A survey of deans of medical schools in the U.S. and Canada finds that the median (midpoint) amount of time in the medical school curriculum dedicated to topics related to the health care needs of lesbian, gay, bisexual and transgender patients is about 5 hours, although there is wide variation among the schools in quantity, content and perceived quality of instruction, according to a study in the September 7 issue of JAMA, a medical education theme issue.
"Lesbian, gay, bisexual and transgender (LGBT) individuals have specific health and health care needs relating to chronic disease risk, adult and adolescent mental health, unhealthy relationships (e.g., intimate partner violence), gender identity, sexually transmitted infections, and human immunodeficiency virus infection, among others. Compared with heterosexual and nontransgender socioeconomically matched peers, LGBT individuals are more likely to face barriers accessing appropriate medical care, which may create or increase existing disparities," according to background information in the article. "Medical education organizations have called for LGBT-sensitive training, but how and to what extent schools educate students to deliver comprehensive LGBT patient care is unknown."
Juno Obedin-Maliver, M.D., M.P.H., of the Stanford University School of Medicine, Stanford, Calif., and colleagues examined among medical schools the presence and coverage of LGBT-related curricular content and topics and deans' opinions of their institutions' LGBT-related content. The deans of medical education (or equivalent) at 176 allopathic or osteopathic medical schools in Canada and the United States were surveyed to complete a 13-question, Web-based questionnaire between May 2009 and March 2010. Of the 176 schools, 150 (85.2 percent) responded, and 132 (75.0 percent) fully completed the questionnaire.
The researchers found that the median reported combined hours dedicated to LGBT content was 5 hours. The corresponding average value was 7 hours. Forty-four medical schools (33.3 percent) reported 0 hours of LGBT content during clinical years, 9 (6.8 percent) reported 0 hours during preclinical years, and 5 (3.8 percent) reported 0 combined hours. U.S. osteopathic schools had significantly fewer median reported clinical hours than U.S. allopathic schools (0 hours vs. 2 hours).
Of the survey respondents, 97.0 percent reported that their institution teaches medical students to ask patients if they have sex with men, women, or both when obtaining a sexual history. Seventy-two percent of the schools reported teaching students the difference between behavior and identity (e.g., men may have sex with men and identify as straight), and 21.2 percent did not know whether this difference was taught.
Regarding the presence or absence of 16 LGBT-related topics in their required or elective curricula, 62.9 percent of the schools reported teaching at least half of the 16 topics and 8.3 percent reported teaching all 16 of the topics in their required curricula.
"Deans evaluated their institutions' levels of coverage of the same 16 LGBT-related topics. The percentage of deans reporting 'too little coverage' of these topics varied from 12.9 percent for 'HIV in LGBT people' to 35.6 percent for 'LGBT adolescent health'. Deans also evaluated the quality of their schools' coverage of LGBT-related content overall. The most common response was 'fair' in 58 schools (43.9 percent), while nearly equal numbers evaluated coverage as 'very good' or 'good' (32; 24.2 percent) and 'very poor' or 'poor' (34; 25.8 percent)," the authors write.
The researchers add that the most popular strategies recommended or present for increasing LGBT content in the curricula included 'curricular material focusing on LGBT-related health and health disparities' and having 'faculty willing and able to teach LGBT-related curricular content'.
Regarding the finding that only about one-quarter of respondents rated their schools' overall coverage of LGBT-related curricular material as "good" or "very good," the authors write that "this indicates dissatisfaction with medical school coverage of LGBT content at a number of schools, especially given the expected positive skew associated with survey self-reporting, and suggests room for improvement in LGBT-related curricula."
Editorial: Capturing Curricula
Raymond H. Curry, M.D., of the Northwestern University Feinberg School of Medicine, Chicago, writes in an accompanying editorial that the findings of this study on the need for teaching LGBT issues can be viewed in relation to evidence for disparities in health care.
"The presence of these disparities is, without question, a concrete reality providing ample reason for students to understand as fully as possible the health challenges and needs of LGBT people. Even absent the health and health care disparities, it would still be important for physicians to understand the full range of human sexual behavior and to address the related psychosocial as well as overtly medical needs of the patients in their care. The study by Obedin-Maliver et al provides a valuable snapshot. However, that which is of most enduring importance is seen not so much through a lens specific to the inclusion of LGBT issues but through the assurance of ongoing attention to human sexuality, sexual behavior, and the accompanying medical implications as integral to the curriculum."
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