Search

Introduction Guidelines recommend that primary care providers complete organ-based routine cancer screening for all transgender patients. Training on critical transgender health topics like cancer screening, as well as residents' confidence in addressing issues their transgender patients may face, remains limited among graduate medical education (GME) programs. Online case-based modules are an effective tool for skills improvement in GME, but their application to transgender health topics has not been assessed. Methods I developed a brief online module on cancer screening for transgender patients using Google Forms and offered it to first-year internal medicine residents. The module was optional and asynchronous with other didactics presented during an oncology-themed ambulatory learning block. Pre- and postmodule surveys assessed resident confidence in counseling transgender patients about cancer screening and sharing screening resources. Results Fourteen of 60 interns elected to complete the module, with all participants submitting pre- and postmodule surveys. Respondents reported increased confidence in counseling transgender patients about appropriate cancer screening (mean increase on 5-point Likert scale of 1.29; confidence interval [CI], 0.81–1.76; p < .01) and increased confidence in discussing resources on cancer screening for transgender individuals (mean increase on 5-point Likert scale of 1.36; CI, 0.66–2.06; p < .01). Discussion While knowledge gaps on transgender health issues like cancer screening remain significant among residents, brief case-based online modules, in conjunction with an expansion of traditional didactics, may help improve confidence among residents in addressing these critical issues with their transgender patients.

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.

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.

Introduction Lesbian, gay, bisexual, and transgender (LGBT) adolescents frequently endure considerable adversity as they encounter identity-related stigma. As a result, LGBT adolescents are often at disproportionate risk for experiencing negative social and health outcomes. Methods This four-module curriculum allows learners to explore challenges common to the clinical care of LGBT adolescents while also providing exposure to current trends and evidence in LGBT health. Through a combination of reflective exercises, didactic lectures, foundational readings, facilitated case discussion, and debate, the curriculum introduces learners to issues of assessment, treatment, and support as they relate to LGBT youth. The curriculum was written for use with learners in an interprofessional training program representing the disciplines of medicine, nursing, nutrition, social work, and psychology. Results Four years of evaluation data indicate that the curriculum is particularly useful for exposing learners to the complexities of serving and supporting LGBT youth and identifying personal skills that may require additional development. Learners emerge with greater confidence in identifying local and national LGBT resources. Discussion Incorporating cultural humility is key to fostering a commitment to lifelong learning and maintaining learners' confidence when working with marginalized populations. Optimal discussion occurs when learners in all disciplines contribute, yet instructors can teach modules separately or modify them when learners from all disciplines are not present. In addition, learners emerge with greater confidence in connecting with outside resources, which assists both referrals for patients and self-directed learning.

Introduction There have been several educational reforms calling for increasing lesbian, gay, bisexual, and transgender (LGBT) education materials, application of basic sciences to clinical medicine, and active engagement of students. While the amount of educational materials for LGBT clinical cases is increasing, this session for preclinical medical students uniquely combines basic science population genetics, cisgender lesbian, gay, and bisexual (LGB) cultural issues and reproductive endocrinology in a 1.5-hour flipped classroom session. Methods Students were assigned a prediscussion video and reading. Facilitators attended a 1.5-hour training session prior to discussion. Each classroom of 30 students with small groups of six was led by a third- or fourth-year medical student facilitator who taught from a PowerPoint that included discussion questions. An audience response system was used to show aggregated, real-time anonymous responses to case questions, a pre- and postsurvey was used to analyze changes in student attitudes and knowledge of assisted reproduction services for same-sex couples, and course evaluations captured overarching student impressions. Results All first-year students (N = 180) attended this mandatory session. Audience response questions showed a high level of knowledge of population genetics concepts. Voluntary surveys showed a higher number of assisted reproduction recommendations for LGB patients compared to heterosexual patients before discussion, with this difference disappearing after the discussion. This may indicate a shift in student attitudes and knowledge of LGB patient barriers and assisted reproduction. Course evaluations showed appreciation of LGB material integration within the course. Discussion Educators will be able to successfully integrate the application of population genetics, assisted reproduction cases, and an examination of cultural barriers in health care for LGB patients with this session.

