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Erschienen in: Journal of General Internal Medicine 6/2019

07.03.2019 | Original Research

Assessment of Internal Medicine Resident Preparedness to Care for Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning Patients

verfasst von: Carl G. Streed Jr, MD MPH, Helene F. Hedian, MD, Amanda Bertram, MS, Stephen D. Sisson, MD

Erschienen in: Journal of General Internal Medicine | Ausgabe 6/2019

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Abstract

Background

Recognizing the unique health needs of sexual and gender minorities (i.e., lesbian, gay, bisexual, transgender, queer/questioning individuals) is critical to providing competent and comprehensive healthcare.

Objective

To assess resident knowledge of healthcare issues uniquely affecting sexual and gender minorities as well as the role of online case-based didactics to measure and improve knowledge in the diagnosis and treatment of these patients.

Design

A multicenter online education intervention from December 2016 to April 2018.

Participants

The study population consisted of 833 PGY1-3 residents at 120 internal medicine residency programs in the USA who completed 1018 tests.

Interventions

A 1-h online module addressing sexual and gender minority (SGM) health. The test evaluated each resident in four categories: (1) terminology relevant to SGM patients; (2) health disparities and preventive care issues affecting SGM patients; (3) substance use and mental health issues unique to SGM patients; and (4) common sexually transmitted illnesses affecting SGM populations.

Main Measures

Participants completed a pre-test assessing SGM health knowledge. A didactic module reviewing diagnosis and management of these diseases was then completed, followed by a post-test.

Key Results

Among 1018 resident respondents, there was no difference between post-graduate year pre-test performance (PGY-1 52%, PGY-2 50%, PGY-3 51%; p = 0.532) or post-test performance (PGY-1 80%, PGY-2 82%, PGY-3 82%; p = 0.285). Pre-test and post-test performance of an online didactic module was the same across test categories and patient populations for PGY-1 vs. PGY-2 vs. PGY-3. Residents demonstrated an improvement between pre- and post-test knowledge.

