Sexual and gender minority health: a roadmap for developing evidence-based medical school curricula
DOI:
https://doi.org/10.36834/cmej.78448Abstract
Background: Educating future physicians about sexual and gender minority (SGM) patients and their health care needs is an important way to mitigate discrimination and health disparities faced by this community. Canada, across its 17 medical schools, lacks a national standard for teaching this essential topic. This paper aims to review the best practices for teaching an SGM curriculum in undergraduate medical education and synthesize this information into actionable propositions for curriculum development.
Methods: A scoping literature review was conducted to identify best practices for SGM teaching. The review elicited peer-reviewed and grey literature on best practices for SGM teaching, policy documents, and opinion pieces from medical education authorities and SGM advocacy groups. Through an iterative process with all authors, the Canadian Queer Medical Students Association (CQMSA), and the Association of Faculties of Medicine of Canada (AFMC), a set of propositions was developed.
Results: The search yielded 1347 papers, of which 89 were kept for data extraction. The main outcomes of these papers were sorted along five repeating themes, which formed the basis for six propositions; two more propositions were then added after discussion with all authors.
Conclusion: We present eight propositions for the development of a national standard for SGM education at the undergraduate medical level. These include standardizing learning objectives across all schools, using established curricular models to guide curriculum development, interweaving concepts across all levels of training, diversifying teaching modalities, providing faculty training, ensuring a safe space for SGM students and faculty, using OSCEs as a teaching tool, and involving the local SGM community in curriculum development and delivery.
Metrics
References
Casey B. The health of LGBTQIA2 communities in Canada. House of Commons. 2019;42nd Parliament (1st Session):70.
de Vries E, Kathard H, Müller A. Debate: Why should gender-affirming health care be included in health science curricula? BMC Med Educ. 2020 Feb 14;20(1):51. https://doi.org/10.1186/s12909-020-1963-6
Woodman J. Brief to the Standing Committee on Health: A Canada without barriers to the health and well-being of trans and gender diverse people. 2019. Available from: https://www.ourcommons.ca/Content/Committee/421/HESA/Brief/BR10482210/br-external/CanadianProfessionalAssociationForTransgenderHealth-1-e.pdf. [Accessed on 2023 Feb 27].
Turban JL, Winer J, Boulware S, VanDeusen T, Encandela J. Knowledge and attitudes toward transgender health. Clin Teach. 2018 Jun;15(3):203-7. https://doi.org/10.1111/tct.12738
Phelan SM, Burke SE, Hardeman RR, et al. Medical school factors associated with changes in implicit and explicit bias against gay and lesbian people among 3492 graduating medical students. J Gen Intern Med. 2017;32(11):1193-201. https://doi.org/10.1007/s11606-017-4127-6
McPhail D, Rountree-James M, Whetter I. Addressing gaps in physician knowledge regarding transgender health and healthcare through medical education. Can Med Educ J. 2016 Oct;7(2):e70-8. https://doi.org/10.36834/cmej.36785
The case for a Canadian standard for 2SLGBTQIA+ medical education https://doi.org/10.1503/cmaj.202642
Charles C, Haaland M, Kulkarni A, Webber J. Improving healthcare for LGBTQ populations. :12.
Yan H, Ahmad T, Kulkarni A. Health care for transgender patients: medical education and patient access. 2015;8.
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. https://doi.org/10.1080/10872981.2017.1368850
Medical Council of Canada. Providing anti-oppressive health care. 2023. Available from: https://mcc.ca/objectives/medical-expert/providing-anti-oppressive-health-care/ [Accessed on May 25, 2024].
Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, et al. Standards of care for the health of transgender and gender diverse people, Version 8. Intern J Transgender Health. 2022 Aug 19;23(sup1):S1-259.
The Royal College of Physicians and Surgeons of Canada. CanMEDS Framework. Available from: https://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e.
The Royal College of Physicians and Surgeons of Canada. CanMEDS Role: Health Advocate. Available from: https://www.royalcollege.ca/rcsite/canmeds/framework/canmeds-role-health-advocate-e. [Accessed on Mar 19, 2023].