Introduction Lesbian, gay, bisexual, and transgender (LGBT) students face challenges in achieving their educational goals. By understanding concepts surrounding sexual orientation and gender identity, faculty, staff, and students can support LGBT community members and provide a safe educational space. In order to address this we created a condensed training resource that focused on skill building and is easily implemented institution-wide for students, residents, fellows, faculty, and staff. Methods This module serves as an introduction to concepts integral to the LGBT community. It is structured into two sections and takes approximately 30 minutes to complete, including pre-/postevaluations. The first section of the module focuses on presenting basic information about the LGBT world experience and basic terminology. The second section contains two real-world scenarios aimed at demonstrating skills used to create a safe educational learning space. Each scenario contains interactive questions that allow participants to practice applying their new skills. Results To date, 89 institutional community members at the Northwestern University Feinberg School of Medicine have completed the module. Survey results demonstrate that the module was well-received and effective at improving attitudes towards creating a safe space. Discussion While this module provides a foundation in terminology and phenomena relevant to the LGBT experience, it is just one part of creating a positive institutional climate for LGBT community members. Additional in-person skills-based training should also be considered to complement and enhance this module's contents.

Abstract Introduction Transgender patients experience poor health outcomes and often avoid seeking medical care because of negative encounters with providers. Despite growing awareness of the health disparities transgender patients face, there is very little curricular time in medical schools to improve medical students’ knowledge and skills for caring for transgender patients. This standardized patient (SP) case was developed for use in a communication challenges workshop for advanced clerkship students in order to address working with transgender patients. Methods This formative SP encounter takes place in a classroom as part of a half-day workshop on communication challenges with patients. We developed the case to focus specifically on skills related to obtaining patients’ preferred names and pronouns, as well as taking an appropriate patient history. Materials for SP recruitment, SP training, and case implementation are included within this publication. Results In preliminary uses of the case, 80% of students (N = 64) agreed or strongly agreed that it had increased their skills for working with transgender patients. Observational data from the debrief discussions also revealed that medical students perceived gaps in their medical training regarding LGBT health and expressed interest in their program incorporating more information on transgender health. Discussion This case adds to a growing number of curricular interventions to address medical students’ knowledge and skills with regard to lesbian, gay, bisexual, and transgender (LGBT) patients and, as a result, aims to address health disparities in LGBT patient populations.

Abstract Introduction This student-driven curriculum intervention, implemented with first-year medical students, was guided by the Association of American Medical Colleges’ standards for medical education on health care for sexual and gender minorities. Its goals are to describe the spectrum of sexual orientation and gender identity and sensitively and effectively elicit relevant information from patients about their sexual orientation and gender identity through inclusive sexual history taking. Methods Developed through student-faculty collaboration, this three-part module includes a 14-minute e-lecture on taking an inclusive sexual history, a 35-minute formative standardized patient encounter in which students take a sexual history and receive feedback, and a 20-minute facilitated group debrief on the standardized patient activity. Results Students completed a postmodule evaluation anonymously; the majority of respondents (92%) agreed that they felt more prepared to take a sexual history inclusive of sexual and gender minority patients. Most were more comfortable discussing sexual orientation (91%) and gender identity (83%) with patients after the module. Content analysis revealed an improved confidence in creating a safe space for sexual and gender minority patients and an increased awareness of biases about sexual and gender minority patients. Discussion This curriculum serves as an early foundation for students to understand sexual and gender minority identities and develop confidence in their inclusive sexual history taking skills before they provide care for patients. In addition, the student-driven curriculum development process used can serve as a template for students at other institutions hoping to collaborate with faculty to develop comprehensive sexual and gender minority curricula.

