OPEN ACCESSFebruary 21, 2013
An Intervention for Clinical Medical Students on LGBTI Health
Introduction: Lesbian, gay, bisexual, transgender, and intersex (LGBTI) individuals face well-documented structural, financial, personal, and cultural barriers when accessing and receiving health care services. LGBTI children and adolescents are particularly affected by internalized stigma, harassment, discrimination, and homelessness. As there is currently a paucity of medical training in caring for the needs of LGBTI adolescents, this intervention curriculum was designed to instruct clinical medical students on the knowledge necessary to care for LGBTI adolescents. Methods: Each 2-hour session begins with an interactive, audience-response PowerPoint presentation. Practical points for care pertaining to each question are discussed and questions are answered throughout the presentation. At the conclusion of the PowerPoint, the sexual history taking flow-chart is distributed and discussed briefly, pointing out the major sections. Following this discussion, students are divided into small groups of approximately 10–12 students, one LGBTI-competent faculty facilitator, and one LGBT adolescent from the community for a guided discussion. When discussion was complete, or the total time of 2 hours had elapsed, students were dismissed. Results: Following the intervention session, 82% of students reported feeling more prepared to care for the LGBTI population. Additionally, students were more likely to agree that same-sex attraction and sexual behavior were valid forms of human sexuality. Specifically, student attitudes were 15% more positive after the intervention when asked to assess whether same-sex sexual attraction is a natural expression of sexuality in humans, and 18% more positive after the intervention when asked to assess whether same-sex sexual behavior is a natural expression of sexuality in humans. Discussion: Adolescents, while they may agree initially, might be uncomfortable, shy, or might not have experiences or thoughts to share. In this event, it is helpful for facilitators to lead the session and ensure volunteer comfort during the session and debriefing. Following the session, instructors should gather feedback from small-group moderators requesting how the environment could be more comfortable for volunteers or if they recommend that other adolescent volunteers be recruited for subsequent sessions. In the event that volunteers are difficult to recruit, small incentives like gift cards have been sufficient to recruit these participants.
By the end of this session, learners will be able to:
Understand the terminology of sexuality, sexual orientation, and gender identity/expression.
Understand health disparities faced by LGBTI adolescents.
Understand the barriers to care and legal implications in caring for LGBTI adolescents.
Understand how to improve the health care of LGBTI adolescent patients.
Practice communicating with patients and colleagues regarding the concepts of sexuality, sexual orientation, and gender identity.
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