AAMC. Advancing health equity: a guide to language, narrative and concepts. 2014.
Al-Shidhani TA. Curriculum Development for Medical Education. Sultan Qaboos Univ Med J. 2010 Dec;10(3):416-7.
Gavzy SJ, Berenson MG, Decker J, et al. The case of Ty Jackson: an interactive module on LGBT health employing introspective techniques and video-based case discussion. MedEdPORTAL. 2019 Jun 4;15:10828. https://doi.org/10.15766/mep_2374-8265.10828
Berenson MG, Gavzy SJ, Cespedes L, et al. The case of sean smith: a three-part interactive module on transgender health for second-year medical students. MedEdPORTAL. 2020 Jul 21;16:10915. https://doi.org/10.15766/mep_2374-8265.10915
Solotke M, Sitkin NA, Schwartz ML, et al. Twelve tips for incorporating and teaching sexual and gender minority health in medical school curricula. Med Teach 2019; 41: 141–146. https://doi.org/10.1080/0142159X.2017.1407867
Vance SRJ, Dentoni-Lasofsky B, Ozer E, et al. Using standardized patients to augment communication skills and self-efficacy in caring for transgender youth. Acad Pediatr. Epub ahead of print 19 May 2021. https://doi.org/10.1016/j.acap.2021.05.010.
Biro L, Song K, Nyhof-Young J. First year medical student experiences with a clinical skills seminar emphasizing sexual and gender minority population complexity. Can Med Educ J 2021; 12: e11–e20. https://doi.org/10.36834/cmej.70496
Kirkpatrick Partners, LLC. The Kirkpatrick Model. Available from: https://www.kirkpatrickpartners.com/the-kirkpatrick-model/. [Accessed on Mar 19, 2023].
Association of American Medical Colleges. Implementing curricular and institutional climate changes to improve health care for individuals. Who are LGBT, gender nonconforming, or born with DSD: a resource for medical educators. 2014. Available from https://store.aamc.org/implementing-curricular-and-institutional-climate-changes-to-improve-health-care-for-individuals-who-are-lgbt-gender-nonconforming-or-born-with-dsd-a-resource-for-medical-educators.html [Accessed Mar 19, 2023].
Roth LT, Friedman S, Gordon R, Catallozzi M. Rainbows and "ready for residency": integrating LGBTQ health into medical education. MedEdPORTAL. 2020 Nov 4;16:11013. https://doi.org/10.15766/mep_2374-8265.11013
Roth LT, Catallozzi M, Soren K, Lane M, Friedman S. Bridging the gap in graduate medical education: a longitudinal pediatric LGBTQ health curriculum. Acad Pediatr. 2021 Jun 4; https://doi.org/10.1016/j.acap.2021.05.027
Zumwalt AC, Carter EE, Gell-Levey IM, Mulkey N, Streed CJ, Siegel J. A novel curriculum assessment tool, based on AAMC competencies, to improve medical education about sexual and gender minority populations. Acad Med. 2021 Jun 8; https://doi.org/10.1097/ACM.0000000000004203
Kelley L, Chou CL, Dibble SL, et al. A critical intervention in lesbian, gay, bisexual, and transgender health: knowledge and attitude outcomes among second-year medical students. Teach Learn Med 2008; 20: 248–53. https://doi.org/10.1080/10401330802199567
Sequeira GM, Chakraborti C, Panunti BA. Integrating lesbian, gay, bisexual, and transgender (LGBT) content into undergraduate medical school curricula: a qualitative study. Ochsner J 2012; 12: 379–382.