Abstract Introduction New strategies are needed to lower health care costs and address the health care needs of communities, especially for marginalized persons and subpopulations. Improved education in health systems, which encompasses population, community, preventive, and public health, is one way to better train the future physician workforce to meet national and local health care needs. This resource was created as part of an 18-month science of health systems and navigation curriculum. Methods The purpose of this resource is to use the socioecological model lens to analyze health disparities for marginalized persons and subpopulations. A medically and socially complex patient with HIV is presented as the initial case study that leads to identification of barriers and needs on individual, community, and public policy levels. This is an active-learning resource that includes both small- and large-group discussion driven by self-directed learners using the provided resources. Results This resource was successfully implemented as a required session for 150 medical students beginning the second year of medical school. A cohort of 21 students randomly selected to complete a standard online course evaluation for the session, rated their agreement (1 = strong disagreement, 5 = strong agreement) to the statement “Rate the extent to which the lecture supported your mastery of the learning objectives,” as 4.4, on average. Discussion This curriculum has been implemented and evaluated for medical students, but it is broadly applicable to residents and interprofessional students in health-related fields. It is designed to give learners a practical medical context for the application of principles that may be taught within a health systems or population health course.

Abstract Introduction Expert recommendations state that all physicians caring for youth should be trained in providing competent and nonjudgmental care for sexual and gender minority (SGM) youth. Despite those recommendations, there is insufficient training to prepare clinicians to provide culturally competent care for SGM youth. We created a 2-hour session to address communication skills critical to caring for SGM youth. The goals of the session were for third- and fourth-year medical learners to affirm, validate, and assess the mental health status of their patient, collaborate with a school counselor, support families in acceptance of SGM children, and provide them with relevant resources. Methods The session utilized multiple active learning modalities including flipped classroom, small-group learning, and peer-to-peer instruction. Learners completed anonymous pre- and postsurveys that aimed to measure their comfort, self-efficacy, and self-reported preparedness in counseling adolescents questioning their sexual orientation. Results Of the 42 learners who participated in the course over two academic terms, 40 (95%) completed the presurvey, and 39 (93%) completed the postsurvey. Learners demonstrated a significant improvement in self-reported knowledge, comfort, and sense of preparedness on all skill-based objectives and reported growth in their comfort and sense of preparedness for counseling adolescents questioning their sexual orientation after participating in the session (p < .001). Discussion This session supports the development of key communication skills needed to provide competent and nonjudgmental care for SGM youth. It can be easily replicated at other health professional schools looking to improve the cultural competency of future clinicians around care for SGM patients.

Abstract Introduction Sexual health is an intrinsic element of overall health; however, opportunities to enhance medical student comfort and knowledge about sexual health vary substantially and receive limited curricular time. Sex, Bugs, and Rock ’n’ Roll is a novel service-learning initiative designed to enhance undergraduate medical student knowledge and comfort with sexual health. A total of 80 fifth-year undergraduate medical students researched, designed, and delivered a short sexual health promotion initiative for a population that experiences inequity. Methods This initiative employed active learning tasks including performing a literature review, participating in team learning, facilitating small-group sessions, and providing peer feedback. Ongoing formative feedback from the program leaders, tutors, and members of the target audience contributed to student development. A summative assessment rubric was used by program leaders to evaluate student performance at the end of the module. Anonymized pre- and posttest knowledge questions and module evaluations were used to evaluate the module. Results All 80 (100%) students completed randomized pre- and posttest knowledge questions and module evaluations. Student knowledge scores about sexuality and sexual health improved by 17% between pre- and posttest. All students reported increased comfort with and understanding of the clinical relevance of sexual health in the module evaluations. Discussion Sex, Bugs, and Rock ’n’ Roll is a promising initiative for improving medical student knowledge and comfort with sexual health. This module also offers a novel way for students to experience sexual health, public health, and social accountability in an active and engaging fashion.