Conclusions

Baseline knowledge of health issues of sexual and gender minorities, as assessed by pre-test performance, did not change during residency training. An online didactic module introduced trainees to critical issues regarding the care of these vulnerable populations until such curricula are required in training. Health disparities in LGBTQ communities may improve with improved physician training on clinical care of LGBTQ patients and families.
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Literatur
1.
Zurück zum Zitat Meyer IH, Brown TN, Herman JL, Reisner SL, Bockting WO. Demographic characteristics and health status of transgender adults in select us regions: behavioral risk factor surveillance system, 2014. Am J Public Health. 2017;107(4):582–589.CrossRefPubMedPubMedCentral Meyer IH, Brown TN, Herman JL, Reisner SL, Bockting WO. Demographic characteristics and health status of transgender adults in select us regions: behavioral risk factor surveillance system, 2014. Am J Public Health. 2017;107(4):582–589.CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Gonzales G, Przedworski J, Henning-Smith C. Comparison of health and health risk factors between lesbian, gay, and bisexual adults and heterosexual adults in the united states: results from the national health interview survey. JAMA Intern Med. 2016;176(9):1344–1351.CrossRefPubMed Gonzales G, Przedworski J, Henning-Smith C. Comparison of health and health risk factors between lesbian, gay, and bisexual adults and heterosexual adults in the united states: results from the national health interview survey. JAMA Intern Med. 2016;176(9):1344–1351.CrossRefPubMed
5.
Zurück zum Zitat Diamant AL, Wold C. Sexual orientation and variation in physical and mental health status among women. J Womens Health (Larchmt). 2003;12(1):41–49.CrossRef Diamant AL, Wold C. Sexual orientation and variation in physical and mental health status among women. J Womens Health (Larchmt). 2003;12(1):41–49.CrossRef
6.
Zurück zum Zitat Gonzales G, Henning-Smith C. Health disparities by sexual orientation: results and implications from the behavioral risk factor surveillance system. J Community Health. 2017;42(6):1163–1172. Gonzales G, Henning-Smith C. Health disparities by sexual orientation: results and implications from the behavioral risk factor surveillance system. J Community Health. 2017;42(6):1163–1172.
7.
Zurück zum Zitat Wang J, Hausermann M, Vounatsou P, Aggleton P, Weiss MG. Health status, behavior, and care utilization in the Geneva Gay Men’s Health Survey. Prev Med. 2007;44(1):70–75.CrossRefPubMed Wang J, Hausermann M, Vounatsou P, Aggleton P, Weiss MG. Health status, behavior, and care utilization in the Geneva Gay Men’s Health Survey. Prev Med. 2007;44(1):70–75.CrossRefPubMed
8.
Zurück zum Zitat Streed CG Jr., Harfouch O, Marvel F, Blumenthal RS, Martin SS, Mukherjee M. Cardiovascular disease among transgender adults receiving hormone therapy: a narrative review. Ann Intern Med. 2017;167(4):256–267.CrossRefPubMed Streed CG Jr., Harfouch O, Marvel F, Blumenthal RS, Martin SS, Mukherjee M. Cardiovascular disease among transgender adults receiving hormone therapy: a narrative review. Ann Intern Med. 2017;167(4):256–267.CrossRefPubMed
9.
Zurück zum Zitat Getahun D, Nash R, Flanders WD, et al. Cross-sex hormones and acute cardiovascular events in transgender persons: a cohort study. Ann Intern Med. 2018;169(4):205–213.CrossRefPubMedPubMedCentral Getahun D, Nash R, Flanders WD, et al. Cross-sex hormones and acute cardiovascular events in transgender persons: a cohort study. Ann Intern Med. 2018;169(4):205–213.CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Streed CG Jr, McCarthy EP, Haas JS. Self-reported physical and mental health of gender nonconforming transgender adults in the United States. LGBT Health. 2018;5(7):443–448. Streed CG Jr, McCarthy EP, Haas JS. Self-reported physical and mental health of gender nonconforming transgender adults in the United States. LGBT Health. 2018;5(7):443–448.
11.
Zurück zum Zitat Streed CG Jr., McCarthy EP, Haas JS. Association between gender minority status and self-reported physical and mental health in the United States. JAMA Intern Med. 2017;177(8):1210–1212.CrossRefPubMedPubMedCentral Streed CG Jr., McCarthy EP, Haas JS. Association between gender minority status and self-reported physical and mental health in the United States. JAMA Intern Med. 2017;177(8):1210–1212.CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995;36(1):38–56.CrossRefPubMed Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995;36(1):38–56.CrossRefPubMed
13.
Zurück zum Zitat Meyer IH. Does an improved social environment for sexual and gender minorities have implications for a new minority stress research agenda? Psychol Sex Rev. 2016;7(1):81–90.PubMedPubMedCentral Meyer IH. Does an improved social environment for sexual and gender minorities have implications for a new minority stress research agenda? Psychol Sex Rev. 2016;7(1):81–90.PubMedPubMedCentral
15.
Zurück zum Zitat McConnell EA, Janulis P, Phillips G 2nd, Truong R, Birkett M. Multiple minority stress and LGBT community resilience among sexual minority men. Psychol Sex Orientat Gend Divers. 2018;5(1):1–12.CrossRefPubMedPubMedCentral McConnell EA, Janulis P, Phillips G 2nd, Truong R, Birkett M. Multiple minority stress and LGBT community resilience among sexual minority men. Psychol Sex Orientat Gend Divers. 2018;5(1):1–12.CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Frost DM, Lehavot K, Meyer IH. Minority stress and physical health among sexual minority individuals. J Behav Med. 2015;38(1):1–8.CrossRefPubMed Frost DM, Lehavot K, Meyer IH. Minority stress and physical health among sexual minority individuals. J Behav Med. 2015;38(1):1–8.CrossRefPubMed
17.
Zurück zum Zitat Hatzenbuehler ML, Pachankis JE. Stigma and minority stress as social determinants of health among lesbian, gay, bisexual, and transgender youth: research evidence and clinical implications. Pediatr Clin N Am. 2016;63(6):985–997.CrossRef Hatzenbuehler ML, Pachankis JE. Stigma and minority stress as social determinants of health among lesbian, gay, bisexual, and transgender youth: research evidence and clinical implications. Pediatr Clin N Am. 2016;63(6):985–997.CrossRef
