ nutrition disparities and highlight the need for tailored recommendations. We examine the evidence on mental health and social disparities in this group, including vulnerabilities to disordered eating, food insecurity, and healthcare provider discrimination. Importantly, we identify a scarcity of literature on dietary concerns and nutrition care guidelines for LGBTQ+ groups, including studies that address intersectionality and differences among specific gender and sexual orientations. These gaps underline the urgency of prioritizing nutrition for LGBTQ+ health needs and for developing tailored public health nutrition recommendations for this underserved population. Our review suggests that future LGBTQ+ health and nutrition research agendas should include personalized and precision nutrition, social determinants of health, diet quality, body image, and healthcare provider cultural competency and responsiveness. Moreover, the current evidence on LGBTQ+ nutrition and health will be strengthened when research studies (including clinical trials) with robust methodologies amplify inclusion and representation of this community to elucidate health and nutrition disparities in sexual and gender minorities.
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Affiliation(s)
- Elisabetta M Ferrero
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Alexandra G Yunker
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sherri Cuffe
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Saloni Gautam
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Kenny Mendoza
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Shilpa N Bhupathiraju
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
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Mueller RC, DeSimone ME. Bringing Gender-Affirming Care to Primary Care: Use of a Multimodal Curriculum to Educate Nurse Practitioners and Nurse Practitioner Students. Nurse Educ 2023; 48:304-309. [PMID: 37104051 DOI: 10.1097/nne.0000000000001427] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND An increasing number of individuals who identify as transgender and gender diverse require informed and compassionate health care, yet there is a dearth of research about which educational strategies are best used to provide nurses and nurse practitioners the foundation upon which to provide appropriate health care. PURPOSE This study evaluated a multimodal approach that included guided readings, a transgender patient panel, standardized patient simulation, and group discussion. METHODS The Sexual Orientation Counselor Competency Scale was administered pre- and postintervention. RESULTS Results demonstrated increases in knowledge, skills, and attitudes among the 16 participants. A high level of satisfaction was expressed for the overall program, but especially for the patient panel and standardized patient encounter. CONCLUSIONS Nurse educators are encouraged to include information about health care of the transgender patient into curricula.
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Affiliation(s)
- Rebecca C Mueller
- Assistant Professor (Dr Mueller), Neumann University, Aston, Pennsylvania; Nurse Practitioner (Dr Mueller), Worth Student Health and Wellness Center, Swarthmore College, Swarthmore, Pennsylvania; and Clinical Professor (Dr DeSimone) Retired
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Fu MX, Zou T, Aiyappan R, Ye X, Onanuga S, Tan A, Smith S, Baptista A. Medical students' perceptions of LGBTQ+ healthcare in Singapore and the United Kingdom. Front Med (Lausanne) 2023; 10:1236715. [PMID: 37942419 PMCID: PMC10627960 DOI: 10.3389/fmed.2023.1236715] [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: 06/08/2023] [Accepted: 10/12/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) individuals have an increased scope of healthcare needs and face many barriers to accessing healthcare. However, LGBTQ+ healthcare education remains scarce, and students' understanding of LGBTQ+ healthcare remains largely uncharacterised. This study investigated the knowledge of and attitudes toward LGBTQ+ healthcare among medical students in Singapore and the United Kingdom (UK), two culturally different countries. Methods Medical students in two medical schools, one in Singapore and the other in the UK, completed self-administered cross-sectional surveys using multiple-choice, Likert scale, and free-text questions to explore their ideas, concerns, and expectations about LGBTQ+ healthcare education within their medical curricula. Results From 330 responses, students' knowledge levels were moderate overall, with pronounced gaps in certain areas, including terminology, sexual health, and conversion therapy. Deficiencies in knowledge were significantly greater among students in Singapore compared to the UK (p < 0.001), whilst LGBTQ+ students and non-religious students had more positive knowledge and attitudes than students not identifying. At least 78% of students had positive attitudes towards LGBTQ+ individuals, but 84% had not received LGBTQ+-specific medical education. Although junior UK students were more satisfied with the adequacy of teaching by their medical school's incorporation of LGBTQ+ inclusive teaching in a newer curriculum, qualitative analyses suggested that students in both countries wanted to receive more training. Students further suggested improvements to the medical curriculum to meet their needs. Conclusion Students in both schools lacked understanding of commonly-used terminology and topics such as sexual healthcare despite affirming attitudes towards LGBTQ+ healthcare. Although sociolegal contexts may affect students' perspectives, differences were less than thought, and students were equally keen to provide affirmative care to their patients. They emphasised a need for more formal teaching of LGBTQ+ healthcare professions to overcome healthcare disparities in these communities.