Abstract Introduction Medical education addressing people with sexual and gender minority (SGM) identities often focuses on sexual risk, is delivered in silos, and overlooks intersecting identities. SGM individuals—particularly those with coexisting stigmatized identities—experience a disproportionate burden of discrimination, which increases vulnerability to adverse health outcomes, especially when maladaptive coping behaviors are used to manage stress. Adaptive coping and resilience can develop in the context of identity affirmation and social support, for which sensitive clinician-patient interactions provide a crucial foundation. Guided by the AAMC publication 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, this session introduced first-year medical and dental students to the concepts of identity and intersectionality, providing an opportunity to practice apropos interviewing techniques. Methods This 2-hour session includes prework, a didactic presentation, role-play scenarios, and a small-group session. Prior to the session, faculty facilitators had small-group leadership experience, and students had already mastered social history taking. Electronic student and faculty surveys provided qualitative assessment. Results Faculty and students reported that the session increased awareness of the health impact of identity and intersectionality and the clinician's role in establishing rapport. Suggestions included adding a prework video defining diversity terminology and a patient panel describing diverse identities and experiences. Discussion Addressing health issues related to SGM and other sociocultural identities is challenging yet crucial. This innovative session gave students an opportunity to explore their unconscious biases and practice novel interviewing techniques in a supportive environment.

Abstract Introduction This standardized patient case introduces the unique needs of lesbian, gay, bisexual, and transgendered (LGBT) youth during an outpatient visit. This workshop was developed by clinician educators as part of a small-group curriculum for preclinical medical students. This case was developed by an internal medicine physician and vetted through pediatricians and clinicians with an interest in LGBT health. The session is intended to be used with preclinical or early clinical learners to give students practice in obtaining a complete history while simultaneously recognizing the added psychosocial stressors on LGBT youth, and how these stressors may manifest as physical complaints. Methods The session was run in a small-group setting, with a faculty facilitator. Students interviewed standardized patients in their weekly small-group session (12 students and one facilitator per group). The case pertained to a 15− to 25-year-old patient with chief complaint of headache. In delving deeper into social history, the students encountered the scenario of a patient with conflicted views on his/her sexual orientation and family pressures. Results The case and session have been used to train about 560 medical students. A subset (n = 95) of students was randomly selected to evaluate the small-group session. Eighty-seven percent of students rated the session as excellent or good, 12% as fair, and 2% as poor. During the 2013-14 and 2014-15 academic years, 88% of facilitators (n = 17) agreed or strongly agreed that the “content of the session was at the appropriate level for the students' level of learning.” Additional comments were generally positive, including “content was excellent and ‘real’” and “students did a great job discussion LGBT content.” Areas for improvement included suggestions that “more time” be allowed for discussion and reflections stating that “addressing both adolescent and LBGT in one session was challenging.” Discussion This standardized patient case introduces the unique needs of an LGBT youth during an outpatient visit, and has been used to train medical students to recognize the unique needs for a patient-centered, compassionate environment when treating adolescents who self-identify as LGBT.