21.
Zurück zum Zitat Association of American Medical Colleges (AAMC). Implementing curricular and institutional climate changes to improve health care for individuals who are LGBT, gender nonconforming, or born with DSD: a resource for medical educators. In: Hollenbach AD, Eckstrand KL, Dreger A, eds. Association of American Medical Colleges; 2014. Available at https://members.aamc.org/eweb/upload/Executive%20LGBT%20FINAL.pdf. Accessed 12 Dec 2017. Association of American Medical Colleges (AAMC). Implementing curricular and institutional climate changes to improve health care for individuals who are LGBT, gender nonconforming, or born with DSD: a resource for medical educators. In: Hollenbach AD, Eckstrand KL, Dreger A, eds. Association of American Medical Colleges; 2014. Available at https://​members.​aamc.​org/​eweb/​upload/​Executive%20​LGBT%20​FINAL.​pdf. Accessed 12 Dec 2017.
22.
Zurück zum Zitat Obedin-Maliver J, Goldsmith ES, Stewart L, et al. Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education. JAMA. 2011;306(9):971–977.CrossRefPubMed Obedin-Maliver J, Goldsmith ES, Stewart L, et al. Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education. JAMA. 2011;306(9):971–977.CrossRefPubMed
23.
Zurück zum Zitat Sanchez NF, Rabatin J, Sanchez JP, Hubbard S, Kalet A. Medical students’ ability to care for lesbian, gay, bisexual, and transgendered patients. Fam Med. 2006;38(1):21–27.PubMed Sanchez NF, Rabatin J, Sanchez JP, Hubbard S, Kalet A. Medical students’ ability to care for lesbian, gay, bisexual, and transgendered patients. Fam Med. 2006;38(1):21–27.PubMed
24.
Zurück zum Zitat McGarry KA, Clarke JG, Landau C, Cyr MG. Caring for vulnerable populations: curricula in U.S. internal medicine residencies. J Homosex. 2008;54(3):225–232.CrossRefPubMed McGarry KA, Clarke JG, Landau C, Cyr MG. Caring for vulnerable populations: curricula in U.S. internal medicine residencies. J Homosex. 2008;54(3):225–232.CrossRefPubMed
28.
Zurück zum Zitat Smedley B, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in health care. Washington: Naitonal Academies Press; 2002. Smedley B, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in health care. Washington: Naitonal Academies Press; 2002.
29.
Zurück zum Zitat Lewis M, Prunuske A. The development of an indigenous health curriculum for medical students. Acad Med. 2017;92(5):641–648.CrossRefPubMed Lewis M, Prunuske A. The development of an indigenous health curriculum for medical students. Acad Med. 2017;92(5):641–648.CrossRefPubMed
30.
Zurück zum Zitat Vanderbilt AA, Baugh RF, Hogue PA, Brennan JA, Ali II. Curricular integration of social medicine: a prospective for medical educators. Med Educ Online. 2016;21:30586.CrossRefPubMed Vanderbilt AA, Baugh RF, Hogue PA, Brennan JA, Ali II. Curricular integration of social medicine: a prospective for medical educators. Med Educ Online. 2016;21:30586.CrossRefPubMed
31.
Zurück zum Zitat Kern D, Thomas PA, Howard DM, Bass EB. Curriculum development for medical education: a six-step approach. Baltimore: Johns Hopkins University Press; 1998. Kern D, Thomas PA, Howard DM, Bass EB. Curriculum development for medical education: a six-step approach. Baltimore: Johns Hopkins University Press; 1998.
32.
Zurück zum Zitat Paniagua MA, Swygert KA, eds. Constructing written test questions for the basic and clinical sciences, 4th ed. Philadelphia: National Board of Medical Examiners; 2016. Paniagua MA, Swygert KA, eds. Constructing written test questions for the basic and clinical sciences, 4th ed. Philadelphia: National Board of Medical Examiners; 2016.
33.
Zurück zum Zitat Department of Health and Human Services (DHHS) and Centers for Disease Control and Prevention (CDC). United States Public Health Services: Pre-Exposure Prophylaxis of HIV Infection in the United States – 2014 Clinical Practice Guideline. Department of Health and Human Services (DHHS) and Centers for Disease Control and Prevention (CDC). United States Public Health Services: Pre-Exposure Prophylaxis of HIV Infection in the United States – 2014 Clinical Practice Guideline.
34.
Zurück zum Zitat Sisson SD, Rastegar DA, Rice TN, Hughes MT. Multicenter implementation of a shared graduate medical education resource. Arch Intern Med. 2007;167(22):2476–2480.CrossRefPubMed Sisson SD, Rastegar DA, Rice TN, Hughes MT. Multicenter implementation of a shared graduate medical education resource. Arch Intern Med. 2007;167(22):2476–2480.CrossRefPubMed
35.
Zurück zum Zitat Sisson SD, Hughes MT, Levine D, Brancati FL. Effect of an Internet-based curriculum on postgraduate education. A multicenter intervention. J Gen Intern Med. 2004;19(5 Pt 2):505–509.CrossRefPubMedPubMedCentral Sisson SD, Hughes MT, Levine D, Brancati FL. Effect of an Internet-based curriculum on postgraduate education. A multicenter intervention. J Gen Intern Med. 2004;19(5 Pt 2):505–509.CrossRefPubMedPubMedCentral
36.
Zurück zum Zitat White Hughto JM MG, Clark K, Pachankis JE, Reisner SL. Geographic and individual differences in healthcare access for U.S. transgender adults: a multilevel analysis. LGBT Health. 2016;3(6):424–433.CrossRefPubMedPubMedCentral White Hughto JM MG, Clark K, Pachankis JE, Reisner SL. Geographic and individual differences in healthcare access for U.S. transgender adults: a multilevel analysis. LGBT Health. 2016;3(6):424–433.CrossRefPubMedPubMedCentral
37.
Zurück zum Zitat Streed C, Eliason M. Resilience development among LGBT health practitioners. In: Eckstrand K, Potter J, eds. Trauma, resilience, and health promotion in LGBT patients: Springer; 2017:245–254. Streed C, Eliason M. Resilience development among LGBT health practitioners. In: Eckstrand K, Potter J, eds. Trauma, resilience, and health promotion in LGBT patients: Springer; 2017:245–254.
Metadaten
Titel
Assessment of Internal Medicine Resident Preparedness to Care for Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning Patients
verfasst von
Carl G. Streed Jr, MD MPH
Helene F. Hedian, MD
Amanda Bertram, MS
Stephen D. Sisson, MD
Publikationsdatum
07.03.2019
Verlag
Springer US
Erschienen in
Journal of General Internal Medicine / Ausgabe 6/2019
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-019-04855-5

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