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Affiliation(s)
- Michael X. Fu
- Medical Education Research Unit, Imperial College London, London, United Kingdom
| | - Tangming Zou
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Raksha Aiyappan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Xinyu Ye
- Medical Education Research Unit, Imperial College London, London, United Kingdom
| | - Simisola Onanuga
- Medical Education Research Unit, Imperial College London, London, United Kingdom
| | - Angela Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Susan Smith
- Medical Education Research Unit, Imperial College London, London, United Kingdom
| | - Ana Baptista
- Medical Education Research Unit, Imperial College London, London, United Kingdom
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Burnham KD, Lady SD, Martin C. Awareness of LGBTQ+ health disparities: A survey study of complementary integrative health providers. THE JOURNAL OF CHIROPRACTIC EDUCATION 2023; 37:124-136. [PMID: 37450413 PMCID: PMC11095652 DOI: 10.7899/jce-22-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/28/2022] [Accepted: 09/13/2022] [Indexed: 07/18/2023]
Abstract
OBJECTIVE The purpose of this study was to survey awareness of lesbian, gay, bisexual, transgender, queer/questioning, plus health disparities among complementary integrative health providers; chiropractors, naturopaths, acupuncturists, and massage therapists and secondly, examine how providers' sexual and gender identity correlated with that awareness. METHODS An electronic survey was designed, which included demographic questions as well as closed-ended and Likert response items to measure provider awareness of LGBTQ+ patients and the health disparities they experience. Kruskal-Wallis H tests with pairwise comparisons were used to evaluate the differences between defined groups and their awareness of health disparities of LGBTQ+ adults and youth. RESULTS The survey showed that most complementary integrative health care providers agreed that LGBTQ+ individuals experience discrimination and health disparities. However, providers are unaware of the specific disparities experienced in this population, including increased risk of substance abuse and mental health issues. Pairwise comparison tests demonstrated that providers that identify as a part of the LGBTQ+ community are often more aware of disparities than their heterosexual cisgender counterparts. CONCLUSION Complementary integrative health care providers demonstrated some general awareness of LGBTQ+ health disparities yet most providers lacked awareness of specific disparities that pose major health risks for this community. Cultural competency training specific to LGBTQ+ individuals is lacking and may explain some of the findings in this study. This suggests that education is needed, both in professional educational programs and in the health care community by way of conferences, webinars, and other opportunities.
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Parenteau AM, Boyer CJ, Campos LJ, Carranza AF, Deer LK, Hartman DT, Bidwell JT, Hostinar CE. A review of mental health disparities during COVID-19: Evidence, mechanisms, and policy recommendations for promoting societal resilience. Dev Psychopathol 2023; 35:1821-1842. [PMID: 36097815 PMCID: PMC10008755 DOI: 10.1017/s0954579422000499] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Social and economic inequality are chronic stressors that continually erode the mental and physical health of marginalized groups, undermining overall societal resilience. In this comprehensive review, we synthesize evidence of greater increases in mental health symptoms during the COVID-19 pandemic among socially or economically marginalized groups in the United States, including (a) people who are low income or experiencing homelessness, (b) racial and ethnic minorities, (c) women and lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) communities, (d) immigrants and migrants, (e) children and people with a history of childhood adversity, and (f) the socially isolated and lonely. Based on this evidence, we propose that reducing social and economic inequality would promote population mental health and societal resilience to future crises. Specifically, we propose concrete, actionable recommendations for policy, intervention, and practice that would bolster five "pillars" of societal resilience: (1) economic safety and equity, (2) accessible healthcare, including mental health services, (3) combating racial injustice and promoting respect for diversity, equity, and inclusion, (4) child and family protection services, and (5) social cohesion. Although the recent pandemic exposed and accentuated steep inequalities within our society, efforts to rebuild offer the opportunity to re-envision societal resilience and policy to reduce multiple forms of inequality for our collective benefit.