Ruud MN, Demma JM, Woll A, et al. Health history skills for interprofessional learners in transgender and nonbinary populations. J Midwifery Womens Health 2021; 66: 778–786. https://doi.org/10.1111/jmwh.13278
Keuroghlian AS, Charlton BM, Katz-Wise SL, et al. Harvard medical school’s sexual and gender minority health equity initiative: curricular and climate innovations in undergraduate medical education. Acad Med 2022; 97: 1786–1793. https://doi.org/10.1097/ACM.0000000000004867
Pregnall AM, Churchwell AL, Ehrenfeld JM. A call for LGBTQ content in graduate medical education program requirements. Acad Med. 2021 Jun 1;96(6):828-35. https://doi.org/10.1097/ACM.0000000000003581
Eriksson SES, Safer JD. Evidence-based curricular content improves student knowledge and changes attitudes towards transgender medicine. Endocr Pract 2016; 22: 837–41. https://doi.org/10.4158/EP151141.OR
Gacita A, Gargus E, Uchida T, et al. Introduction to safe space training: interactive module for promoting a safe space learning environment for LGBT medical students. MedEdPORTAL 2017; 13: 10597. https://doi.org/10.15766/mep_2374-8265.10597
Cherabie J, Nilsen K, Houssayni S. Transgender health medical education intervention and its effects on beliefs, attitudes, comfort, and knowledge. Kans J Med 2018; 11: 106–109. https://doi.org/10.17161/kjm.v11i4.8707
Gibson AW, Gobillot TA, Wang K, et al. A novel curriculum for medical student training in lgbtq healthcare: a regional pathway experience. J Med Educ Curric Dev 2020; 7: 2382120520965254. https://doi.org/10.1177/2382120520965254
Fadus MC, Peterson NK, Jilich CL, et al. Improving communication with LGBTQ patients: a pilot curriculum during the psychiatry clerkship. Acad Psych. 2020; 44: 218–222. https://doi.org/10.1007/s40596-019-01157-0
Pathoulas JT, Blume K, Penny J, et al. Effectiveness of an educational intervention to improve medical student comfort and familiarity with providing gender-affirming hormone therapy. Fam Med 2021; 53: 61–64. https://doi.org/10.22454/FamMed.2021.612374
Safer JD, Pearce EN. A simple curriculum content change increased medical student comfort with transgender medicine. Endocr Pract 2013; 19: 633–637. https://doi.org/10.4158/EP13014.OR
Sawning S, Steinbock S, Croley R, et al. 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. Educ Health (Abingdon) 2017; 30: 108–114. https://doi.org/10.4103/efh.EfH_78_16
Najor AJ, Kling JM, Imhof RL, et al. Transgender health care curriculum development: a dual-site medical school campus pilot. Health Equity 2020; 4: 102–113. https://doi.org/10.1089/heq.2019.0106
Zheng C, D’Costa Z, Zachow RJ, et al. Teaching trans-centric curricular content using modified jigsaw. MedEdPORTAL 2022; 18: 11257. https://doi.org/10.15766/mep_2374-8265.11257
Liang JJ, Gardner IH, Walker JA, Safer JD. Observed deficiencies in medical student knowledge of transgender and intersex health. Endocr Pract. 2017 Aug;23(8):897-906. https://doi.org/10.4158/EP171758.OR
Yang H-C. Teaching LGBT+ health and gender education to future doctors: implementation of case-based teaching. Int J Environ Res Public Health. 2021 Aug 10;18(16):8429. https://doi.org/10.3390/ijerph18168429
Bakhai N, Shields R, Barone M, et al. An active learning module teaching advanced communication skills to care for sexual minority youth in clinical medical education. MedEdPORTAL 2016; 12: 10449. https://doi.org/10.15766/mep_2374-8265.10449
Stumbar SE, Garba NA, Holder C. Let’s talk about sex: the social determinants of sexual and reproductive health for second-year medical students. MedEdPORTAL 2018; 14: 10772. https://doi.org/10.15766/mep_2374-8265.10772
McCave EL, Aptaker D, Hartmann KD, et al. Promoting affirmative transgender health care practice within hospitals: an IPE standardized patient simulation for graduate health care learners. MedEdPORTAL 2019; 15: 10861. https://doi.org/10.15766/mep_2374-8265.10861
Salkind J, Gishen F, Drage G, et al. LGBT+ health teaching within the undergraduate medical curriculum. Int J Environ Res Public Health; 16. Epub ahead of print 28 June 2019. https://doi.org/10.3390/ijerph16132305.
Yang H-C. Education first: promoting lgbt+ friendly healthcare with a competency-based course and game-based teaching. Int J Environ Res Public Health; 17. Epub ahead of print 2019. https://doi.org/10.3390/ijerph17010107.
