Sexual and gender minority content in undergraduate medical education in the United States and Canada: current state and changes since 2011

Author:

Streed Carl G.,Michals Amy,Quinn Emily,Davis John A.,Blume Kylie,Dalke Katharine B.,Fetterman David,Garcia Gabriel,Goldsmith Elizabeth,Greene Richard E.,Halem Jessica,Hedian Helene F.,Moring Isabel,Navarra May,Potter Jennifer,Siegel Jennifer,White William,Lunn Mitchell R.,Obedin-Maliver Juno

Abstract

Abstract Purpose To characterize current lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI +) health-related undergraduate medical education (UME) curricular content and associated changes since a 2011 study and 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. Method Deans of medical education (or equivalent) at 214 allopathic or osteopathic medical schools in Canada and the United States were invited to complete a 36-question, Web-based questionnaire between June 2021 and September 2022. The main outcome measured was reported hours of LGBTQI + health-related curricular content. Results Of 214 schools, 100 (46.7%) responded, of which 85 (85.0%) fully completed the questionnaire. Compared to 5 median hours dedicated to LGBTQI + health-related in a 2011 study, the 2022 median reported time was 11 h (interquartile range [IQR], 6–16 h, p < 0.0001). Two UME institutions (2.4%; 95% CI, 0.0%-5.8%) reported 0 h during the pre-clerkship phase; 21 institutions (24.7%; CI, 15.5%-33.9%) reported 0 h during the clerkship phase; and 1 institution (1.2%; CI, 0%-3.5%) reported 0 h across the curriculum. Median US allopathic clerkship hours were significantly different from US osteopathic clerkship hours (4 h [IQR, 1–6 h] versus 0 h [IQR, 0–0 h]; p = 0.01). Suggested strategies to increase content included more curricular material focusing on LGBTQI + health and health disparities at 55 schools (64.7%; CI, 54.6%-74.9%), more faculty willing and able to teach LGBTQI + -related content at 49 schools (57.7%; CI, 47.1%-68.2%), and more evidence-based research on LGBTQI + health and health disparities at 24 schools (28.2%; CI, 18.7%-37.8%). Conclusion Compared to a 2011 study, the median reported time dedicated to LGBTQI + health-related topics in 2022 increased across US and Canadian UME institutions, but the breadth, efficacy, or quality of instruction continued to vary substantially. Despite the increased hours, this still falls short of the number of hours based on recommended LGBTQI + health competencies from the Association of American Medical Colleges. 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.

Funder

University Chobanian and Avedisian School of Medicine Department of Medicine Career Investment Award

Publisher

Springer Science and Business Media LLC

Reference49 articles.

1. National Academies of Sciences Engineering and Medicine (NASEM). Understanding the Well-Being of LGBTQI+ Populations. Washington: The National Academies Press; 2020.

2. Statistics Canada. A statistical portrait of Canada's diverse LGBTQ2+ communities, https://www150.statcan.gc.ca/n1/daily-quotidien/210615/dq210615a-eng.htm (2021, Accessed 19 Aug 2021).

3. Jones J. LGBTQ+ Identification in U.S. Now at 7.6%, https://news.gallup.com/poll/611864/lgbtq-identification.aspx (2024).

4. Streed CG, Jr., Lunn MR, Siegel J and Obedin-Maliver J. Meeting the Patient Care, Education, and Research Missions: Academic Medical Centers Must Comprehensively Address Sexual and Gender Minority Health. Acad Med 2020 2020/08/28. https://doi.org/10.1097/ACM.0000000000003703.

5. Streed CG, Jr., Beach LB, Caceres BA, et al. Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse: A Scientific Statement From the American Heart Association. Circulation 2021: CIR0000000000001003. 2021/07/09. https://doi.org/10.1161/CIR.0000000000001003.

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