Abstract Introduction The pelvic exam is by nature a challenging procedure to perform well, as it requires a provider to establish with a patient a level of trust high enough to permit inspection and palpation of one of the most private and intimate parts of the body. Unfortunately, data suggest that providers have not mastered the art of performing a sensitive and tolerable pelvic exam. Levels of distress have been shown to be especially high among certain groups, including patients with sexual and gender minority status, disabilities, obesity, and a history of trauma. Individuals who experience exam-related pain or discomfort are less likely to return for future care; accordingly, disparities in cervical cancer screening have been documented in each of the aforementioned populations. This resource includes all of the materials needed to run an OSCE station focused on providing formative feedback to primary care residents regarding their ability to perform a sensitive and technically proficient pelvic exam/Pap test for a standardized patient who identifies as lesbian and has a history of trauma. Methods For the past 3 years we have implemented (and continue to use) this OSCE as an integral component of a multistation OSCE designed to provide formative feedback to residents enrolled in the HIV Primary Care Track of the 3-year BIDMC internal medicine residency program. After completion of each year of training, residents rotate through four sequential OSCE stations; this OSCE is one of these stations administered at the end of the PGY2 year. Results To date, 12 PGY2 residents (four per year) enrolled in the HIV Primary Care Track have participated in this OSCE station. Total performance, encompassing history, exam, and counseling skills, as rated by faculty checklists was 23.5 out of 30. Communication performance (i.e., patient centered communication, interpersonal skills, and global rating), available for eight of the residents, as rated by standardized patients, was 78.3/90. Discussion The pelvic exam is by nature a challenging procedure to perform well. Unfortunately, data suggest that providers have not mastered the art of performing a sensitive and tolerable pelvic exam. This OSCE includes all the materials to run a station focused on providing formative feedback to residents regarding their ability to perform a sensitive and technically proficient pelvic exam. With minor adaptations, the case can be adapted to feature a patient on the female-to-male transgender spectrum. Use of the case may also be appropriate for other health professions trainees.

Abstract Introduction LGBTQI' Defined: An Introduction to Understanding and Caring for the Queer Community was designed to improve the quality of care provided to the LGBTQI' community by educating health care professionals about the complexities of queer culture. The curriculum uniquely and interactively deconstructs sex, gender, and sexual orientation as separately experienced entities comprising an individual's identity. This innovative approach to teaching a challenging topic allows learners to discover a deeper understanding of their own identities while developing greater empathy for LGBTQI'-identified people. Additionally, the curriculum defines other terminology and identities relevant to the LGBTQI' population. Finally, “LGBTQI' Defined” provides learners with institutional considerations and specific clinical recommendations and techniques to help providers care for their future LGBTQI'-identified patients with compassion and cultural sensitivity. Methods The module includes PowerPoint presentations, activity guides, and evaluations. Positive evaluations have been collected from the presentations given at Mayo Clinic. Results Of the learners who have completed evaluations, 99% (n = 110) rated the overall value (relevance to their professions) of the curriculum as “very good” or “excellent,” and 98% (n = 87) rated the overall quality (effectiveness of curriculum) as “very good” or “excellent.” Ninety-nine percent (n = 92) “agreed” or “strongly agreed” that the five learning objectives were successfully met. Discussion Specific learner feedback supports the interactive and didactic elements of the curriculum and the importance of delivering LGBTQI healthcare-related education to providers.

Abstract Across the developmental spectrum, lesbian, gay, bisexual, and transgender (LGBT) individuals experience disproportionate levels of serious psychosocial problems and health disparities. Even though all major medical and mental health professions within the United States endorse LGBT-affirmative clinical treatment as the ethical standard of care, a growing body of research documents limited LGBT competency training within their professional programs. The purpose of the Sexual Orientation Counselor Competency Scale (SOCCS) is to readdress LGBT health disparities by providing mental health and medical providers, trainees, supervisors, researchers, and educators a psychometrically developed and tested self-assessment tool that can examine practitioner barriers to LGBT competent clinical care. The SOCCS is theoretically grounded in the tripartite multicultural counseling/psychology model and consists of 29 questions with three subscales: (1) Skills, which includes 11 items focused on LGBT affirmative clinical work; (2) Attitudinal Awareness, which includes 10 items examining self-awareness of LGBT biases and stigmatization; and, (3) Knowledge, which consists of eight items assessing knowledge of LGBT psychosocial issues. The SOCCS has been used across an array of applied psychology and counselor training and research settings. This publication includes the SOCCS Instructor's Guide, SOCCS Instrument, and SOCCS Scoring Guide. The SOCCS Instructor's Guide should be read first and provides information on the purpose, application, usage, psychometric properties, and limitations of the SOCCS. The remaining two resources pertain to the actual administration of three versions of the SOCCS. Version 1 of the SOCCS is most applicable for those clinicians and/or trainees providing mental health services and assesses only sexual orientation competency (i.e., not gender identity/transgender competency). Version 2 is adapted for use among broader healthcare settings and specializations and Version 3 assess transgender clinical competency.

