Many of our LGBTQ patients experience unique challenges and barriers to accessing high-quality, patient-centered health care services. The historical disparities in the care they have received, including structural stigma and provider discrimination, have subsequently translated to health disparities experienced by this population.
LGBT individuals are less likely to have health insurance,1,2 more likely to delay or not seek timely medical care3 (more likely to receive health services in the emergency room3), and have higher rates of substance use4,5,6 (which has been explained as consequences of the minority stress theory7). A recent study examining the pregnancy experiences of transgender men, found low levels of provider awareness and knowledge about the unique needs of this population.9 This is not surprising given that the average medical student only receives 5 hours of training on LGBT health issues over their four years10.
Medical education allows the unique opportunity to address these health disparities by 1) increasing health care professionals’ awareness and knowledge of health inequities experienced by LGBTQ individuals 2) training learners in patient-centered care including community specific practice guidelines, and 3) inspiring learners to become advocates for the health and wellbeing of their patients.
In November 2014, the Association of American Medical Colleges (AAMC) released the first guidelines for training healthcare providers who care for individuals who are LGBT, gender nonconforming, or born with DSD. 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, is available for download here and outlines 30 professional competency objectives for medical professionals to obtain. Medical educators are encouraged to integrate these guidelines into their existing curricula rather than looking at these patients as an entirely separate population.
The following are additional resources for you to use in your own institution:
- Fenway Guide to Lesbian, Gay, Bisexual, Transgender Health
- Visit their website at http://www.lgbthealtheducation.org
- World Professional Association for Transgender Health
- American Academy of Family Physicians (AAFP) Recommended Curriculum Guidelines for Family Medicine Residents: Lesbian, Gay, Bisexual, Transgender Health
- National Gay and Lesbian Taskforce. National transgender discrimination survey: Preliminary findings. Washington, DC: National Gay and Lesbian Taskforce; November 2009.
- Gates, G.R. In U.S., LGBT more likely than Non-LGBT to be uninsured. Gallup Poll.
- Center for American Progress analysis of 2007 California Health Interview Survey data.
- Lee GL, Griffin GK, Melvin CL. Tobacco use among sexual minorities in the USA: 1987 to May 2007: A systematic review. Tob Control. 2009;18:275-82.
- Hughes TL. Chapter 9: Alcohol use and alcohol-related problems among lesbians and gay men. Ann Rev of Nurs Res. 2005;23:283-325.
- Lyons T, Chandra G, Goldstein J. Stimulant use and HIV risk behavior: The influence of peer support. AIDS Ed and Prev. 2006;18(5):461-73.
- Hunt, Jerome. Why the Gay and Transgender Population Experiences Higher Rates of Substance Use. Center for American Progress. March 9. 2012.
- Center for Disease Control and Prevention. HIV Among Gay and Bisexual Men. March 2013.
- Light AD, et al. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstet Gynecol. 2014 Dec; 124(6):1120-7
- Obedin-Maliver J, et al. Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education. 2011 Sep 7; 306 (9):971-7.