An Elective Course in Lesbian, Gay, Bisexual, and Transgender Health and Practice Issues

Michael W. Jann, PharmD; Scott Penzak, PharmD; Annesha White, PharmD, PhD; Amulya Tatachar, PharmD


Am J Pharm Educ. 2019;83(8):6967 

In This Article

Abstract and Introduction


Objective: To design, implement and assess a lesbian, gay, bisexual, and transgender (LGBT) health and practice elective course for second- and third-year Doctor of Pharmacy (PharmD) students.

Methods: The course focused on health promotion, health care barriers, disease prevention, and treatment throughout an LGBT person's lifespan. The course included topic discussions, reading assignments, various active-learning activities, an objective structured clinical examination (OSCE) with a transgender person, and guest speakers from the LGBT community. Five quizzes were administered during the course that were mapped to specific session learning objectives and course learning outcomes. Students completed an anonymous pre- and post-course survey on the seven course learning outcomes to assess their knowledge and skills regarding the health of LGBT people.

Results: Students exhibited significant learning with improvement in the seven course learning outcomes. The two most improved course learning outcomes were the medications used for LGBT people and summarizing health care resources available to LGBT people. The content of student portfolios included general themes of discrimination, health care access problems, advocacy, inclusive pharmacy environments, and desire to be a better practitioner. More than 91% of the students actively engaged the guest speakers from the LGBT community. Student performance on quizzes and in the OSCE activity was excellent. The capstone presentations covered a variety of topics including LGBT in Islam.

Conclusion: Students demonstrated knowledge of the unique health care issues among the LGBT community. This elective course provides a framework for other pharmacy programs to incorporate LGBT health topics into the curriculum and to engage with their local LGBT community.


The health care of lesbian, gay, bisexual, and transgender (LGBT) persons has been incorporated into the Healthy People 2020 goals and objectives, which state that these people have significant barriers to health care because of societal stigma, discrimination, and denial of their civil rights.[1] Based on limited data, an estimated 3.4% of the US population identifies as lesbian, gay, or bisexual.[2] In 2010, approximately 950,000 persons identified as transgender individuals.[3,4] The percentage of women and men aged 18 to 29 years identified as LGBT individuals was 8.3% and 4.6%, respectively.[5] However, as the age demographic increased, the percentages of persons identifying as LGBT decreased from 3.2% (ages 30–49 years) to 1.6% (65+ years). Correspondingly, as the age demographic increased, the percentage of persons refusing to answer or choosing "don't know" increased from 3.2% (30–49 years) to 6.5% (65+ years). According to the 2010 US Census same-sex households are present in 93% of all US counties.[6]

The Healthy People 2020 document describes a shortage of health care providers who are culturally competent in LGBT health.[1] A survey sent to the deans of medical school programs in Canada and the United States (N=150) indicated that the median time spent on LGBT-related topics in the curriculum was five hours (range three to eight hours), and faculty development for teaching these topics was offered in only 27 programs.[7] Of the 4,262 medical students surveyed, 67% agreed that the curricula containing specific LGBT areas could be improved, and they felt comfortable with but not fully prepared to care for LGBT patients.[8] A survey of physician assistant programs (N=106) reported a median time of 12 hours in the curriculum dedicated to general sexual health topics.[9] A 2015 survey in which students from 69 out of 138 medical school programs responded revealed that only 16% of the programs included competency-based training in LGBT health. Thirty-two percent of the medical schools had LBGT-related components in their training programs, while 52% lacked any training.[10] An elective interprofessional LGBT Queer, Intersex (QI) health forum to supplement the health care curricula was developed that included medical, pharmacy, nursing, dentistry, and physical therapy students that consisted of 10 hours of content presented over a weekend.[11] Few physicians self-identify as competent in LGBT health care and practice.[12] Despite efforts like these, another study of US physicians found that only 16% reported having LBGT-competency training.[13] For the few programs that incorporate training in LGBT health, most include it under an "umbrella" term that lacks differentiation between these groups and ignores the unique health issues of each. This occurs despite the availability of published guidelines to aid training programs in standardizing education for health care professionals.[13–15]

As integral members of the health care team, it is essential for pharmacists to be culturally competent. If not culturally competent, whether the pharmacist is a trusted professional can be questioned.[16] The Accreditation Council for Pharmacy Education (ACPE) emphasizes the significance of cultural competency in the standards used for pharmacy program assessment. Standards 3 and 4 provide only guidance related to the importance of cultural competency. Specific statements on LGBT health issues are not mentioned.[17] The American Association of Colleges of Pharmacy (AACP) has sponsored an institute entitled, "Cultural Competency: Beyond Race and Gender," where they noted that LGBT issues were underappreciated and then provided selected resources for instruction.[18] A cultural competency course was described for selected sociocultural groups but lacks LGBT persons as a specific entity.[19] Although LGBT health-related issues may be sparsely incorporated into various courses such as these, pharmacy programs that have a dedicated course on the topic are rare.[20,21] For example, a two-hour didactic lecture on transgender health care was included in a therapeutics course on special populations, and a panel discussion on transgender health care was incorporated into a required diversity course, which was favorably received by the students and engaged the transgender community.[20,22] Many challenges for the health care of LGBT persons exist. The practice of pharmacy and educational programs must continue to evolve to meet the needs of these individuals.[23]

The specific goals of the elective course described here were to develop, implement, and assess pharmacy students' knowledge of and skills in managing the different health-related issues among LGBT persons. Assessment of the specific course learning outcomes supported by didactic discussion topics with quizzes, active-learning activities, an objective structured clinical examination (OSCE), and student portfolios were key elements to determine student achievement.