Like water in a desert

Despite recent legal and societal advances, patients who identify as lesbian, gay, bisexual and transgender still face significant disparities in health care. Individuals who are born with differences of sex development, those who are transgender and gender-nonconforming individuals often face even greater difficulties obtaining compassionate, patient-centered care. Reducing the health disparities affecting these communities requires an interdisciplinary approach, beginning with ensuring a competent, sensitive and welcoming health-care workforce.

For the past two years, we had the honor and privilege of serving on a committee dedicated to improving the education of the next generation of physicians in caring for patients who may be LGBT, gender nonconforming or born with DSD: the Association of American Medical Colleges Advisory Committee on Sexual Orientation, Gender Identity and Sex Development. Our initial charge was to develop learning competencies for medical educators and institutions to guide the advancement of medical curricula to provide high-quality, patient-centered care for these populations. However, we quickly realized that learning competencies alone are insufficient to produce the desired change in medical curricula. Medical institutions need to ensure the effectiveness of curricula and promote a climate that supports, values and includes people who are LGBT, gender nonconforming and/or born with DSD at all levels.

On Nov. 11, the committee released the culmination of these efforts in the publication “Instituting Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born with DSD: A Resource for Medical Educators.” This book has three goals:

  1. to help educate the reader about people who may be LGBT, gender nonconforming or born with DSD and how academic medicine can support these populations;
  2. to instruct medical schools on the importance of evaluating their cultural climates and on how to implement curricular changes as they relate to people within these populations; and
  3. to provide a framework to facilitate and assess the effectiveness of new curricula.

This book achieves these goals by detailing the history of disparities faced by these populations, by providing the learning competencies that all medical students should achieve, and by explaining how to integrate and evaluate the effectiveness of the curriculum. The publication also discusses how to assess institutional climate to identify the barriers to curricular reform and the role of trauma and resiliency in the health of these individuals. To highlight national leaders, the book lists institutions that are implementing these curricula into their educational programs.

WHAT YOU’LL FIND INSIDE THE BOOK

History – laying the foundation for inclusion and equality:

  • Historically, people who are LGBT, gender nonconforming and/or born with DSD face discrimination.
  • Discrimination leads to challenges when these populations interact with the health-care system, which translates into significant health disparities.

The role of medical education in eliminating these disparities:

  • Increase awareness and knowledge of health disparities and risks for patients in these populations.
  • Train students to provide high-quality, patient-centered care.
  • Inspire students to be advocates for change.
  • Promote resilience in and foster positive health outcomes for patients in these populations.

A detailed list of competency objectives to improve health care for patients in these populations

How to integrate competencies into medical school curricula:

  • Encourage trainees, faculty members or administrators to serve as champions for change.
  • Identify barriers and implement strategies to incorporate change.
  • Integrate competencies across all years of education and learning modalities.

Clinical scenarios relating to these populations with discussion points for experiential learning

Assess and evaluate the curricular initiatives:

  • Assess the learners to evaluate the effectiveness of the curricular changes.
  • Evaluate the effects of curricular changes on institutional environment.

At this point, you, as a reader of ASBMB Today, are probably asking yourself, “If this book targets health-care professionals, how does this relate to me, a basic scientist?” If this is your question, we instead suggest asking, “How can a basic scientist support this work?” The answers are numerous. If you work in a medical institution, then part of your job is to teach medical students and to develop curricula. The book targets a wide audience including teaching faculty and basic scientists.

Also, chances are someone you know is LGBT, gender nonconforming or born with a DSD – although you may not know that about him or her. On any team, team members play a valuable role in ensuring the well-being of their peers. Whether it is supporting inclusive nondiscrimination policies, demanding inclusive healthcare benefits or even inquiring about what you can do to make a colleague feel more welcome, your actions can help create a supportive climate.

Regardless of where you are employed or your role, you can be that agent of change.

Change can be frustratingly slow, but any level of change is important. Remember that it has taken centuries for marriage equality to become a reality, yet this one change has impacted millions. Smaller changes frequently become the impetus for larger changes, and the actions of a person at one institution may spark someone else to initiate a similar process at another institution, thereby leading to true, sustainable health-system change.

The book is the first and only comprehensive, evidence-based curriculum and institutional climate guide from an academic health association to address the health disparities of these unique populations. For the many individuals who have advocated for such change with few resources and for those individuals who have been marginalized and ignored for so long, the publication fills a striking need, much like water in a desert.

We hope that the publication will initiate much-needed change across the health-care professions. With dedication and perseverance by all people involved in health-care education, including basic scientists, our work can grow and truly transform medical education and improve health-care delivery and outcomes for any population facing health-care disparities as a result of implicit or explicit prejudice.

Andrew D. HollenbachAndrew D. Hollenbach (aholle
@lsuhsc.edu) is an associate professor in the genetics department at the Louisiana State University Health Sciences Center. He is a member of the Association of American Medical Colleges’ Sexual Orientation, Gender Identity and Sexual Development Patient Care Advisory Panel and the lead editor of the recent publication.

Kristen L. Eckstrand Kristen L. Eckstrand is an M.D. candidate at Vanderbilt University, chair of the Association of American Medical Colleges’ Sexual Orientation, Gender Identity and Sexual Development Patient Care Advisory Panel and co-editor of the recent publication. She is vice president of the Gay and Lesbian Medical Association: Health Professionals Advancing LGBT Equality and a member of the American Medical Association Advisory Committee on Lesbian, Gay, Bisexual and Transgender Issues.