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Affiliation(s)
- Anna M. Parenteau
- Psychology Department, University of California-Davis
- Center for Poverty and Inequality Research, University of California-Davis
| | - Chase J. Boyer
- Department of Human Ecology, University of California-Davis
| | | | | | - LillyBelle K. Deer
- Psychology Department, University of California-Davis
- Center for Poverty and Inequality Research, University of California-Davis
| | | | - Julie T. Bidwell
- Betty Irene Moore School of Nursing, University of California-Davis
| | - Camelia E. Hostinar
- Psychology Department, University of California-Davis
- Center for Poverty and Inequality Research, University of California-Davis
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Moncayo JE, Pérez-Arizabaleta MDM, Villegas-Trujillo LM, Rodríguez-Ortiz A. Adherence to Oral Pre-Exposure Prophylaxis Intervention by Transgender Women: A Systematic Review. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:362-375. [PMID: 37843906 DOI: 10.1521/aeap.2023.35.5.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Prevalence of human immunodeficiency virus (HIV) is higher in transgender populations. Pre-exposure prophylaxis (PrEP) intervention is successful in reducing HIV acquisition. We aimed to investigate the adherence to oral PrEP by HIV-negative transgender women (TW). We followed the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA Statement. We searched in WoS, OVID, Scopus, MEDLINE, and the Cochrane Central Register of Controlled Trials databases. Participation and adherence to the intervention were low for TW compared to cisgender men who have sex with men (cMSM), and it was measured mostly by self-report (72.7%) or tenofovir-diphosphate/emtricitabine triphosphate dried blood spot (45.5%). Awareness should increase and the effect of oral PrEP on gender-affirming hormone therapy should be explained to TW at the beginning of the trials. One limitation is that our sample size was dominated by two Thai studies with TW sex workers. Future studies should evaluate adherence to new PrEP modalities.
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Affiliation(s)
| | - María Del Mar Pérez-Arizabaleta
- Faculty of Psychology, Universidad Antonio Nariño, Cali, Colombia
- Faculty of Psychology, Universidad Cooperativa de Colombia-Campus Cali
| | - Lina María Villegas-Trujillo
- Faculty of Health, Universidad del Valle, Cali, Colombia
- SIT Consulting-Science, Innovation & Technology, Cali, Colombia
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Wang YC, Miao NF, You MH, Wang FTY, Hsu CY, Lee PH, Du SC. Enhancing cultural competence in caring for lesbian, gay, bisexual, and transgender patients: An online training program for Taiwanese student nurses and nurses. NURSE EDUCATION TODAY 2023; 129:105914. [PMID: 37481921 DOI: 10.1016/j.nedt.2023.105914] [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: 04/14/2023] [Revised: 06/05/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Health disparities exist among lesbian, gay, bisexual, and transgender (LGBT) populations worldwide. However, student nurses and nurse staff have limited knowledge and skills in providing culturally competent nursing care for LGBT patients in Taiwan. OBJECTIVES This paper describes the development, implementation, and evaluation of an online training program for the cultural competence of student nurses and nurses in Taiwan. DESIGN A one-group pre-/post-test study design. SETTINGS The study was conducted in five nursing schools, 10 nursing associations, and 37 long-term care facilities. Two prominent online bulletin boards (PTT Nurse and Dcard Nurse) and one Taiwanese nursing group on Facebook were used to recruit participants. PARTICIPANTS In total, 301 student nurses and nurses participated in the study and responded to pre- and post-test questionnaires. METHODS An online training program for culturally competent nursing care was developed and implemented. The pre- and post-test questionnaires contained three sections: (1) demographics, (2) knowledge of LGBT health, and (3) the Sexual Orientation Counselor Competency Scale. Three open-ended questions were included in the post-test questionnaire to evaluate the online training program. RESULTS The online training program significantly improved the participants' knowledge and cultural competence skills. However, their attitudes towards cultural competence did not change after the program was implemented. Regarding qualitative feedback of the online training program, feedback on the strengths and limitations of the program was summarized under three themes: program content, website design, and online modules. CONCLUSIONS The results suggest the importance of an online training program which may contribute to reducing health disparities among the LGBT population.
