How much is needed? Patient exposure and curricular education on medical students’ LGBT cultural competency

Dustin Z Nowaskie,Anuj U Patel

doi:10.1186/s12909-020-02381-1

Abstract

BackgroundFor medical students, providing exposure to and education about the lesbian, gay, bisexual, and transgender (LGBT) patient population are effective methods to increase comfort, knowledge, and confidence in caring for LGBT people. However, specific recommendations on the number of patient exposures and educational hours that relate to high LGBT cultural competency are lacking.MethodsMedical students (N = 940) at three universities across the United States completed a survey consisting of demographics, experiential variables (i.e., number of LGBT patients and LGBT hours), and the 7-point Likert LGBT-Development of Clinical Skills Scale (LGBT-DOCSS). LGBT-DOCSS scores were stratified by 1-point increments, and experiential variable means were computed per each stratification to characterize the mean LGBT patients and hours of medical students with higher scores and those with lower scores.ResultsMedical students reported caring for some LGBT patients annually (M = 6.02, SD = 20.33) and receiving a low number of annual LGBT curricular hours (M = 2.22, SD = 2.85) and moderate number of annual LGBT extracurricular hours (M = 6.93, SD = 24.97). They also reported very high attitudinal awareness (M = 6.54, SD = 0.86), moderate knowledge (M = 5.73, SD = 1.01), and low clinical preparedness (M = 3.82, SD = 1.25). Medical students who cared for 35 or more LGBT patients and received 35 or more LGBT total hours reported significantly higher preparedness and knowledge.ConclusionsMedical students have shortcomings in LGBT cultural competency and limited LGBT patient exposure and education. To improve LGBT cultural competency, medical schools and accrediting bodies should consider providing medical students with at least a total of 35 LGBT patient contacts and 35 LGBT education hours (10 h of required curricular education and 25 h of supplemental education).

Highlights

For medical students, providing exposure to and education about the lesbian, gay, bisexual, and transgender (LGBT) patient population are effective methods to increase comfort, knowledge, and confidence in caring for LGBT people
While Obedin-Maliver et al have characterized the wide range of LGBT education delivered in medical schools in the United States and Canada [12], specific recommendations on the number of patient exposures and educational hours that can lead to high LGBT cultural competency are lacking
This finding is akin to the few studies that have shown that for medical students, LGBT patient contact and curricular education can be effective in increasing comfort [6], knowledge [6], and confidence [7] in caring for the LGBT population

Summary

Introduction

For medical students, providing exposure to and education about the lesbian, gay, bisexual, and transgender (LGBT) patient population are effective methods to increase comfort, knowledge, and confidence in caring for LGBT people. Discrimination in healthcare encounters for this patient population is reportedly as high as 20% [4] and has been shown to occur in forms such as medication refusal as well as verbal and physical violence [5] These acts can lead LGBT patients to avoid essential healthcare, and in turn, cause an exacerbation of existing health disparities [5]. While Obedin-Maliver et al have characterized the wide range of LGBT education delivered in medical schools in the United States and Canada [12], specific recommendations on the number of patient exposures and educational hours that can lead to high LGBT cultural competency are lacking. Such recommendations could allow for a standardized approach to LGBT curricular education for medical schools

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