Journal of Science Policy & Governance
​Volume 20, Issue 02 | May 16, 2022

Literature Review: The Lack of Sexual and Gender Minority Curriculum in U.S. Medical Schools

Kyra Varley
Duke University, Durham, NC

Corresponding author: [email protected]
Keywords: sexual and gender minorities; LGBTQ; medical education; inclusive healthcare; medical curriculum; transgender health; health policy; minority healthcare
https://doi.org/10.38126/JSPG200209 ​

Executive Summary

Health outcomes of sexual and gender minorities are often disproportionately negative compared to their heterosexual counterparts. One reason is that healthcare providers report low confidence treating SGM patients and a low rate of interaction with this population. The curriculum being taught in U.S. medical schools is largely insufficient in teaching the healthcare needs of SGM individuals. Consequently, physicians are underprepared to treat these patients, leading to large health disparities. Physicians show improved levels of knowledge and confidence treating SGM patients after additional educational efforts, showing that adding SGM healthcare modules to medical schools will better prepare physicians to treat these patients. This would decrease health disparities and improve patient experiences and health outcomes. Additional curriculum should be multi-modal and include SGM individuals in their creation and implementation. This method has been shown to encourage the greatest improvement in physician knowledge and confidence working with patients. This paper also includes policy recommendations geared towards policymakers and stakeholders to guide future initiatives to improve the health outcomes of SGM patients. It is crucial that this conversation around social determinants of health leads to policy and structural changes. Future research in this area is needed and future policy changes or initiatives should be studied for their effectiveness.  ​

-Read the full article through download.-

Background header image courtesy of AAMC
Kyra Varley is a student at Duke University studying Social Determinants of Health and Inequality. She is passionate about investigating the factors leading to health disparities and eliminating them on a systemic level. Her previous research experience is with the Duke Center for Health Policy and Inequalities and has studied across Europe comparing the healthcare systems of various countries. As an aspiring physician, she will use her knowledge of the social components of health to improve patient experiences. Her experience is in both physical health, as an Emergency Medical Technician, and mental health as a Crisis Text Line Counselor.  

