An increasing number of U.S. medical schools offer courses that focus on the art and science of providing compassionate and informed health care for people who identify as LGBTQ.
A survey of New England M.D. students in 2018 revealed that nearly 77% of respondents rated themselves as not competent or somewhat not competent at providing medical care for gender and sexual minorities. At seven of the 10 schools represented in the survey, a majority of students said coverage of the medical concerns of sexual and gender minorities in their M.D. curriculum and preparation to serve those patients were inadequate.
This study is one of many that reveal a knowledge gap among U.S. medical students and professors who want to adopt best practices with LGBTQ patients but aren’t sure how. In response, the Association of American Medical Colleges offers an array of educational resources on the topic.
Increasingly, medical educators across the U.S. are working to ensure that future doctors are able to address the medical needs of patients who identify as LGBTQ. Some research indicates a correlation between victimization through homophobic bullying and diagnosis with serious disorders among these individuals, who have a higher risk of contracting and dying from certain illnesses than the general population.
According to the 2022 National Survey on LGBTQ Youth Mental Health that was published by The Trevor Project, an LGBTQ-oriented mental health advocacy organization, LGBTQ children who directly experienced homophobic bullying were twice as likely to attempt suicide in comparison to their LGBTQ peers who had not been subjected to homophobia. Research from the Trevor Project has also shown that LGBTQ youth “may use substances to cope with minority stress and negative experiences in unsupportive, anti-LGBTQ environments.”
LGBTQ Health Issues in Medical School Courses
Required courses at some U.S. medical schools provide significant instruction about the biology of sexual orientation and gender identity. They often teach extensively about health issues common among lesbian, gay, bisexual, transgender and queer or questioning — LGBTQ — medical patients in core classes. They also usually address the medical concerns of people who are intersex — having anatomical characteristics that are neither typically female nor typically male — or nonbinary, meaning that they don’t identify exclusively with one gender.
In addition, preclinical training at these schools on how to appropriately interact with and evaluate patients typically includes lessons on best practices for interviewing, examining and diagnosing LGBTQ patients, since some research has indicated that many LGBTQ people are wary of seeking medical appointments due to fear of discriminatory harassment. Med schools that prioritize LGBTQ medicine also frequently offer elective LGBTQ-focused clinical rotations where medical students can get practice addressing the needs of LGBTQ patients.
Lessons about LGBTQ medicine at these schools aren’t solely focused on certain sexually transmitted infections that more frequently affect LGBTQ people who have had sex with men, such as monkeypox, HIV and AIDS. Those topics are covered in the LGBTQ health curriculum, but excluding other information about LGBTQ medicine, such as the pros and cons of various hormone therapies, would be inappropriate and stigmatizing, officials at these schools say.
Dr. Amy Holthouser, senior associate dean for undergraduate medical education at the University of Louisville School of Medicine in Kentucky, helped redesign the school’s curriculum to expand its coverage of LGBTQ health concerns. These issues range from the risk of irreversible male-pattern baldness in transgender men if they begin taking male hormones, to the need for pap smears among lesbians, who often mistakenly believe that they cannot catch human papillomavirus or get cervical cancer.
Holthouser says the goal of the curriculum reform was to address LGBTQ topics in any medical class where such information is relevant.
“We truly integrated this content along with all the other content,” she says. “It’s just part of what you teach. It’s not a special call-out box. It’s not another thing to alienate a group or a population.”
For example, when the university invited local LGBTQ people to the medical school to speak with students about their experiences in the health care system, some described upsetting interactions with doctors, Holthouser says.
“The excuse that’s used is that, ‘I don’t know enough about what you need to care for you,'” she says. “Well, again, in a good well-rounded medical education curriculum, what becomes clear is that the majority of what this patient needs is the same as everybody else — there are some medical nuances — and the majority of things that are actually different have to do with the provider’s behavior, the provider’s language and the provider’s attitude.”
Many medical schools have curricula that barely touch on LGBTQ medicine, according to some medical students and faculty, who note that the absence or presence of LGBTQ content in courses depends on the culture and values of a school.
Austen Ott, director of external affairs for the Medical Student Pride Alliance, a national coalition of LGBTQ medical students, says the political climate at a school may influence whether it addresses LGBTQ health issues.
“If it’s really difficult to access information about LGBTQ-plus curricular content, then that could be a sign that it’s not a welcoming environment,” says Ott, a student at the University of Minnesota School of Medicine.
Reasons to Study LGBTQ Medicine
Administrators and professors at med schools that require coursework in LGBTQ health, such as the University of Louisville School of Medicine and Harvard Medical School, say that basic knowledge about LGBTQ medicine is necessary for every future doctor regardless of specialization. Nearly every doctor throughout their career will encounter patients who openly or privately identify as LGBTQ and should be prepared to provide the same level of care for those patients as others.
Dr. Alex S. Keuroghlian, an associate professor of psychiatry at Harvard and director of the National LGBTQIA+ Health Education Center, says the degree to which a medical school covers medical issues that affect sexual and gender minorities is “an indicator of the extent to which that school is emphasizing health equity and social justice.”
According to a 2022 Gallup Poll, more than one-fifth of Generation Z adults born between 1997 and 2003 identify as something other than heterosexual and cisgender, the latter a term for people whose gender identity matches the sex they were assigned at birth.
“If medical students entering school now aren’t graduating capable of serving at least 20% of future generations they’ll be serving during their medical career, they are not adequately prepared,” Keuroghlian says.
How to Tell if a Med School Excels in LGBTQ Health Education
Inquire About Required Classes
Though medical school coursework about LGBTQ health issues is more likely to be elective than mandatory, a rising number of schools are incorporating this content into foundational classes for all students.
“Offering it as a requirement really does put the teeth behind it in the curriculum, saying this is something for all students,” says Dr. Steven Rougas, director of the doctoring program at Brown University’s Warren Alpert Medical School in Rhode Island and an associate professor of emergency medicine and medical science.
At Brown, all med students begin examining LGBTQ health issues early through a deep-dive session where they consider medical case studies about LGBTQ patients. LGBTQ topics are addressed throughout the curriculum in a wide range of courses.
Search for LGBTQ Clinics or Institutes
“Looking for centers is how I would go about doing it,” says clinical psychologist Dane Whicker, director of gender and sexual diversity initiatives in the Office of Equity, Diversity, and Inclusion at Duke University School of Medicine in North Carolina.
One particularly good sign, Whicker says, is if a medical school and its affiliated university conduct research and provide comprehensive treatment for transgender youth and adults.
Duke has a child and adolescent gender care clinic and offers nonbinary and transgender adult patients hormone therapy. There’s also a primary care clinic tailored to the needs of LGBTQ patients, a pre-exposure prophylaxis clinic for people at higher-than-average risk of contracting HIV, a fertility program for LGBTQ couples and fertility preservation services for transgender individuals.
Find Out if LGBTQ Lessons Are Adjusted Regularly
“One key question is how the institution plans for change,” Dr. John A. Davis, the University of California–San Francisco School of Medicine‘s associate dean for curriculum, wrote in an email. “Areas particularly involving gender identity and expression and sexuality are rapidly changing, and curriculum must keep up with that. How an institution plans for that type of rapid change says a lot.”
UCSF seeks input from many LGBTQ advocates and scholars when crafting its LGBTQ curriculum, Davis says.
“We have a fantastic group of students, staff, faculty, and community partners helping us to think about not just what we teach, but how we’re teaching it.”
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LGBTQ Health Issues: How to Choose a Medical School at the Forefront originally appeared on usnews.com