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

Abstract

Background: Historically, medical students who are lesbian, gay, bisexual or transgendered (LGBT) report higher rates of social stress, depression, and anxiety, while LGBT patients have reported discrimination and poorer access to healthcare. Objective: The objectives of this study were: (1) to assess if medical students have perceived discrimination in their learning environment and; (2) to determine self-reported comfort level for caring for LGBT patients. Design: Medical students at the University of Ottawa (N = 671) were contacted via email and invited to complete a confidential web-based survey. Results: Response rate was 15.4% (103/671). This included 66 cis-gender heterosexuals (64.1%) and 37 LGBT students (35.9%). Anti-LGBT discrimination had been witnessed by 14.6% and heterosexism by 31.1% of respondents. Anti-LGBT discrimination most often originated from fellow medical students. Respondents who self-identified as LGBT were more likely to have perceived heterosexism (favoring opposite-sex relationships) (OR = 8.2, p < 0.001) or anti-LGBT discrimination (OR = 6.6, p = 0.002). While half of LGBT students shared their status with all classmates (51.4%), they were more likely to conceal this from staff physicians (OR = 27.2, p = 0.002). Almost half of medical students (41.7%) reported anti-LGBT jokes, rumors, and/or bullying by fellow medical students and/or other members of the healthcare team. Still, most respondents indicated that they felt comfortable with and capable of providing medical care to LGBT patients (≥83.5%), and were interested in further education around LGBT health issues (84.5%). Conclusion: Anti-LGBT discrimination and heterosexism are noted by medical students, indicating a suboptimal learning environment for LGBT students. Nonetheless, students report a high level of comfort and confidence providing health care to LGBT patients.

Effectiveness of Transgender Care Content in a Nurse Practitioner Program

“…The NP students felt that their education did not adequately prepare them to provide care to transgender patients. Consistent with other studies, NPs do not feel competent in providing healthcare to transgender patients [6,9]. Shukla (2015) found slightly higher mean number of hours received on transgender health education in their study [6].…”

“…Consistent with other studies, NPs do not feel competent in providing healthcare to transgender patients [6,9]. Shukla (2015) found slightly higher mean number of hours received on transgender health education in their study [6]. There are no other studies evaluating transgender education among NP students.…”

“…The Assessing Medical Attitude Survey was used to evaluate the competence and comfort levels in transgender health care among NP students. The survey instrument was developed to examine attitudes of medical, NP and PA students towards transgender care [6]. The tool is made up of demographic questions, and 13 items regarding experiences with transgender patients, educational hours on transgender health care, assessment of competence on transgender health issues and questions on competence or comfort in providing various aspects of transgender care e.g.…”

“…Many healthcare providers are not comfortable when dealing with LGBT patients and they do not have the knowledge to address their healthcare issues [2]. Shukla, Dundas, Asp, Saltzman and Duggan (2015) examined the education and attitude of medical, nurse practitioner (NP) and physician assistant students regarding transgender care [6]. The study reported that 74.1% did not feel competent in providing healthcare to transgender patients.…”

Queering medical education: systematically assessing LGBTQI health competency and implementing reform

“…In some instances, lack of medical training, along with bias, has led LGBTQI patients to fear abuse in healthcare settings [6,7]. Such abuse is echoed by LGBTQI identified medical students, almost half of which report witnessing ‘anti-LGBT jokes, rumors, and/or bullying by fellow medical students and/or other members of the healthcare team’ [8]. LGBTQI patients have reported health care professionals refusing to touch them, blaming them for their health status, using harsh/abusive language, and sometimes even being physically abusive.…”