According to an investigation in the September 7 issue of JAMA, a medical education theme issue, approximately 5 hours is the median (midpoint) amount of time in the medical school curriculum assigned to topics associated to health care needs of lesbian, gay, bisexual and transgender patients. Even though there is a large variation among the schools in quantity, content and perceived quality of instruction, it was revealed by a survey of deans of medical schools in the U.S. and Canada.

Background information in the report suggests:

“Lesbian, gay, bisexual and transgender (LGBT) individuals have specific health and health care needs relating to chronic disease risk, adult and adolescent mental health, unhealthy relationships (e.g., intimate partner violence), gender identity, sexually transmitted infections, and human immunodeficiency virus infection, among others. Compared with heterosexual and nontransgender socioeconomically matched peers, LGBT individuals are more likely to face barriers accessing appropriate medical care, which may create or increase existing disparities.

Medical education organizations have called for LGBT-sensitive training, but how and to what extent schools educate students to deliver comprehensive LGBT patient care is unknown.”

Among 176 medical schools across the U.S. and Canada, the presence and coverage of LGBT-related curricular content, as well as the deans’ views of their schools LGBT-related content were analyzed by Juno Obedin-Maliver, M.D., M.P.H., of the Stanford University School of Medicine, Stanford, Calif., and colleagues. The deans of medical education (or equivalent) at the 176 allopathic or osteopathic medical schools were asked to complete a 13-question, Web-based survey between May 2009 and March 2010. Out of all the schools who were asked to complete the survey, 150 (85.2%) responded, and 132 (75%) fully completed the survey.

They discovered that the average reported combined hours assigned to lesbian, gay, bisexual and transgender content was five hours. The corresponding median value was seven hours. During clinical years, 44 medical schools (33.3%) reported 0 hours of LGBT content, 9 schools (6.8%) reported 0 hours during preclinical years, and five medical schools (3.8%) reported 0 combined hours. Compared to U.S. allopathic schools whose reported median clinical hours were 2 hours, U.S. osteopathic schools had considerably less median with 0 clinical hours.

97% of those who responded to the questionnaire, reported that their school educates medical students to ask patients if they have sex with men, women, or both when obtaining a sexual history. 72% of the institutions reported teaching students the difference between behavior and identity (e.g., men might have sex with men and identify as straight), while 21.2% were not sure if this difference was taught.

62.9% of the institutions reported teaching half of 16 topics related to LGBT in their required or elective curricular, while 8% reported teaching all 16 of the topics.

The researchers write:

“Deans evaluated their institutions’ levels of coverage of the same 16 LGBT-related topics. The percentage of deans reporting ‘too little coverage’ of these topics varied from 12.9 percent for ‘HIV in LGBT people’ to 35.6 percent for ‘LGBT adolescent health’. Deans also evaluated the quality of their schools’ coverage of LGBT-related content overall. The most common response was ‘fair’ in 58 schools (43.9 percent), while nearly equal numbers evaluated coverage as ‘very good’ or ‘good’ (32; 24.2 percent) and ‘very poor’ or ‘poor’ (34; 25.8 percent).”

They added that the most popular plans suggested or present for increasing lesbian, gay, bisexual and transgender content in the curricula included ‘curricular material focusing on LGBT-related health and health disparities’ and having ‘faculty willing and able to teach LGBT-related curricular content’.

Concerning the discoveries that only around one-quarter of deans rated their institutions’ overall coverage of LGBT-related curricular material as “good” or “very good”, the researchers state that: “this indicates dissatisfaction with medical school coverage of LGBT content at a number of schools, especially given the expected positive skew associated with survey self-reporting, and suggests room for improvement in LGBT-related curricula.”

In an associated report Raymond H. Curry, M.D., of the Northwestern University Feinberg School of Medicine, Chicago, writes that the discoveries of this investigation on the need for educating LGBT issues can be viewed in connection to evidence for disparities in health care:

“The presence of these disparities is, without question, a concrete reality providing ample reason for students to understand as fully as possible the health challenges and needs of LGBT people. Even absent the health and health care disparities, it would still be important for physicians to understand the full range of human sexual behavior and to address the related psychosocial as well as overtly medical needs of the patients in their care. The study by Obedin-Maliver et al. provides a valuable snapshot. However, that which is of most enduring importance is seen not so much through a lens specific to the inclusion of LGBT issues but through the assurance of on-going attention to human sexuality, sexual behavior, and the accompanying medical implications as integral to the curriculum.”

Written by Grace Rattue