America’s inadequate LGBTQ medical education

As medical students, we are asked to learn in exquisite detail the ins and outs of rare diseases that we may never encounter in clinical practice. Yet the education we receive on caring for a population numbering in the millions is sorely lacking, and the health of those patients — the members of our communities identifying as lesbian, gay, bisexual, transgender, or as another sexual or gender minority — is suffering as a result.

Data is dishearteningly sparse concerning health disparities among LGBTQ individuals, driven in large part by researchers failing to collect sexual preference data on medical study participants. Even so, we know that health outcomes are almost uniformly worse among this group and the diverse communities it encompasses. This is true of modifiable risk factors for cardiovascular disease, prevalence of obesity and type 2 diabetes, risk of mortality from breast cancer, use of tobacco and other harmful substances, sexually transmitted infections, suicidal ideation and suicidality and more.

Some of these health disparities are known to the average medical student or practitioner — increased rates of STIs and suicidality among certain LGBTQ communities, for instance. Some are not. All require population-specific training to effectively treat and counsel patients regarding the factors influencing these outcomes. Yet medical students consistently report that they lack adequate training in caring for LGBTQ patients and believe additional medical education in this area makes them “more prepared” in the clinic.

Noting these deficiencies in our undergraduate medical training, a recent NPR feature highlighted several medical students’ efforts to push for more LGBTQ health education in their own institutions’ curricula. I, too, have worked to supplement the available LGBTQ curriculum by putting on educational lunch talks covering queer, transgender, and intersex health. Planning a national continuing medical education session on caring for patients with differences in sex development. Starting an online publication to help physicians and other providers get up to speed on issues of LGBTQ health care.

I was once told by a faculty member that, when I begin my clinical rotations, I will likely be the expert in the care of transgender patients and that I should pass on this knowledge to my residents and attendings.

None of this should be necessary.

The task of buttressing the shortcomings of our country’s LGBTQ health care education should not fall to medical students. Our job as students is to learn — not teach, not design curricula. More than that, student-led efforts to change medical education are sporadic, overly reliant on extraordinary student engagement and at constant risk of being lost to follow-up as students enter their clinical years and ultimately graduate.

We know our LGBTQ patients have unique health care needs and poorer health outcomes compared to the population at large. It is incumbent on those whose job it is to design and accredit our nation’s medical school curricula to ensure that our future physicians learn how to provide excellent health care to the more than eight million people in this country who identify as LGBTQ.

Haidn Foster is a medical student and founding editor, Pride in Practice.

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