(Boston)—Reducing barriers to comprehensive and affirming healthcare for lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) populations requires physicians to receive LGBTQI+ health content during undergraduate medical education (UME). With more than 7% of the U.S. adult population, 4% of the Canadian adult population and 20% of persons in the U.S. ages 18-25 who are LGBTQI+, there is a critical need to train health care professionals on their specific healthcare needs. LGBTQI+ people experience a higher prevalence of tobacco, alcohol, substance use, and mental health concerns like anxiety, depression and suicidality, as well as elevated cardiovascular disease morbidity and mortality.
The Association of American Medical Colleges (AAMC) recommends core competencies regarding LGBTQI+ health-related content. Researchers at Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center (BMC), report time dedicated to these topics did increase in 2022, as compared to a study done in 2011; but they also found the breadth, efficacy, or quality of instruction continues to vary substantially.
"Despite the increased hours, the numbers still fall short based on recommended LGBTQI+ health competencies from the AAMC," says lead author Carl G. Streed, MD, MPH, FACP, FAHA, associated professor of medicine at the school. "While most deans of medical education reported their institutions' coverage of LGBTQI+ health as 'fair,' 'good,' or 'very good,' there continues to be a call from UME leadership to increase curricular content. This requires dedicated training for faculty and students," said Streed.
To determine the frequency and extent of institutional instruction in 17 LGBTQI+ health-related topics, strategies for increasing LGBTQI+ health-related content and faculty development opportunities, researchers invited the deans of medical education (or their equivalent) at 214 allopathic or osteopathic medical schools in the U.S. and Canada to complete a 36-question, web-based questionnaire between June 2021 and September 2022.
The responses revealed that the time dedicated to LGBTQI+ health-related content in medical school in 2022 was a median of 11 hours, a significant increase of 6 hours since 2011. However, the number of hours in the required curriculum, as well as number of LGBTQI+ health-related topics covered, remained varied from school to school.
According to the researchers, gaps in UME curricula and outcomes are well documented and persist in the face of calls to action. "Consequently, student comfort with caring for LGBTQI+ populations has lagged. Similar gaps in knowledge and comfort have been reported internationally. These results are contemporary with our findings, suggesting that even a median of 11 hours of LGBTQI+ content is insufficient," explains Streed, who also is research lead of the GenderCare Center at BMC.
Streed believes that successful incorporation of LGBTQI+ health into UME requires thoughtfully developed LGBTQI+ health competencies and objectives with appropriate instructional methods and assessments to ensure mastery. "While the optimal solution to improving LGBTQI+ training is likely institution- and context-dependent, without a mandate from governing bodies such as the AAMC we will continue to see a dearth of physicians prepared to care for these populations. Additionally, graduate medical education must complement UME to ensure trainees receive specialty-specific training on LGBTQI+ health."
These findings appear online in BMC Medical Education.
Dr. Streed was partially supported through the American Heart Association career development grant (20CDA35320148), National Heart, Lung, and Blood Institute career development grant (K01HL151902), Doris Duke Charitable Foundation (Grant #2022061). Streed received funding from the Boston University Chobanian and Avedisian School of Medicine Department of Medicine Career Investment Award utilized to fund statistical support (Michals, Sisson) for this study. Dr. Obedin-Maliver's and Lunn's time were partially supported by the following grants (on topics unrelated to this work) during the conduct of this study by the National Institutes of Health (R21MD015878, R01CA237670, R01DA052016, OT2OD025276).
