Sexual and gender minority content in undergraduate medical education in the United States and Canada: current state and changes since 2011

Carl G Streed Jr; Amy Michals; Emily Quinn; John A Davis; Kylie Blume; Katharine B Dalke; David Fetterman; Gabriel Garcia; Elizabeth Goldsmith; Richard E Greene; Jessica Halem; Helene F Hedian; Isabel Moring; May Navarra; Jennifer Potter; Jennifer Siegel; William White; Mitchell R Lunn; Juno Obedin-Maliver

doi:10.1186/s12909-024-05469-0

Sexual and gender minority content in undergraduate medical education in the United States and Canada: current state and changes since 2011

BMC Med Educ. 2024 May 1;24(1):482. doi: 10.1186/s12909-024-05469-0.

Authors

Carl G Streed Jr^{1

2}, Amy Michals³, Emily Quinn³, John A Davis⁴, Kylie Blume⁵, Katharine B Dalke⁶, David Fetterman^{7

8}, Gabriel Garcia⁹, Elizabeth Goldsmith^{10

11}, Richard E Greene¹², Jessica Halem¹³, Helene F Hedian^{14

15}, Isabel Moring¹⁶, May Navarra¹⁷, Jennifer Potter^{18

19}, Jennifer Siegel^{20

21}, William White^{22

23}, Mitchell R Lunn^#^{24

25}, Juno Obedin-Maliver^#^{25

26}

Affiliations

¹ Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, 801 Massachusetts Ave., Room 2082, Boston, MA, 02118, USA. Carl.Streed@bmc.org.
² GenderCare Center, Boston Medical Center, Boston, MA, USA. Carl.Streed@bmc.org.
³ Biostatistics & Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA.
⁴ Division of Infectious Diseases, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
⁵ Department of Neurology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
⁶ Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA.
⁷ Fetterman & Associates, Hadley, MA, USA.
⁸ Claremont Graduate University, Claremont, CA, USA.
⁹ Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
¹⁰ Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.
¹¹ Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
¹² Division of General Internal Medicine, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.
¹³ Eidos LGBTQ+ Health Initiative, University of Pennsylvania, Philadelphia, PA, USA.
¹⁴ Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁵ Center for Transgender and Gender Expansive Health, Johns Hopkins, Baltimore, MD, USA.
¹⁶ Treehouse Pediatrics, Round Rock, TX, USA.
¹⁷ GenderCare Center, Boston Medical Center, Boston, MA, USA.
¹⁸ The Fenway Institute, Fenway Health, Boston, MA, USA.
¹⁹ Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
²⁰ Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
²¹ Transgender Health Program, Massachusetts General Hospital, Boston, MA, USA.
²² San Francisco Emergency Medical Associates, California Pacific Medical Center, San Francisco, CA, USA.
²³ Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, CA, USA.
²⁴ Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
²⁵ Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
²⁶ Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA.

^# Contributed equally.

Abstract

Purpose: To characterize current lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI +) health-related undergraduate medical education (UME) curricular content and associated changes since a 2011 study and to determine the frequency and extent of institutional instruction in 17 LGBTQI + health-related topics, strategies for increasing LGBTQI + health-related content, and faculty development opportunities.

Method: Deans of medical education (or equivalent) at 214 allopathic or osteopathic medical schools in Canada and the United States were invited to complete a 36-question, Web-based questionnaire between June 2021 and September 2022. The main outcome measured was reported hours of LGBTQI + health-related curricular content.

Results: Of 214 schools, 100 (46.7%) responded, of which 85 (85.0%) fully completed the questionnaire. Compared to 5 median hours dedicated to LGBTQI + health-related in a 2011 study, the 2022 median reported time was 11 h (interquartile range [IQR], 6-16 h, p < 0.0001). Two UME institutions (2.4%; 95% CI, 0.0%-5.8%) reported 0 h during the pre-clerkship phase; 21 institutions (24.7%; CI, 15.5%-33.9%) reported 0 h during the clerkship phase; and 1 institution (1.2%; CI, 0%-3.5%) reported 0 h across the curriculum. Median US allopathic clerkship hours were significantly different from US osteopathic clerkship hours (4 h [IQR, 1-6 h] versus 0 h [IQR, 0-0 h]; p = 0.01). Suggested strategies to increase content included more curricular material focusing on LGBTQI + health and health disparities at 55 schools (64.7%; CI, 54.6%-74.9%), more faculty willing and able to teach LGBTQI + -related content at 49 schools (57.7%; CI, 47.1%-68.2%), and more evidence-based research on LGBTQI + health and health disparities at 24 schools (28.2%; CI, 18.7%-37.8%).

Conclusion: Compared to a 2011 study, the median reported time dedicated to LGBTQI + health-related topics in 2022 increased across US and Canadian UME institutions, but the breadth, efficacy, or quality of instruction continued to vary substantially. Despite the increased hours, this still falls short of the number of hours based on recommended LGBTQI + health competencies from the Association of American Medical Colleges. While most deans of medical education reported their institutions' coverage of LGBTQI + health as 'fair,' 'good,' or 'very good,' there continues to be a call from UME leadership to increase curricular content. This requires dedicated training for faculty and students.

Keywords: LGBTQ persons; Undergraduate medical education.

MeSH terms

Canada
Curriculum*
Education, Medical, Undergraduate* / standards
Female
Humans
Male
Sexual and Gender Minorities*
Surveys and Questionnaires
United States