Where We Stand
Section: Workforce Issues
Policy: Training Health Professionals on LGBTQ+ Topics
Appendix V

Training Health Professionals on LGBTQ+ Topics

*GLMA: Health Professionals Advancing LGBTQ+ Equality does not generally spell out the acronym “GLMA” as part of the name since adopting a more inclusive organizational name.

**Using gender-inclusive language means speaking and writing in a way that does not discriminate against a particular sex, social gender or gender identity, and does not perpetuate gender stereotypes. Given the key role of language in shaping cultural and social attitudes, using gender-inclusive language is a powerful way to promote gender equality and eradicate gender bias. (https://www.un.org/en/gender-inclusive-language/)

Comments

Prior studies have indicated that there is a lack of formal LGBTQ+ health training across the Graduate Medical Education (GME) curricula and within the multidisciplinary healthcare team (ACGME, 2020; ACGME 2022a; ACGME 2022b; Gardner et al., 2014; Kortes-Miller, Wilson, & Stinchcombe, 2019). Evidence suggests that medical students may be unprepared to care for LGBTQ+ patients at graduation (Nama et al., 2017; Zelin et al., 2018). Studies further suggest that residents lack competence when caring for LGBTQ+ patients (Streed et al., 2019; Zelin et al., 2019).  Surveys of residents across different specialties demonstrate that they feel unprepared and uncomfortable treating LGBTQ+ patients and would like training in LGBTQ+ health topics (Guerrero-Hal, 2021; Hayes et al., 2015; Moll et al., 2019; Roth et al., 2021; Streed et al., 2019).

The absence of formal training results in physicians who have not acquired basic knowledge on LGBTQ+ health topics, which may negatively affect patient care (Hurd, 2015). The need for formal training was demonstrated by a recent study showing that senior residents in internal medicine had poor knowledge about sexual and gender minority health and health disparities, despite several years of residency training (Streed et al., 2021).  Basic knowledge of health topics and disparities is necessary for the provision of competent care.

The American Geriatrics Society position statement on care of older LGBTQ+ adults identifies education for healthcare providers on “LGBT health concerns focused on the older adult population, the effect of discrimination on healthcare delivery, the social circumstances of LGBT individuals, and the relationship between social history (including gender identity, relationship status, and sexual behavior) and health and health care” as one of the most important steps for the delivery of high-quality health care (Hurd, 2015). Recently, the American Geriatrics Society has been joined by several medical societies and other members of the Graduate Medical Education (GME) community in calling for training that is responsive to the health needs of the LGBTQ+ community (Hurd, 2015; Pregnall, Churchwell, & Ehrenfeld, 2021; Roth et al., 2021; Streed et al., 2021). Despite these calls, no formal curricula on LGBTQ+ health is required as part of internal medicine residency or geriatric fellowship training (ACGME, 2020; ACGME 2022a, 2022b). Several residency programs have independently developed their own LGBTQ+ curricula (Barrett et al., 2021; Grova et al., 2021; Klein & Nakhai, 2016; Roth et al., 2021; Streed et al., 2021); however, the lack of a formal curricula or guidance from the ACGME, means that residency and fellowship programs incorporate content on LGBTQ+ health topics inconsistently.

Physicians, Physician Assistants, and other healthcare providers have an important role in supporting the health and needs of older LGBTQ+ patients (Hurd, 2015; Maingi et al., 2021). LGBTQ+ patients report feeling more comfortable accessing medical care when their provider is also LGBTQ+ or is familiar with the LGTBQ+ community (Martos et al., 2018; Rossman, Salamanca, & Macapagal, 2017; Rutherford et al., 2012), which is particularly important given the wide health disparities for LGBTQ+ individuals (Gonzales, Przedworkski, & Henning-Smith, 2016). Education in LGBTQ+ health topics is vital for the provision of high-quality and comprehensive healthcare for creating the safe and inclusive environment that patients need to have conversations about their health, goals of care, and end of life decisions (Pecanac, Hill, & Borkowski, 2021).

Healthcare professionals, including physicians and physician assistants, have an obligation to provide high-quality and comprehensive care to all patients, including LGBTQ+ individuals. Support for training, education, and competencies for healthcare professionals related to LGBTQ+ health will help ensure that patients receive the high-quality care they deserve. To assist OMA policy development, this workgroup reviewed and considered existing policies from the AMA and the GLMA: Health Professionals Advancing LGBTQ Equality. In addition to examining these policies, the workgroup also reviewed other policies, statements, studies, and resources from state and national medical associations and organizations advocating for LGBTQ+ health.

These recommendations will become OMA policy and allow OMA to advocate, influence, and educate to advance and improve LGBTQ+ healthcare in the state. These recommendations will further the OMA’s goals of advocating for an equitable and accessible healthcare environment and building and supporting the community of physicians and physician assistants.