Abstract Introduction Most health care providers feel unprepared to address issues related to sexual orientation with adolescent patients. Adolescents with same-gender attraction or sexual behavior have greater physical and mental health care needs compared to their peers; specifically, these populations have higher rates of suicidal behavior, substance use, and risky sexual behavior, including unprotected sex and sex under the influence. Thus, it is important for medical students to become comfortable discussing sexual orientation and its related sequelae with adolescent patients. Methods This resource is a standardized patient (SP) case focused on interviewing adolescents who are questioning their sexuality. Two to three students each take a turn interviewing an SP over a 45-minute time period. Before the case begins, students are provided with a syllabus that includes supplementary materials regarding some of the techniques and challenges that may arise when interviewing specific patient populations, including LGBT individuals. Medical students participating in the case (either interviewing the SP or observing) and facilitators are surveyed immediately after completing the case to determine whether the educational objectives have been met and whether the case content is considered to be valuable material in our Advanced Medical Interviewing (AMI) curriculum. SPs who play the case are also surveyed about the quality of the case and training materials. Results In all, 139 out of 143 students (97%), 29 out of 29 faculty facilitators (100%), and nine out of 10 SPs (90%) completed surveys. Key areas of interest included communicating with patients about sexual attraction/preferences, communicating with patients about sexual orientation, communicating with patients about sexual behaviors, screening adolescents for depression, screening adolescents for bullying, and interviewing adolescents. The surveys revealed significant improvement in student preparedness for each area of interest. Additionally, most faculty felt that the case helped prepare students to a moderate or large degree for each category. To determine whether the content of the case was perceived to be of value, medical students and faculty members were queried regarding the importance of four topics in medical school training: taking a detailed sexual history, screening adolescents for depression, screening adolescents for bullying, and interviewing adolescent patients. The overwhelming majority of students and faculty members found these areas to be mostly important or very important. Discussion We did not objectively determine whether the case improved learners' skills in interviewing sexual minority adolescents. Because our AMI course focuses on allowing learners to practice interviewing skills in a safe and comfortable environment, learners are provided with formative feedback rather than formally graded on their performance. This case could be adapted for use in clinical clerkships for third- and fourth-year medical students as well as for residents, fellows, and even faculty in certain settings, given the widespread discomfort with discussing sexual orientation with adolescents. However, this case is not recommended for beginning medical students. The case is also not recommended for learners who have not had any exposure to LGBT populations previously in their medical school curriculum.

Abstract Introduction An inclusive sexual history is critical to providing comprehensive patient care and an environment supportive of lesbian, gay, bisexual, and transgender (LGBT) patients. This sexual history taking module engages medical students in discussion and practice with standardized patients in taking an inclusive (orientation- and gender-neutral) sexual history. This case was developed for first- and second-year medical students who have had basic communication skills training. Methods This session was designed to be delivered in one 40-minute large-group session followed by three 1-hour-long small-group sessions (with one third of the class participating in each session) with standardized patients. Four students per group is optimal. Faculty training should take approximately 30 minutes prior to the session as well as participation in the large-group session. The materials associated with this publication include guidelines for faculty facilitators and students to prepare them for the large-group discussion and small-group practice sessions with standardized patients. Also included are four standardized patient cases, a slide presentation using an audience response system for the large-group session, and an evaluation form. Results The average response to “Overall, this session was effective in improving my sexual history taking skills” has been 4.3 out of 5. Our communication needs assessment has shown a statistically significant improvement in those reporting increased importance, confidence, and performance of a sexual history between the first and second year of medical school (before and after the curriculum). In addition, students reported performing more components of the sexual history after the session. Discussion This sexual history taking module has been incorporated into our Foundations of Doctoring communications curriculum and has been rated as highly effective by learners. Performing an inclusive sexual history is critical to providing comprehensive patient care as well as providing an environment supportive of LGBT patients.