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Affiliation(s)
- Ya-Ching Wang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
| | - Nae-Fang Miao
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
| | - Mei-Hui You
- Graduate Institute of Gender Education, National Kaohsiung Normal University, Taiwan.
| | - Frank T Y Wang
- Graduate Institute of Social Work, National Chengchi University, Taipei, Taiwan.
| | | | - Po-Han Lee
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Sih-Cheng Du
- Taiwan Tongzhi (LGBTQ+) Hotline Association, Taiwan.
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Dhillon G, Grewal H, Monga V, Munjal R, Buddhavarapu VS, Verma RK, Sharma P, Kashyap R. Gender inclusive care toolkit for hospitals. LANCET REGIONAL HEALTH. AMERICAS 2023; 26:100583. [PMID: 37876668 PMCID: PMC10593560 DOI: 10.1016/j.lana.2023.100583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Gagandeep Dhillon
- Department of Internal Medicine, University of Maryland Baltimore Washington Medical Center, Glen Burnie, MD, USA
| | | | - Varun Monga
- Banner Medical Group, Banner Thunderbird Medical Center, Glendale, AZ, USA
| | | | | | - Ram Kishun Verma
- Department of Sleep Medicine, Parkview Health System, Fort Wayne, IN, USA
| | - Pranjal Sharma
- Clinical Assistant Professor of Internal Medicine, Northeast Ohio Medical University, OH, USA
| | - Rahul Kashyap
- Department of Research, WellSpan Health, York, PA, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Halloran J, Szilagyi N, Stevens J, Olezeski C. Assessment of Transgender/Gender-Expansive Accessibility in Inpatient Pediatric Mental Health Facilities. Transgend Health 2023; 8:457-466. [PMID: 37810937 PMCID: PMC10551763 DOI: 10.1089/trgh.2021.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose This study surveyed a national sample of inpatient pediatric behavioral health facilities on policies related to care for transgender and gender-expansive (TGE) youth to assess adherence to best practices. Methods Staff/providers at youth inpatient psychiatric facilities were recruited by phone or email. Participants completed an electronic survey on facilities' training policies, staff comfort related to gender diversity, and other policies related to caring for TGE youth. Results Of 479 potential participating facilities, 124 surveys were initiated and 59 were completed. Measures to ensure accessibility to TGE patients are present in many facilities surveyed, with most reporting that their facility had nondiscrimination policies in place (86.2%) and required training on working with TGE patients (52.5%). A minority of participants (12.1%) reported that their facility roomed TGE youth based on sex assigned at birth, although only a small portion roomed based on gender identity alone (19.0%). Slightly more than two-thirds stated that their facility had individual restrooms available. Most participants (74.6%) stated that facility staff were comfortable discussing gender diversity in general, although this was less common for other topics related to TGE patient care. Conclusion Our survey highlights efforts made by inpatient behavioral health facilities to ensure accessibility of services to TGE youth, although our results showed notable differences across facilities. Given inconsistent federal protections for TGE patients, there remains a need for efforts to ensure that TGE youth are receiving all possible support in these treatment settings, such as accessible restrooms and bedroom assignments, as well as the opportunity to room with peers.
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Affiliation(s)
- Justin Halloran
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Pediatric Gender Program, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nathalie Szilagyi
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jaime Stevens
- Affirming Psychiatry LLC, Hobe Sound, Florida, USA
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii, USA
| | - Christy Olezeski
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Pediatric Gender Program, Yale School of Medicine, New Haven, Connecticut, USA
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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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Nguyen MK, Anthony SP, Manganiello MP, Bell KA, Papanagnou D. An Interactive Module to Enhance Clinical and Non-clinical Communication Skills With LGBTQIA2S+ Patients. Cureus 2023; 15:e44999. [PMID: 37701162 PMCID: PMC10493465 DOI: 10.7759/cureus.44999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2023] [Indexed: 09/14/2023] Open
Abstract
The Lesbian, Gay, Transgender, Queer, Intersex, Asexual, Two-Spirit, and all others (LGBTQIA2S+) community comprises a diverse array of people who challenge conventional norms regarding sexual orientation and/or gender identity. This group possesses a distinct set of social and cultural principles that necessitate personalized and all-encompassing medical attention. In light of the increase in the number of individuals openly sharing their LGBTQIA2S+ identity and a growing societal openness toward this community, most healthcare providers do not feel prepared with the requisite knowledge and skills to appropriately care for the needs of this community. We describe the development of an educational intervention, the LGBTQIA2S+ Healthcare Module, to address this significant gap in health professions education. It offers current and future clinicians just-in-time training on the language and cultural context to adequately provide patient-centered care to this community.