 

References

Accreditation Council for Graduate Medical Education (ACGME). (2020). ACGME program requirements for graduate medical education in geriatric medicine. ACGME. https://www.acgme.org/globalassets/PFAssets/ProgramRequirements/125_GeriatricMedicine_2020.pdf?ver=2020-06-23-055053-010&ver=2020-06-23-055053-010

Accreditation Council for Graduate Medical Education (ACGME). (2022a). ACGME common program requirements (residency). ACGME. https://www.acgme.org/globalassets/pfassets/programrequirements/cprresidency_2022v3.pdf

Accreditation Council for Graduate Medical Education (ACGME). (2022b). ACGME program requirements for graduate medical education in internal medicine. ACGME. https://www.acgme.org/globalassets/pfassets/programrequirements/140_internalmedicine_2022v4.pdf

Barrett, D. L., Supapannachart, K. J., Caleon, R. L., Ragmanauskaite, L., McCleskey, P., & Yeung, H. (2021). Interactive session for residents and medical students on dermatologic care for lesbian, gay, bisexual, transgender, and queer patients. MedEdPORTAL : The Journal of Teaching and Learning Resources, 17, 11148.

Gardner, A. T., de Vries, B., & Mockus, D. S. (2014). Aging out in the desert: Disclosure, acceptance, and service use among midlife and older lesbians and gay men. Journal of Homosexuality, 61(1), 129–144. https://doi.org/10.1080/00918369.2013.835240

Gonzales G, Przedworski J, Henning-Smith C. Comparison of health and health risk factors between lesbian, gay, and bisexual adults and heterosexual adults in the United States: results from the national health interview survey. JAMA Intern Med. 2016;176(9):1344–51. doi: 10.1001/jamainternmed.2016.3432.

Grova, M. M., Donohue, S. J., Bahnson, M., Meyers, M. O., & Bahnson, E. M. (2021). Allyship in surgical residents: Evidence for LGBTQ competency training in surgical education. The Journal of Surgical Research, 260, 169–176.

Guerrero-Hall, K. D., Muscanell, R., Garg, N., Romero, I. L., & Chor, J. (2021). Obstetrics and gynecology resident physician experiences with lesbian, gay, bisexual, transgender and queer healthcare training. Medical science Educator, 31(2), 599–606. https://doi.org/10.1007/s40670-021-01227-9

Hayes, V., Blondeau, W., & Bing-You, R. G. (2015). Assessment of medical student and resident/fellow knowledge, comfort, and training with sexual history taking in LGBTQ patients. Family medicine, 47(5), 383–387.

Hurd, Z. (2015). American geriatrics society care of lesbian, gay, bisexual, and transgender older adults position statement: American geriatrics society ethics committee. Journal of the American Geriatrics Society, 63(3), 423–426.

Klein, E. W., & Nakhai, M. (2016). Caring for LGBTQ patients: Methods for improving physician cultural competence. International Journal of Psychiatry in Medicine, 51(4), 315–324. https://doi.org/10.1177/0091217416659268

Kortes-Miller, K., Wilson, K., & Stinchcombe, A. (2019). Care and LGBT aging in Canada: A focus group study on the educational gaps among care workers. Clinical Gerontologist, 42(2), 192–197. https://doi.org/10.1080/07317115.2018.1544955

Maingi, S., Radix, A., Candrian, C., Stein, G. L., Berkman, C., & O’Mahony, S. (2021). Improving the hospice and palliative care experiences of LGBTQ patients and their caregivers. Primary care, 48(2), 339–349. https://doi.org/10.1016/J.POP.2021.02.012

Martos AJ, Wilson PA, Gordon AR, Lightfoot M, Meyer IH. “Like finding a unicorn”: healthcare preferences among lesbian, gay, and bisexual people in the United States. Soc Sci Med. 2018;208:126–133. doi: 10.1016/j.socscimed.2018.05.020.

Moll, J., Krieger, P., Heron, S. L., Joyce, C., & Moreno‐Walton, L. (2019). Attitudes, behavior, and comfort of emergency medicine residents in caring for LGBT patients: What do we know? AEM education and Training, 3(2), 129–135.

Nama N, MacPherson P, Sampson M, McMillan HJ. Medical students’ perception of lesbian, gay,bisexual, and transgender (LGBT) discrimination in their learning environment and their self-reported comfort level for caring for LGBT patients: A survey study. Med Educ Online. 2017;22(1):1368850.

Pecanac, K., Hill, M., & Borkowski, E. (2021). “It made me feel like i didn’t know my own body”: Patient-provider relationships, LGBTQ+ identity, and end-of-life discussions. The American Journal of Hospice & Palliative Care, 38(6), 644–649.

