Integration of sex and Gender Minority Standardized Patients Into a Workshop on Gender-Inclusive Patient Care

Exploring Medical Student Perspectives

Sarah E. Stumbar, MD, MPH; Nana Aisha Garba, MD, PhD, MPH; MariaSyl de la Cruz, MD; Prasad Bhoite, MPH; Emiri Uchiyama, MD

Disclosures

South Med J. 2022;115(9):722-726. 

In This Article

Abstract and Introduction

Abstract

Objectives: Sexual and gender minority (SGM) communities experience significant health disparities. Although coverage of health issues specific to these communities has increased in the undergraduate medical curriculum, there is still opportunity for improved teaching about sexual diversity and inclusive care. The goal of this study was to assess students' perceptions of and satisfaction with a half-day workshop focused on sexual history taking and transgender health.

Methods: The second-year clinical skills course at the Florida International University Herbert Wertheim College of Medicine includes a sexual history workshop that starts with a 1-hour lecture on sexual history taking. This is followed by a faculty-facilitated small group session during which students interview an SGM patient and debrief about this experience. In 2020, for the first time, the standardized patients were members of the SGM community, and the session was on Zoom. Students completed an optional, anonymous postsession survey assessing the workshop.

Results: Students overwhelmingly believed that the integration of SGM standardized patients into the session helped improve their knowledge, attitudes, and skills related to providing care for this population. They noted that the standardized patient interaction and debriefing were the most beneficial parts of the session.

Conclusions: Given the positive feedback, future iterations of this session will continue to use the SGM community as standardized patients. In addition, student competency related to SGM patient care will be assessed through observed structured clinical examinations.

Introduction

The Association of American Medical Colleges, among other health organizations, has identified significant health disparities experienced by people who are sexual and gender minorities (SGM).[1] The SGM community is diverse, including people who identify as lesbian, gay, bisexual, asexual, transgender, gender nonbinary, queer, and/or intersex.[2] Seventy percent of gender minority and more than 50% of sexual minority individuals have reported harassment and discrimination when seeking health care.[3] Because of these experiences, SGM individuals often avoid seeking out needed healthcare services.[3]

In 2014, the Association of American Medical Colleges published 30 professional competencies related to the care of SGM patients including the areas of clinical care, knowledge for practice, and interpersonal and communication skills.[1] Additional articles published in 2017 and 2020 outlined sexual health curricular competencies for undergraduate medical education.[4,5] Despite this, previous studies have shown that education on sexual health is inconsistent and limited in most North American medical schools, and insufficient training remains a prevalent barrier to adequate sexual history taking.[6–8] Existing curricula typically include topics of sexually transmitted infections, pregnancy prevention, and contraception; whereas topics including sexual dysfunction, sexual pleasure, safer sex across the life cycle, and decision making are less likely to be included.[6] Although coverage of lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) health issues has increased in recent years, there is still significant opportunity for improved education about sexual diversity (identity, orientations, practices).[6]

In a pilot survey of students at nine New England allopathic medical schools, a minority of respondents (31.7%) reported comfort in caring for gender minority patients. More than 25% of students were somewhat not/not comfortable discussing gender identity, and more than 40% of students were somewhat not/not comfortable discussing gender minority health topics such as hormone therapy. Students reported the least comfort with interviewing patients about gender identity, detailing treatment options for gender minorities, and describing the etiologies of differences of sex development. More than half of the respondents reported that their medical school curriculum did not adequately prepare them to serve SGM patients.[9] A recent study, hindered by a low response rate, found that half of responding medical schools had implemented standardized patient cases involving SGM patients.[10] Another study, also published in 2020, elucidated the experience of SGM people acting as standardized patients in the undergraduate medical education curriculum, but little has been published on student perceptions of these sessions.[11]

Challenges to the implementation of a sexual health curriculum include prioritization in a time-limited curriculum, lack of knowledge or training of faculty themselves, and the influences of the surrounding religious and/or cultural traditions of a medical school.[12] Despite facing similar challenges at our own institution, we sought to first develop a session during our second-year clinical skills course that would expose medical students to the inclusive care of LGBTQ+ communities, and then assess student perceptions of this session.

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