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Affiliation(s)
- Michael K Nguyen
- Emergency Medicine, Thomas Jefferson University, Philadelphia, USA
| | | | | | - Karla A Bell
- Population Health/Physical Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, USA
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Stout J, Stahl A, Fortenberry JD. Developing medical professionalism in care of gender nonconforming patients: Reflections of second-year medical students after a curricular experience with gender nonconforming people and allies. MEDICAL TEACHER 2023; 45:984-990. [PMID: 37068168 DOI: 10.1080/0142159x.2023.2197136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Negative healthcare experiences persist for gender nonconforming individuals. Clinician-related factors, including lack of comfort with gender nonconforming persons and unexamined personal biases, present barriers to equitable and affirming healthcare. We explored the effects of contact with gender nonconforming individuals in preclinical medical education through a structured curricular intervention designed to build medical and humanistic knowledge and stimulate the development of medical professionalism surrounding the care of gender nonconforming individuals. METHODS A curricular module (didactic prework, time-synchronous online panel discussion, and post-event written reflection) was implemented in a second-year preclinical course in a large multi-campus Midwestern medical school. The module was based on pedagogical foundations of contact theory and reflective writing. Post-event written reflections were investigated using thematic analysis. RESULTS Analysis of 355 written reflections revealed three major themes (moments of insight, topics of confusion, connections to professional identity formation) and eight sub-themes. The findings demonstrated emerging gender professionalism and the importance of contact in professional development. DISCUSSION Contact with gender nonconforming people and the use of written reflections can encourage self-examination and foster professional identity formation among preclinical medical students. Modeling gender-affirming approaches may help counteract negative cultural messages about gender nonconforming people, aiding development of inclusive future physicians.
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Affiliation(s)
- Julianne Stout
- Veterinary Administration Department, Purdue University, West Lafayette, IN, USA
| | - Aletha Stahl
- Center for Intercultural Learning, Mentorship, Assessment and Research Purdue University, West Lafayette, IN, USA
| | - J Dennis Fortenberry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Hannans J. Integrating LGBTQI+ Content in Nursing Education Using Immersive Virtual Reality: Embodying Eden. Nurs Educ Perspect 2023; 44:321-322. [PMID: 37594431 DOI: 10.1097/01.nep.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
ABSTRACT Teaching nursing students to understand LGBTQI+ health care perspectives is critical in providing safe and effective care. Nursing curricula often have limited LGBTQI+ content to prepare students, with clinical experiences too varied to ensure exposure to specific gender diversity learning opportunities. Immersive virtual reality is a promising strategy to offer rich learning experiences from the perspective of the LGBTQI+ community.
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Affiliation(s)
- Jaime Hannans
- About the Author Jaime Hannans, PhD, RN, CNE, is associate dean, California State University Channel Islands, Camarillo, California. For more information, contact Dr. Hannans at
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Harbell MW, Maloney J, Anderson MA, Attanti S, Kraus MB, Strand N. Addressing Bias in Acute Postoperative Pain Management. Curr Pain Headache Rep 2023; 27:407-415. [PMID: 37405551 DOI: 10.1007/s11916-023-01135-0] [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] [Accepted: 05/17/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE OF REVIEW This review evaluates disparities in acute postoperative pain management with regard to gender, race, socioeconomic status, age, and language. Strategies for addressing bias are also discussed. RECENT FINDINGS Inequities in acute postoperative pain management may lead to longer hospital stays and adverse health outcomes. Recent literature suggests that there are disparities in acute pain management related to patient gender, race, and age. Interventions to address these disparities are reviewed but require further investigation. Recent literature highlights inequities in postoperative pain management, particularly in relation to gender, race, and age. There is a need for continued research in this area. Strategies such as implicit bias training and using culturally competent pain measurement scales may help reduce these disparities. Continued efforts by both providers and institutions to address and eliminate biases in postoperative pain management are needed to ensure better health outcomes.
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Affiliation(s)
- Monica W Harbell
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA.
| | - Jillian Maloney
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
| | | | | | - Molly B Kraus
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Natalie Strand
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
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