How well are medical schools preparing the next generation of doctors to care for gay, lesbian, bisexual and transgender patients? Not too well, it seems.
In a survey of medical school deans in the U.S. and Canada, a group of researchers found that the median number of teaching hours dedicated to LGBT content during an a four-year medical education was just five hours. While the researchers said there was a lot of variation between schools, they noted that five hours as a median was “small.”
Their results were published this week in the Journal of the American Medical Association in a special issue on medical education.
This gap in medical education reflects a larger problem medical care for LGBT people, the researchers say. While LGBT people face the same general health risks as the rest of the population, they also may have specific health care needs relating to mental health, gender identity, sexually transmitted diseases, and other issues. Earlier this year, the Institute of Medicine noted in a report on the health of LGBT Americans that they “face a profound and poorly understood set of additional health risks due largely to social stigma.”
"Our understanding of LGBT health issues is poor," Juno Obedin-Maliver, lead author of the JAMA study and a resident physician in obstetrics and gynecology at the University of California, San Francisco, tells Shots. “We don’t ask patients about it and we don’t perform research on it. We know little bits about some populations in certain settings, but it remains a hidden population and therefore a hidden health demographic.”
And while 32 percent of the 132 deans who responded to Obedin-Maliver’s questionnaire said they thought the quality of their LGBT content was very good, about 44 percent said it was fair and 34 percent said it was very poor.
"That speaks to their recognition that they’re not doing as well as they could be," Obedin-Maliver says.
But one thing nearly all med students are learning is to ask patients about sexual activity. Some 97 percent of the deans surveyed reported that their institution teaches medical students to ask patients if they have sex with men, women, or both when doing a sexual history. Obedin-Maliver says she was surprised to learn it was so high.
But she notes they also need to differentiate between behavior and identity; for example, men who have sex with men but identify as straight. “It’s actually behavior — not identity — which describes health risks,” she says. “Both are important to know in terms of taking care of patients.”