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      The Case of Ty Jackson: An Interactive Module on LGBT Health Employing Introspective Techniques and Video-Based Case Discussion

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          Abstract

          Introduction

          The Institute of Medicine's 2011 report on lesbian, gay, bisexual, and transgender (LGBT) health and the legalization of same-sex marriage are just two of the numerous milestones that have hastened medical schools' efforts to prepare trainees to address the needs of LGBT community members. Early awareness of sexual diversity through self- and peer introspection and video-based education can help trainees build a foundation towards providing affirming care to LGBT patients.

          Methods

          The Kern model was used to develop, implement, and evaluate an interactive multimodal workshop to provide first-year medical students with a formative introduction to LGBT health. Learning objectives focused on comprehending the spectrum of human sexuality, health issues for LGBT patients, and better practices for promoting affirming care. The module consisted of a PowerPoint presentation, sexuality survey, videos of provider-patient encounters, and community-based resources.

          Results

          The workshop was implemented among 178 first-year medical students in September 2018, with 93% completing the pre-/postworkshop evaluations. Comparison of evaluations showed an increase in confidence in addressing each of the three learning objectives. Over 85% rated the PowerPoint and videos as very good or excellent.

          Discussion

          This workshop was effective in helping first-year medical students appreciate the spectrum of sexual diversity, health issues facing LGBT individuals, and better practices to promote affirming care. The real-time sexuality survey helped trainees appreciate sexual diversity through self-reflection and near-peer sharing. The videos and accompanying discussion provided real-life encounters, along with common pitfalls in and pearls for communicating with LGBT patients.

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          Most cited references18

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          Medical students' ability to care for lesbian, gay, bisexual, and transgendered patients.

          Our objective was to assess medical students' ability to care for lesbian, gay, bisexual, and transgender (LGBT) patients and to identify potential deficiencies in medical school curricula pertaining to this care. Between March 1 and April 15, 2004, third- and fourth-year medical students at a metropolitan medical school were sent an e-mail requesting participation in a confidential on-line survey of 64 quantitative questions designed to assess their ability to care for LGBT patients. A total of 248 of 320 (77.5%) students responded. Medical students with greater clinical exposure to LGBT patients reported more frequent sexual history taking with LGBT patients, had more positive attitude scores, and possessed higher knowledge scores than students with little or no clinical exposure. Overall, on the 13-item attitude survey, the mean was 4.15 (5 = most positive, SD = .55, range 1.86-5.00), indicating a desire and willingness to provide health care to LGBT patients. The mean score on the 14-item knowledge test was 60% (SD = .12) correct. Medical students with increased clinical exposure to LGBT patients tended to perform more comprehensive histories, hold more positive attitudes toward LGBT patients, and possess greater knowledge of LGBT health care concerns than students with little or no clinical exposure.
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            Incorporating LGBT Health in an Undergraduate Medical Education Curriculum Through the Construct of Social Determinants of Health

            Introduction The AAMC has provided a resource to medical schools for implementing curricular change in lesbian, gay, bisexual, and transgender (LGBT) health education. However, studies have identified that many health professionals who do not feel comfortable in their ability to provide quality care for LGBT patients do not perform complete sexual histories routinely and/or harbor bias towards these patients or their sexual practices. This situation underscores the continued need for further education on this topic. Methods Based on a needs assessment survey of medical students and faculty, we developed a 1-hour didactic lecture to provide instruction on how social determinants of health impact the care of LGBT patients. Students were not required to have any prerequisite knowledge for the session. A content expert in LGBT health taught the lecture using Microsoft PowerPoint in a traditional medical school lecture hall. Results The lecture was given to 180 third-year medical students. A total of 63 students (35%) responded to the retrospective pre- and postlecture survey. After the didactic lecture, students reported a statistically significant change in their knowledge of the lecture objectives. Discussion The didactic lecture was able to increase students' knowledge of how social determinants impact the health of LGBT patients. The lecture can be incorporated into a longitudinal curriculum on LGBT health. Additional work and research are needed on increasing comfort in faculty teaching.
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              Beyond Men, Women, or Both: A Comprehensive, LGBTQ-Inclusive, Implicit-Bias-Aware, Standardized-Patient-Based Sexual History Taking Curriculum

              Introduction This standardized-patient-based module prepares medical students to take inclusive, comprehensive sexual histories from patients of all sexual orientations and gender identities. Health disparities faced by lesbian, gay, bisexual, transgender, and queer (LGBTQ) people are at least partially the result of inadequate access to health care and insufficient provider training. This module incorporates implicit bias activities to emphasize the important role providers can play in mitigating these disparities through compassionate, competent care. Furthermore, two of the three included cases highlight the negative impact sexual dysfunction can have on emotional well-being. Methods Over 3 hours, students participate in a 30-minute large-group lecture and three 40-minute small-group standardized patient encounters with debrief. Prework consists of a short video on sexual history taking, assigned readings, and an implicit bias activity. These materials are included in this resource, along with lecture slides, facilitator guide, and standardized patient cases. Though the cases are adaptable to all levels of medical education, this module is designed for second-year and early third-year medical students. Results Qualitative student evaluations were positive, and postparticipation surveys revealed statistically significant improvement in comfort with their ability to take a sexual history in general, and take one from patients with a differing sexual orientation. Deployed in the second year of our Doctoring curriculum, this module continues to receive positive evaluations. Discussion Introducing these skills begins to address the curricular deficiencies seen across medical education and lays the foundation for a more competent health care workforce to address the needs of LGBTQ patients.
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                Author and article information

                Journal
                MedEdPORTAL
                MedEdPORTAL
                MEP
                MedEdPORTAL : the Journal of Teaching and Learning Resources
                Association of American Medical Colleges
                2374-8265
                2019
                04 June 2019
                : 15
                : 10828
                Affiliations
                [1 ]Fourth-Year Medical Student, Rutgers New Jersey Medical School
                [2 ]Resident, Obstetrics and Gynecology Department, Rutgers New Jersey Medical School
                [3 ]Resident, Medicine Department, Rutgers New Jersey Medical School
                [4 ]Assistant Professor of Emergency Medicine, Indiana University School of Medicine
                [5 ]Executive Vice Dean, Rutgers New Jersey Medical School
                [6 ]Associate Professor of Medicine, Weill-Cornell Medical College
                [7 ]Associate Dean, Diversity and Inclusion, Rutgers New Jersey Medical School
                Author notes
                *Corresponding author: jps304@ 123456njms.rutgers.edu
                Article
                10.15766/mep_2374-8265.10828
                6571794
                31259237
                4a1ecd92-1b0d-4bb7-9055-ba72fbeaed5e
                Copyright © 2019 Gavzy et al.

                This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial license.

                History
                : 31 December 2018
                : 29 April 2019
                Page count
                Tables: 1, References: 23, Pages: 10
                Categories
                Original Publication

                case-based learning,preclinical medical education,lgbt health issues,sexuality survey,video-based education

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