Vance SRJ, Buckelew SM, Dentoni-Lasofsky B, et al. A pediatric transgender medicine curriculum for multidisciplinary trainees. MedEdPORTAL publ 2020; 16: 10896. https://doi.org/10.15766/mep_2374-8265.10896
Paul CR, Wolfe AD, Catallozzi M, et al. Teaching sexual orientation and gender identity in pediatric clinical settings: a training workshop for faculty and residents. MedEdPORTAL 2021; 17: 11137. https://doi.org/10.15766/mep_2374-8265.11137
George T, Carey RAB, Abraham OC, et al. Trainee doctors in medicine prefer case-based learning compared to didactic teaching. J Family Med Prim Care 2020; 9: 580–584. https://doi.org/10.4103/jfmpc.jfmpc_1093_19
Bakhai N, Ramos J, Gorfinkle N, et al. introductory learning of inclusive sexual history taking: an e-lecture, standardized patient case, and facilitated debrief. MedEdPORTAL 2016; 12: 10520. https://doi.org/10.15766/mep_2374-8265.10520
Neff A, Kingery S. Complete androgen insensitivity syndrome: a problem-based learning case. MedEdPORTAL 2016; 12: 10522. https://doi.org/10.15766/mep_2374-8265.10522
Underman K, Giffort D, Hyderi A, et al. Transgender health: a standardized patient case for advanced clerkship students. MedEdPORTAL 2016; 12: 10518. https://doi.org/10.15766/mep_2374-8265.10518
Mayfield JJ, Ball EM, Tillery KA, et al. Beyond men, women, or both: a comprehensive, lgbtq-inclusive, implicit-bias-aware, standardized-patient-based sexual history taking curriculum. MedEdPORTAL 2017; 13: 10634. https://doi.org/10.15766/mep_2374-8265.10634
Ufomata E, Eckstrand KL, Spagnoletti C, et al. Comprehensive curriculum for internal medicine residents on primary care of patients identifying as lesbian, gay, bisexual, or transgender. MedEdPORTAL 2020; 16: 10875. https://doi.org/10.15766/mep_2374-8265.10875
Weingartner L, Noonan EJ, Bohnert C, et al. Gender-affirming care with transgender and genderqueer patients: a standardized patient case. MedEdPORTAL 2022; 18: 11249. https://doi.org/10.15766/mep_2374-8265.11249
Spigner ST, Rivera NV, Ufomata E, et al. assessing patient goals for gender-affirming hormone therapy: a standardized patient case for medical students. MedEdPORTAL 2023; 19: 11356. https://doi.org/10.15766/mep_2374-8265.11356
Potter LA, Burnett-Bowie S-AM, Potter J. Teaching medical students how to ask patients questions about identity, intersectionality, and resilience. MedEdPORTAL publ 2016; 12: 10422. https://doi.org/10.15766/mep_2374-8265.10422
Thompson H, Coleman JA, Iyengar RM, et al. Evaluation of a gender-affirming healthcare curriculum for second-year medical students. Postgrad Med J 2020; 96: 515–519. https://doi.org/10.1136/postgradmedj-2019-136683
Elkin B, Beck-Esmay K, Chu K, et al. An LGBTQIA+ symposium to improve care for sexual and gender minority youth. PRiMER 2021; 5: 11. https://doi.org/10.22454/PRiMER.2021.802969
Barrett DL, Supapannachart KJ, Caleon RL, et al. Interactive session for residents and medical students on dermatologic care for lesbian, gay, bisexual, transgender, and queer patients. MedEdPORTAL 2021; 17: 11148. https://doi.org/10.15766/mep_2374-8265.11148
Cannon SM, Graber S, King HL, et al. PrEP University: a multi-disciplinary university-based HIV prevention education program. J Community Health. Epub ahead of print 9 June 2021. https://doi.org/10.1007/s10900-021-01007-x.