References

  1. Alpert, Alison B., Eileen M. CichoskiKelly, and Aaron D. Fox. 2017. “What Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Patients Say Doctors Should Know and Do: A Qualitative Study.” Journal of Homosexuality 64 (10): 1368–89. https://doi.org/10.1080/00918369.2017.1321376.
  2. Bi, Stephanie, Monica B. Vela, Aviva G. Nathan, Kathryn E. Gunter, Scott C. Cook, Fanny Y. López, Robert S. Nocon, and Marshall H. Chin. 2020. “Teaching Intersectionality of Sexual Orientation, Gender Identity, and Race/Ethnicity in a Health Disparities Course.” MedEdPORTAL. https://doi.org/10.15766/mep_2374-8265.10970.​
  3. Bureau, US Census. 2022. “Population under Age 18 Declined Last Decade.” Census.gov. April 22. https://www.census.gov/library/stories/2021/08/united-states-adult-population-grew-faster-than-nations-total-population-from-2010-to-2020.
  4. Cooper, M. Brett, Mariam Chacko, and Jennifer Christner. 2018. “Incorporating LGBT Health in an Undergraduate Medical Education Curriculum through the Construct of Social Determinants of Health.” MedEdPORTAL. https://doi.org/10.15766/mep_2374-8265.10781.
  5. Desrosiers, Jennifer, Tim J Wilkinson, Gillian Abel, and Suzanne Pitama. 2016. “Curricular Initiatives That Enhance Student Knowledge and Perceptions of Sexual and Gender Minority Groups: A Critical Interpretive Synthesis.” Canadian Medical Education Journal 7 (2). https://doi.org/10.36834/cmej.36644.
  6. DeVita, Timothy, Casey Bishop, and Michael Plankey. 2018. “Queering Medical Education: Systematically Assessing LGBTQI Health Competency and Implementing Reform.” Medical Education Online 23 (1): 1510703. https://doi.org/10.1080/10872981.2018.1510703.
  7. Donald, Cameron A., Sayantani DasGupta, Jonathan M. Metzl, and Kristen L. Eckstrand. 2017. “Queer Frontiers in Medicine.” Academic Medicine 92 (3): 345–50. doi.org/10.1097/acm.0000000000001533.
  8. Encandela, John, Nicole S. Zelin, Michael Solotke, and Michael L. Schwartz. 2019. “Principles and Practices for Developing an Integrated Medical School Curricular Sequence about Sexual and Gender Minority Health.” Teaching and Learning in Medicine 31 (3): 319–34. https://doi.org/10.1080/10401334.2018.1559167.
  9. Fakhoury, Joseph W., and Steven Daveluy. 2020. “Incorporating Lesbian, Gay, Bisexual, and Transgender Training into a Residency Program.” Dermatologic Clinics 38 (2): 285–92. https://doi.org/10.1016/j.det.2019.10.013.
  10. Fallin-Bennett, Keisa. 2015. “Implicit Bias against Sexual Minorities in Medicine.” Academic Medicine 90 (5): 549–52. doi.org/10.1097/acm.0000000000000662.
  11. Gessner, McKenna, Meg D. Bishop, Alexander Martos, Bianca D. Wilson, and Stephen T. Russell. 2019. “Sexual Minority People’s Perspectives of Sexual Health Care: Understanding Minority Stress in Sexual Health Settings.” Sexuality Research and Social Policy 17 (4): 607–18. https://doi.org/10.1007/s13178-019-00418-9.
  12. Haghiri-Vijeh, Roya, Tara McCulloch, Lynda Atack, and Gabriel Bedard. 2019. “The Impact of Positive Space Training on Students’ Communication with LGBTTQ+ Communities.” Nursing Education Perspectives 41 (2): 115–16. https://doi.org/10.1097/01.nep.0000000000000474.
  13. Honigberg, Michael C., Neir Eshel, Marlise R. Luskin, Shimon Shaykevich, Stuart R. Lipsitz, and Joel T. Katz. 2017. “Curricular Time, Patient Exposure, and Comfort Caring for Lesbian, Gay, Bisexual, and Transgender Patients among Recent Medical Graduates.” LGBT Health 4 (3): 237–39. https://doi.org/10.1089/lgbt.2017.0029.
  14. Jones, Jeffrey M. 2021. “LGBT Identification Rises to 5.6% in Latest U.S. Estimate.” Gallup.com. Gallup. November 20. https://news.gallup.com/poll/329708/lgbt-identification-rises-latest-estimate.aspx.
  15. Khalili, Joshua, Lucinda B. Leung, and Allison L. Diamant. 2015. “Finding the Perfect Doctor: Identifying Lesbian, Gay, Bisexual, and Transgender–Competent Physicians.” American Journal of Public Health 105 (6): 1114–19. https://doi.org/10.2105/ajph.2014.302448.
  16. Kutscher, Eric, and Carla Boutin-Foster. 2016. “Community Perspectives in Medicine: Elective for First-Year Medical Students.” MedEdPORTAL. https://doi.org/10.15766/mep_2374-8265.10501.
  17. Leslie, Katie F., Susan Sawning, M. Ann Shaw, Leslee J. Martin, Ryan C. Simpson, Jennifer E. Stephens, and V. Faye Jones. 2017. “Changes in Medical Student Implicit Attitudes Following a Health Equity Curricular Intervention.” Medical Teacher 40 (4): 372–78. doi.org/10.1080/0142159x.2017.1403014.
  18. Minturn, Matthew S., Erica I. Martinez, Thien Le, Natalie Nokoff, Louis Fitch, Carley E. Little, and Rita S. Lee. 2021. “Early Intervention for LGBTQ Health: A 10-Hour Curriculum for Preclinical Health Professions Students.” MedEdPORTAL. https://doi.org/10.15766/mep_2374-8265.11072.
