Attitudes and Knowledge of Medical Students Towards Healthcare for Lesbian, Gay, Bisexual, and Transgender Seniors: Impact of a Case-Based Discussion With Facilitators From the Community

Abstract

Background: Lesbian, gay, bisexual, and transgender (LGBT) seniors are generally a medically underserved population that faces unique healthcare challenges. When compared to younger patients, LGBT seniors are at a greater risk for social isolation and have higher rates of smoking, disability, physical and mental distress, and lack of access to healthcare services. They are often reluctant to discuss their sexual orientations and gender identities with healthcare providers due to fear of discrimination and receiving inferior care based on prior unsatisfactory experiences with untrained or insensitive healthcare providers. Furthermore, recent research has revealed that only about 50% of primary care providers indicated confidence in providing culturally competent LGBT healthcare, highlighting the need for more LGBT proficiency training in medical school curricula. Objectives: The aim of this study was to provide early intervention training to first-year medical students regarding best practices for equitable healthcare for LGBT seniors through integrative, small group, case-based discussions. The impact of this activity on the knowledge and attitudes of medical students regarding LGBT healthcare was also assessed. Methods: First-year medical students participated in a two-hour small group, case-based discussion. Each group consisted of seven to eight students with one of seven facilitators who were invited members of the LGBT community. Students were provided with two clinical case scenarios related to treatment of LGBT senior patients. Students were given a pre/post-session knowledge and attitude survey to assess the impact of the session on their attitudes and understanding of the importance of providing equitable healthcare to LGBT patients. A rubric was also used by facilitators to evaluate level of student engagement and professionalism. Results: A total of 51 first-year medical students attended the session and 38 (74.5%) completed the pre/post surveys. There was diverse representation in our student demographic with 5.2% of respondents identifying as LGBT. Survey results showed a significant increase in knowledge confidence and attitudes following the session. Students’ attitudes regarding determinants of health status changed significantly for nine of the 13 (69%) survey items. In addition, their confidence in knowledge regarding healthcare barriers, health issues, and practices for LGBT culturally competent care significantly increased post-session. Data from our assessment rubrics also show that students were highly professional and engaged with the LGBT facilitators. Conclusion: Our study provides some evidence that case-based training of medical students regarding issues that affect health of LGBT seniors can improve attitudes and sensitize them to the unique needs of this population. Through this activity, the students indicated their desire to learn more about the topics covered and to receive further training in this field of study. While the study wa...

Transgender health content in medical education: a theory-guided systematic review of current training practices and implementation barriers & facilitators

“…Other facilitators were commonly identified at the audience level about which most authors referred to the advantage of students’/residents’ pre-existing awareness, knowledge, positive attitudes, interest, perceived significance, prior professional and/or lived experience that was a foundation for further learning on the topic of transgender health (Berenson et al, 2020 ; Click et al, 2019 , 2020 ; Cooper et al, 2018 ; Eriksson & Safer, 2016 ; Gibson et al, 2020 ; Levy et al, 2021 ; Marshall et al, 2017 ; Park & Safer, 2018 ; Safer & Pearce, 2013 ; Sawning et al, 2017 ; Taylor et al, 2018 ; Underman et al, 2016 ; Vance et al, 2017 ). In some cases, this was linked to “the fact that [the training] was elective and might have attracted a sample of students who were already interested and informed on the topic” (Eriksson & Safer, 2016 , p. 840).…”

“…However, such initiatives are often isolated or not structurally embedded in the curriculum, do not always reach all students, and do not always have access to the pedagogical conditions (e.g., experienced and knowledgeable staff, curriculum time and financial and material resources) necessary to optimize teaching and learning about transgender health. Educators also urge for more emphasis on the incorporation of complexity in sessions about transgender health, for instance by exploring identity factors that intersect with transgender identity, such as sexuality, ethnicity/race, class and age in teaching material (Barrett et al, 2021 ; Bi et al, 2020 ; Biro et al, 2021 ; Levy et al, 2021 ; Muntinga et al, 2020 ). And while we found that involvement of transgender perspectives in developing and delivering content was beneficial for student learning and part of necessary advocacy work, some authors warn of overburdening people with lived experiences (including transgender students), in particular when experiential knowledge cannot be properly compensated (Bi et al, 2020 ; Biro et al, 2021 ).…”

Inclusive LGBTQIA+ healthcare: An interprofessional case-based experience for cultural competency awareness

“…healthcare programs ( 28 ). However, despite a positive impact on the students, there are only a limited number of published studies in this area, and more needs to be done to substantiate the intended widespread curricular change ( 27 – 29 ). With continued efforts in this field, expanded culturally competent interprofessional collaboration could be beneficial to improving healthcare for LGBTQIA+ patients.…”

Attitudes towards LGBTQ+ individuals among Thai medical students

“…These negative attitudes can be associated with lower acceptance, discrimination, and mental health issues, which, in turn, have been found to be related with medical schools dropout [18]. On the contrary, positive attitudes are correlated with higher levels of LGBTQ+ knowledge and confidence among medical students in providing care to LGBTQ+ patients [14,15,[19][20][21].…”

“…Understanding the attitudes of medical students towards LGBTQ+ individuals is crucial for revising an LGBTQ+ inclusive curriculum that prepares students to provide care to LGBTQ + patients and become LGBTQ+-friendly professionals [14,15,[19][20][21]. Since attitudes differ globally, it is important to conduct psychosocially and culturally specific studies to investigate attitudes, and previous research has primarily focused on non-Asian contexts.…”