Grova MM, Donohue SJ, Bahnson M, et al. Allyship in surgical residents: evidence for LGBTQ competency training in surgical education. J Surg Res 2021; 260: 169–176. https://doi.org/10.1016/j.jss.2020.11.072
Freeman NW, Keuroghlian AS. Supporting transgender and gender diverse medical students. Lancet 2022; 400: 804–805. https://doi.org/10.1016/S0140-6736(22)01698-1
Ortiz-López N, Jerez-Yáñez O, Cortés-Chau F, et al. Experiences of medical students belonging to sexual and gender diversity: a systematic review. Rev Med Chil. 2021; 149: 1058–1069. https://doi.org/10.4067/s0034-98872021000701058
Burke SE, Dovidio JF, Przedworski JM, et al. Do contact and empathy mitigate bias against gay and lesbian people among heterosexual first-year medical students? a report from the medical student CHANGE study. Acad Med 2015; 90: 645–51. https://doi.org/10.1097/ACM.0000000000000661
Greene RE, Blasdel G, Cook TE, et al. How do OSCE cases activate learners about transgender health? Acad Med 2020; 95: S156–S162. https://doi.org/10.1097/ACM.0000000000003704
Leslie KF, Steinbock S, Simpson R, et al. Interprofessional LGBT health equity education for early learners. MedEdPORTAL 2017; 13: 10551. https://doi.org/10.15766/mep_2374-8265.10551
Jin H, Dasgupta S. Genetics in LGB assisted reproduction: two flipped classroom, progressive disclosure cases. MedEdPORTAL 2017; 13: 10607. https://doi.org/10.15766/mep_2374-8265.10607
Taylor AK, Condry H, Cahill D. Implementation of teaching on LGBT health care. Clin Teach 2018; 15: 141–144. https://doi.org/10.1111/tct.12647
AAMC. Unique populations. Available from https://www.aamc.org/professional-development/affinity-groups/gfa/unique-populations [Accessed on Aug 3, 2021].
DeBrosse R, Mao X, Anand NS, et al. Evaluating the impact of an adolescent sexuality education workshop on medical student communication in an objective structured clinical examination. J Adolesc Health 2024; 74: 1026–1032. https://doi.org/10.1016/j.jadohealth.2023.12.013
Stumbar SE, Garba NA, de la Cruz M, et al. Integration of sex and gender minority standardized patients into a workshop on gender-inclusive patient care: exploring medical student perspectives. South Med J 2022; 115: 722–726. https://doi.org/10.14423/SMJ.0000000000001435
Park JA, Safer JD. Clinical exposure to transgender medicine improves students’ preparedness above levels seen with didactic teaching alone: a key addition to the boston university model for teaching transgender healthcare. Transgend Health 2018; 3: 10–16. https://doi.org/10.1089/trgh.2017.0047
Arora M, Walker K, Luu J, et al. Education of the medical profession to facilitate delivery of transgender health care in an Australian health district. Aust J Prim Health. Epub ahead of print 2019. https://doi.org/10.1071/PY19102.
Katz-Wise SL, Jarvie EJ, Potter J, et al. Integrating LGBTQIA + community member perspectives into medical education. Teach Learn Med 2023; 35: 442–456. https://doi.org/10.1080/10401334.2022.2092112
Ellaway RH, Thompson NL, Temple-Oberle C, et al. An undergraduate medical curriculum framework for providing care to transgender and gender diverse patients: a modified Delphi study. Perspect Med Educ. 2022 Jan;11(1):36-44. https://doi.org/10.1007/S40037-021-00692-7.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Cathrine Giffin, Sari Glow, Douglas Lebo, Tara Freeman, Jovana Miladinovic, Sonja Hansen, Chad Brown, Nessika Karsenti
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Submission of an original manuscript to the Canadian Medical Education Journal will be taken to mean that it represents original work not previously published, that it is not being considered elsewhere for publication. If accepted for publication, it will be published online and it will not be published elsewhere in the same form, for commercial purposes, in any language, without the consent of the publisher.
Authors who publish in the Canadian Medical Education Journal agree to release their articles under the Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 Canada Licence. This licence allows anyone to copy and distribute the article for non-commercial purposes provided that appropriate attribution is given. For details of the rights an author grants users of their work, please see the licence summary and the full licence.