Pregnall, A., Churchwell, A., & Ehrenfeld, J. (2021). A call for LGBTQ content in graduate medical education program requirements. Academic medicine: Journal of the Association of American Medical Colleges, 96(6), 828–835. https://doi.org/10.1097/ACM.0000000000003581

Rossman K, Salamanca P, Macapagal K. A qualitative study examining young adults’ experiences of disclosure and nondisclosure of LGBTQ identity to health care providers. J Homosex. 2017;64(10):1390–1410. doi: 10.1080/00918369.2017.1321379.

Roth, L. T., Catallozzi, M., Soren, K., Lane, M., & Friedman, S. (2021). Bridging the gap in graduate medical education: A longitudinal pediatric lesbian, gay, bisexual, transgender. Academic pediatrics, 21(8), 1449–1457. https://doi.org/10.1016/j.acap.2021.05.027

Rutherford K, Mcintyre J, Daley A, Ross LE. Development of expertise in mental health service provision for lesbian, gay, bisexual and transgender communities. Med Educ. 2012;46(9):903–13. doi: 10.1111/j.1365-2923.2012.04272.x.

Streed, C. G., Jr., Hedian, H. F., Bertram, A., & Sisson, S. D. (2019). Assessment of internal medicine resident preparedness to care for lesbian, gay, bisexual, transgender, and queer/questioning patients. Journal of General Internal Medicine, 34(6), 893–898. https://doi.org/10.1007/s11606-019-04855-5

Streed, C. G., Jr., Lunn, M. R., Siegel, J., & Obedin-Maliver, J. (2021). Meeting the patient care, education, and research missions: Academic medical centers must comprehensively address sexual and gender minority health. Academic Medicine : Journal of the Association of American Medical Colleges, 96(6), 822–827. https://doi.org/10.1097/ACM.0000000000003703

Zelin NS, Encandela J, Van Deusen T, Fenick AM, Qin L, Talwalkar JS. Pediatric residents’

beliefs and behaviors about health care for sexual and gender minority youth. Clin Pediatr.

2019;58(13):1415–1422.

Zelin NS, Hastings C, Beaulieu-Jones BR, et al. Sexual and gender minority health in medical

curricula in new England: A pilot study of medical student comfort, competence and perception

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Citations

1 136‐21‐105. Scope of Practice for Primary Healthcare Clinicians https://www.memberleap.com/news_archive_headlines.php?org_id=GLMA&sniid=33318731 

2 092-97-107-20. Inclusion of LGBTQ+ Focused Curriculum in Health Professions Education https://www.memberleap.com/news_archive_headlines.php?org_id=GLMA&sniid=32614859

3 111-98-111-21. Call for Health Insurance Organizations to Identify LGBTQ+ Competent Healthcare Clinicians. https://www.memberleap.com/news_archive_headlines.php?org_id=GLMA&sniid=33290625

4 093-97-108-20.  Non-Discrimination in Health Professions Education Programs https://www.memberleap.com/news_archive_headlines.php?org_id=GLMA&sniid=32616081

5 052-92-106-19. Support for Research and Education Regarding the Needs of LGBTQ+ Youth  https://www.memberleap.com/news_archive_headlines.php?org_id=GLMA&sniid=32594085

6 H-160.991 Health Care Needs of Lesbian, Gay, Bisexual, Transgender and Queer Populations https://policysearch.ama-assn.org/policyfinder/detail/LGBTQ%2B%20%09%09%09people.%20?uri=%2FAMADoc%2FHOD.xml-0-805.xml

7  H-160.991 https://policysearch.ama-assn.org/policyfinder/detail/relevant%20gender%20and%20%09%09%09%09sexuality%20information%20from%20the%20patient.?uri=%2FAMADoc%2FHOD.xml-0-805.xml

8 H-160.991 https://policysearch.ama-assn.org/policyfinder/detail/LGBTQ%2B%20%09%09%09people.%20?uri=%2FAMADoc%2FHOD.xml-0-805.xml

9 D-515.978 Ban Conversion Therapy  https://policysearch.ama-assn.org/policyfinder/detail/%22Ban%20Conversion%20Therapy%20D-515.978%22?uri=%2FAMADoc%2Fdirectives.xml-D-515.978.xml

 10 H-160.991 https://policysearch.ama-assn.org/policyfinder/detail/LGBTQ%2B%20%09%09%09people.%20?uri=%2FAMADoc%2FHOD.xml-0-805.xml

11 H-160.991 https://policysearch.ama-assn.org/policyfinder/detail/LGBTQ%2B%20%09%09%09people.%20?uri=%2FAMADoc%2FHOD.xml-0-805.xml

12 H-160.991 https://policysearch.ama-assn.org/policyfinder/detail/LGBTQ%2B%20%09%09%09people.%20?uri=%2FAMADoc%2FHOD.xml-0-805.xml