Development and evaluation of a clinical simulation-based educational innovation on sexual orientation and gender identity in emergency medicine

INTRODUCTION

Sexual orientation and gender identity (SOGI)-diverse patients are marginalized and poorly cared for in the emergency department, yet well-designed educational interventions to meet this gap are lacking. We developed, implemented, and assessed a novel multi-modal SOGI curriculum on health and cultural humility for emergency medicine physician trainees.

METHODS

We conducted a prospective, single-arm evaluation of our educational intervention. A convenience sample of emergency medicine resident physicians (n = 21) participated in the facilitated curriculum including didactic and clinical simulation components. Participants completed a pre- and post-curriculum evaluation that assessed clinical skills, preparedness, attitudinal awareness, and basic knowledge in caring for SOGI-diverse patients. The content of the module was based on a scoping literature review and national needs assessment of Canadian emergency physicians, educators, and trainees along with expert collaborator and input from patient/community partners. The curriculum included a facilitated pre-brief, didactic presentation, clinical simulation modules, and a structured de-brief. Participant clinical skills were evaluated before and after the educational intervention. Our primary outcome was change in clinical preparedness, attitudinal awareness, and basic knowledge in caring for SOGI-diverse patients pre- and post-intervention.

RESULTS

Our patient-centered, targeted emergency medicine SOGI health and cultural humility training resulted in a significant improvement in resident self-rated clinical preparedness, attitudes, and knowledge in caring for SOGI-diverse patients. This training was valued by participants.

CONCLUSION

We have designed an effective, patient-centered curriculum in health and cultural humility for SOGI-diverse patients in EM. Other programs can consider using this model and developed resources in their jurisdictions to enhance provider capacities to care for this marginalized group.

Sexual and gender minority relevant policies in Canadian and United States organ and tissue donation and transplantation systems: An opportunity to improve equity and safety

Current policies in organ and tissue donation and transplantation (OTDT) systems in Canada and the United States unnecessarily restrict access to donation for sexual and gender minorities (SGMs) and pose safety risks to transplant recipients. We compare SGM-relevant policies between the Canadian and United States systems. Policy domains include the risk assessment of living and deceased organ and tissue donors, physical examination considerations, viral testing recommendations, and informed consent and communication. Identified gaps between current evidence and existing OTDT policies along with differences in SGM-relevant policies between systems, represent an opportunity for improvement. Specific recommendations for OTDT system policy revisions to achieve these goals include the development of behavior-based, gender-neutral risk assessment criteria, a reduction in current SGM no-sexual contact period requirements pending development of inclusive criteria, and destigmatization of sexual contact with people living with human immunodeficiency virus. OTDT systems should avoid rectal examinations to screen for evidence of receptive anal sex without consent and mandate routine nucleic acid amplification test screening for all donors. Transplant recipients must receive enhanced risk-to-benefit discussions regarding decisions to accept or decline an offer of an organ classified as increased risk. These recommendations will expand the donor pool, enhance equity for SGM people, and improve safety and outcomes for transplant recipients.

Queer(ing) medical spaces: queer theory as a framework for transformative social change in anesthesiology and critical care medicine

Queer theory is a disruptive lens that can be adopted by researchers, educators, clinicians, and administrators to effect transformative social change. It offers opportunities for anesthesiologists, critical care physicians, and medical practitioners to more broadly understand what it means to think queerly and how queering anesthesiology and critical care medicine spaces improves workplace culture and patient outcomes. This article grapples with the cis-heteronormative medical gaze and queer people's apprehensions of violence in medical settings to offer new ways of thinking about structural changes needed in medicine, medical language, and the dehumanizing application of medical modes of care. Using a series of clinical vignettes, this article outlines the historical context underlying queer peoples' distrust of medicine, a primer in queer theory, and an understanding of how to begin to "queer" medical spaces using this critical framework.

Presentation of Patients with Eating Disorders to a Pediatric Quaternary-Level Care Emergency Department During the COVID-19 Pandemic

Despite an overall decrease in utilization of emergency departments during COVID-19 (Hartnett et al. in MMWR Morb Mortal Wkly Rep. 69(23):699-704, 2020), US pediatric emergency departments experienced an increase in mental health visits for children and adolescents (Leeb et al. in MMWR Morb Mortal Wkly Rep. 69(45):1675-80, 2020). Simultaneously, individuals with eating disorders reported increasing symptomology (Termorshuizen et al. in Int J Eat Disord. 53(11):1780-90, 2020). This study compares Emergency Department utilization at a pediatric quaternary-level care center by patients with eating disorders during the pandemic (March-Dec 2020) vs March-Dec 2019. We hypothesize that there was an increase in presentation of patients with eating disorders. An Informatics for Integrating Biology and the Bedside query of the electronic medical record system identified patients with eating disorder diagnoses per ICD9/ICD10 codes aged 6-23 who presented to the Emergency Department between March 1^st and December 31^st of 2020 and 2019. Subsequent retrospective chart review was carried out. Patients were excluded from analysis if the presenting problem was not directly related to the eating disorder. During March-Dec 2019, 0.581% percent of all patients presented to the Emergency Department due to an eating disorder. During the same time frame in 2020, however, that percentage increased to 1.265%. Statistical significance was corrected using a Benjamini-Hochberg analysis. Despite a 66.5% decline in overall visits to the Emergency Department, the percentage of patients presenting with eating disorders doubled during the pandemic. During the pandemic, the total time spent awaiting placement significantly increased, and the number of patients identifying as transgender and/or nonbinary increased. Our data support the hypothesis that eating disorder presentation increased during the pandemic.