Abstract Introduction The healthcare needs of lesbian, gay, bisexual, and transgender (LGBT) patients can differ significantly from those of their cisgender and/or heterosexual counterparts, and a modern medical education must be able to provide the training necessary to provide appropriate medical care for this patient population. Healthcare professionals may often consider themselves to be “neutral” or “unbiased” towards LGBT-identifying patients, and assert that sexual identity does not affect their ability to provide care. Despite this, significant disparities can be found regarding not only health care needs, but also the care of LGBT and non-LGBT identified patients. This case provides a standardized patient encounter that allows examinees to evaluate their comfort working with a young patient that identifies as a part of the LGBT community. Methods Students have 15 minutes to elicit a focused history and physical examination while building rapport and maintaining professionalism with an LGBT-identified standardized patient. They then have a separate 10-minute block to type out a note detailing their findings, an assessment, and a plan. After the encounter is complete, students attend a short presentation about the topics of LGBT patients, depression, and HIV infection. Moreover, if the student's performance on the exam overall is unsatisfactory, they are given a one-on-one review with a member of the faculty. Results The case was used as one of 10 cases on the required third-year clinical exam at the University at Buffalo School of Medicine and Biomedical Sciences. To date, the case has been run in a live examination setting twice with minor adjustments after each exam. Discussion This case provides a standardized patient encounter that allows students to evaluate their comfort working with a young patient that identifies as a part of the LGBT community. Moreover, it highlights three important aspects of LGBT health care, namely HIV, depression, and building rapport with a patient that identifies as a part of the LGBT community. The educational value of these resources is limited by the gender and age of the patient, as well as sexual practices and social setting. There are many other topics in the healthcare of LGBT youth that require attention in the medical school curriculum, including, but not limited to, high school harassment and bullying, high rates of tobacco and alcohol use, and eating disorders.

Abstract Introduction The lesbian, gay, bisexual, transgender, and intersex (LGBTI) population is disproportionately affected by providers' lack of training, particularly related to the inability to take an LGBTI-inclusive sexual history. Indeed, there is a general deficit in physician knowledge and training surrounding sexual health, including the ability to take a comprehensive sexual history. While many medical schools teach students to ask the question “Do you have sex with men, women, or both?” during a sexual history, only half of practicing physicians regularly take sexual histories, and less than a quarter elicit sexual orientation or assess for type of sexual activity. The current case evolved from an existing case featuring a heterosexual female, presenting for her Well Woman Exam, inquiring about her risk for cervical cancer. In an effort to diversify student standardized clinical experiences, the case was refined to shift the focus from cervical cancer to inclusive sexual history taking, specifically students' ability to provide quality and equitable care to the LGBTI community. Methods During the standardized patient (SP) case, students are provided a standard gynecology clinic's Well Woman's Exam template containing the question “Do you have sex with men, women, or both?” as a reference. Students are assessed on the accuracy of the clinical data they attain via an online quiz after the encounter while SPs assess students on the thoroughness of the history solicited and quality of the counseling provided using a checklist. After the encounter, students participate in a small-group debrief that addresses students' questions, discusses implicit biases, and provides LGBTI education/resources to improve knowledge and performance. Results Of 211 third-year medical students completing the SP encounter, 12.3% (n = 26) failed to ask the sexual history-taking question “Do you have sex with men, women, or both?” During debriefing, many students who failed to ask the question shared their omission and acknowledged their implicit assumptions. Of students who did elicit sexual orientation, most disclosed that they felt unprepared to provide appropriate risk-reduction counseling. Discussion Our findings demonstrate that medical students feel unprepared to perform a comprehensive sexual history inclusive of sexual and gender minorities. Targeted debriefing heightened student awareness of LGBT-specific concerns, making this a valuable exercise for students in their preparation to provide quality and equitable care to diverse populations.