Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Health Education in Primary Care Graduate Medical Education Programs: A National Survey of Program Directors

Abstract

Lesbian, gay, bisexual, transgender, queer, and other sexual and/or gender minority (LGBTQ+) people experience numerous health disparities. Graduate medical education (GME) programs need curricula to address these disparities. We sought to characterize curricula related to LGBTQ+ health in primary care specialty (internal medicine, combined internal medicine/pediatrics, family medicine, pediatrics, and geriatric medicine) GME, and to identify barriers experienced by program directors (PDs) in incorporating LGBTQ+ curriculum. We conducted a national survey study of PDs in August–October 2020 via Qualtrics. Overall, 292 of 1,571 eligible PDs responded (18.6%). Nearly a third of PDs (n= 96%; 32.9%) indicated that their program did not include any didactic training about LGBTQ+ health. Those who did indicated a mean of 5.4–5.7 hours in each year from PGY1-3 dedicated to LGBTQ+ health. Didactic and clinical training about LGBTQ+ health was overwhelmingly focused on content related to sexual health. PDs who indicated they had ‘out’ faculty were more likely to include didactic and clinical training on multiple aspects of LGBTQ+ health. Our results identify a significant gap and a need for the integration of LGBTQ+ content into primary care GME curricula with additional focus placed on domains associated with known mental and physical health disparities, beyond sexual health, and inclusion of transgender and gender diverse health needs. Programs may aim to accomplish this through recruitment of LGBTQ+ health educators, invitations to content experts in the field, and adaptation of existing resources to teach about LGBTQ+ health.