  19. Nowaskie, Dustin Z., and Anuj U. Patel. 2020. “How Much Is Needed? Patient Exposure and Curricular Education on Medical Students’ LGBT Cultural Competency.” BMC Medical Education 20 (1). https://doi.org/10.1186/s12909-020-02381-1.
  20. O’Leary, Kerry B., and George H. Kunkel. 2021. “Restructuring LGBTQ Curriculum in Medical Schools.” Academic Psychiatry 45 (4): 487–90. https://doi.org/10.1007/s40596-021-01414-1.
  21. Phelan, Sean M., Sara E. Burke, Rachel R. Hardeman, Richard O. White, Julia Przedworski, John F. Dovidio, Sylvia P. Perry, et al. 2017. “Medical School Factors Associated with Changes in Implicit and Explicit Bias against Gay and Lesbian People among 3492 Graduating Medical Students.” Journal of General Internal Medicine 32 (11): 1193–1201. https://doi.org/10.1007/s11606-017-4127-6.
  22. Potter, Laura A., Sherri-Ann M. Burnett-Bowie, and Jennifer Potter. 2016. “Teaching Medical Students How to Ask Patients Questions about Identity, Intersectionality, and Resilience.” MedEdPORTAL. https://doi.org/10.15766/mep_2374-8265.10422.
  23. Pratt-Chapman, Mandi L. 2020. “Implementation of Sexual and Gender Minority Health Curricula in Health Care Professional Schools: A Qualitative Study.” BMC Medical Education 20. https://doi.org/10.21203/rs.2.18264/v3.
  24. Pratt-Chapman, Mandi L., and Serena Phillips. 2019. “Health Professional Student Preparedness to Care for Sexual and Gender Minorities: Efficacy of an Elective Interprofessional Educational Intervention.” Journal of Interprofessional Care 34 (3): 418–21. https://doi.org/10.1080/13561820.2019.1665502.
  25. Roth, Lauren T., Suzanne Friedman, Rachel Gordon, and Marina Catallozzi. 2020. “Rainbows and ‘Ready for Residency’: Integrating LGBTQ Health into Medical Education.” MedEdPORTAL. https://doi.org/10.15766/mep_2374-8265.11013.
  26. Sawning, Susan, Stacie Steinbock, Rachel Croley, Ryan Combs, Ann Shaw, and Toni Ganzel. 2017. “A First Step in Addressing Medical Education Curriculum Gaps in Lesbian-, Gay-, Bisexual-, and Transgender-Related Content: The University of Louisville Lesbian, Gay, Bisexual, and Transgender Health Certificate Program.” Education for Health 30 (2): 108. https://doi.org/10.4103/efh.efh_78_16.
  27. Schweiger-Whalen, Lindsey, Shelly Noe, Stephanie Lynch, Linda Summers, and Eve Adams. 2018. “Converging Cultures: Partnering in Affirmative and Inclusive Health Care for Members of the Lesbian, Gay, Bisexual, and Transgender Community.” Journal of the American Psychiatric Nurses Association 25 (6): 453–66. https://doi.org/10.1177/1078390318820127.
  28. Solotke, Michael, Nicole A. Sitkin, Michael L. Schwartz, and John A. Encandela. 2017. “Twelve Tips for Incorporating and Teaching Sexual and Gender Minority Health in Medical School Curricula.” Medical Teacher 41 (2): 141–46. https://doi.org/10.1080/0142159x.2017.1407867.
  29. Wahlen, Raphaël, Raphaël Bize, Jen Wang, Arnaud Merglen, and Anne-Emmanuelle Ambresin. 2020. “Medical Students’ Knowledge of and Attitudes towards LGBT People and Their Health Care Needs: Impact of a Lecture on LGBT Health.” PLOS ONE 15 (7). https://doi.org/10.1371/journal.pone.0234743.
  30. Warner, Christina, Samantha Carlson, Renee Crichlow, and Michael W. Ross. 2018. “Sexual Health Knowledge of U.S. Medical Students: A National Survey.” The Journal of Sexual Medicine 15 (8): 1093–1102. https://doi.org/10.1016/j.jsxm.2018.05.019.
  31. White, William, Stephanie Brenman, Elise Paradis, Elizabeth S. Goldsmith, Mitchell R. Lunn, Juno Obedin-Maliver, Leslie Stewart, et al. 2015. “Lesbian, Gay, Bisexual, and Transgender Patient Care: Medical Students' Preparedness and Comfort.” Teaching and Learning in Medicine 27 (3): 254–63. https://doi.org/10.1080/10401334.2015.1044656.
  32. Yang, Hsing-Chen. 2019. “Education First: Promoting LGBT+ Friendly Healthcare with a Competency-Based Course and Game-Based Teaching.” International Journal of Environmental Research and Public Health 17 (1): 107. https://doi.org/10.3390/ijerph17010107.
  33. Zelin, Nicole Sitkin, Charlotte Hastings, Brendin R. Beaulieu-Jones, Caroline Scott, Ana Rodriguez-Villa, Cassandra Duarte, Christopher Calahan, and Alexander J. Adami. 2018. “Sexual and Gender Minority Health in Medical Curricula in New England: A Pilot Study of Medical Student Comfort, Competence and Perception of Curricula.” Medical Education On fetline 23 (1): 1461513. https://doi.org/10.1080/10872981.2018.1461513.
DISCLAIMER: The findings and conclusions published herein are solely attributed to the author and not necessarily endorsed or adopted by the Journal of Science Policy and Governance. Articles are distributed in compliance with copyright and trademark agreements.

ISSN 2372-2193
© 2022 Journal of Science Policy & Governance, Inc. All rights reserved. The opinions, findings and conclusions from JSPG publications, additional article commentaries and related events do not necessarily reflect the views of the journal.