Study says new doctors not taught LGBT issues

Oct. 21, 2011, 2:55 a.m.

American medical schools are lacking LGBT-related health curriculum, according to a new study published by the Stanford School of Medicine. A survey of 132 schools discovered that medical students spend a median total of five hours studying LGBT-related issues.

The study was published in early September by members of the Lesbian, Gay, Bisexual and Transgender Medical Education Research Group (LGBT MERG).

Deans from medical schools in the United States and Canada were surveyed on topics such as length of classroom time devoted to LGBT-related issues and adequacy of material.

Dr. Juno Obedin-Maliver, an OB-GYN resident at UCSF and the primary author of the study, said that most of the five hours were taught during the preclinical or classroom years. One-third of the schools surveyed had zero exposure to LGBT issues in the clinical years.

“These issues are primarily about patient-relation skills,” Obedin-Maliver said.

“Taking care of patients is not just about knowledge–it’s also about learning how to interact with patients from many different backgrounds, including sexual orientation.”

Obedin-Maliver helped found MERG in 2007 while completing her medical degree at Stanford. The group aims to improve LGBT health using a threefold approach of conducting research, influencing health policy and advocating for LGBT patients and providers. This includes conducting research, influencing health policy and advocating for LGBT patients and providers.

“MERG initially came from questions of how can we better take care of ourselves and our loved ones and [sic] our community,” Obedin-Maliver said. The researchers soon discovered that very little data had been published on how LGBT-sensitive material was being taught in medical schools.

The survey that MERG conducted asked deans to grade their school’s performances on coverage of LGBT-related healthcare issues. Seventy percent of those who responded reported a fair, poor or very poor curriculum.

The study also identified 16 key topics related to LGBT health, such as transitioning and intimate partner violence. When the deans were asked to assess the broadness of their coverage of these topics, only 11 of the 132 schools claimed to cover all 16 issues.

“LGBT health has expanded way beyond sexually transmitted disease and HIV,” Obedin-Maliver said. She cited many areas in which LGBT individuals differ from their peers, including substance use, body image and medical care for LGBT adolescents.

Gastroenterology and hepatology professor Gabriel Garcia, who also serves as dean of admission at the School of Medicine, cited several reasons for the inadequate attention given to this subgroup of patients, including lack of material, expertise and requirements related to LGBT health concerns.

“The most likely reason is the lack of educators who have specific expertise in this area. It’s easier to find teachers in organic chemistry,” he said.

Obedin-Maliver had another reason why she believed these topics lacked coverage.

“Research and awareness isn’t there,” she said. “We don’t have providers who can do research that can really help us understand to what extent the disparities are there and how to address them.”

Garcia says Stanford medical students take a class during their preclinical years that specifically addresses many of the 16 key topics identified by MERG.

What they miss is a required rotation through an LGBT-specific provider or clinic, an experience that Obedin-Maliver said she believed is key to learning provider sensitivity.

Steps are being taken to fill in the gaps in education, both Garcia and Obedin-Maliver said. Garcia is a member of a task force within the Association of American Medical Colleges (AAMC), an organization charged with making concrete recommendations to improve education on LGBT healthcare. The group hopes to provide new curriculum material and policy framework for institutions seeking change.

Garcia says the increasing attention on such LGBT-related issues, such as gay marriage and Don’t Ask Don’t Tell, will encourage advocacy in the medical field.

“As we have this nationwide discussion, we will also have a medical school education discussion,” Garcia added.

Obedin-Maliver said she hopes the study will provide necessary data to prompt change among institutions in the United States. She added that perhaps in the future, educators may be held to national standards of LGBT-related curriculum coverage.

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