LGBT Health Curriculum Final

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Information about LGBT Health Curriculum Final
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Published on February 4, 2008

Author: Toni

Source: authorstream.com

Lesbian, Gay, Bisexual and Transgender Health Curriculum:  Lesbian, Gay, Bisexual and Transgender Health Curriculum Knowledge and Attitude Outcomes among Second Year Medical Students Leah Kelley MD1, Calvin Chou MD, PhD2, Patricia Robertson MD1 1 Department of Obstetrics, Gynecology and Reproductive Sciences, and the Lesbian Health Research Center, University of California, San Francisco 2 Department of Medicine, University of California, San Francisco Objectives:  Objectives To develop and implement a comprehensive curriculum about LGBT health issues for 2nd year medical students To asses the students’ pre-existing knowledge of these issues and attitudes toward these populations To measure the impact of the curriculum on the knowledge and attitudes of medical students. Methods: Curriculum:  Methods: Curriculum Developed cooperatively by the authors with input from educators, physicians and members of the community Three learning modules Syllabus for the Module Patient Panel Discussion Small group sessions with Case Studies Presented in February, 2004 Methods: Written Syllabus:  Methods: Written Syllabus Introduction emphasizing basic definitions and the health hazards of homophobia Primary care issues for lesbians Primary care issues for gay men Introduction to transgender terms, health issues and social context Clinical approach to LGBT patients Methods: Patient Panel:  Methods: Patient Panel Intended to highlight difficulties in accessing care and establishing trust with providers Voluntary participants: an older gay man, a middle-age lesbian, and a young transgender man Open floor for questions after short presentation by each panelist Methods: Case Studies:  Methods: Case Studies Small group sessions following the patient panel. Groups previously established, so students knew each other well Three cases, each designed to highlight several critical LGBT health issues Group leaders were LGBT faculty and residents, who shared their personal and professional ‘coming out’ process with students Case #1:  Case #1 A 28 year old G1P1 woman presents with the chief complaint of a mass in her right breast which is painful. She just finished weaning her one year old infant one week ago. She is a full-time mother at home. She is worried that she has breast cancer, but doesn’t have health insurance since she stopped working to stay home with the baby. With her is another woman, who appears to know her well. They both wear wedding bands on their ring fingers, but she did not mark “married” on the intake forms. On your exam, you find a slightly tender mass in the right upper outer quadrant of her breast, 1 cm in diameter. Case #1, continued:  Case #1, continued When you take her history, and you ask her if she is having sexual activity with women, men or both, she states that she is monogamous with her female partner who is in the room with her. You ask her who is the “real mother” of the baby, as you are curious as to how they have set up their household, and you know that sometimes the non-biological mother can induce breast milk. The patient immediately becomes withdrawn after your question, and her partner becomes hostile, due to your assumption that the only “real mother” would be the biological mother. Case #2:  Case #2 A 65yo African American male who presents for the first time to your primary care clinic. He is usually healthy, however in the last several weeks he has had worsening diarrhea, between 3-4 loose bowel movements per day. He denies recent travel abroad, has taken no antibiotics or over-the-counter medications except occasional Pepto-Bismol. He has had no fevers, nausea, vomiting, abdominal pain, or symptoms of depression. He notes a mild weight loss of approximately 5 lbs over the last month. He has noted some pain in both knees recently, and some lumpiness in the skin on his legs, both of which predate his diarrhea. Case #2, continued:  Case #2, continued When you ask him what he thinks might be causing his symptoms, he pauses for a moment, grins sheepishly, and asks, “Can sex give you diarrhea?” He has been divorced for 5 years. He began having furtive sex with men on business trips in his 40s, and felt that he could no longer hide his sexual identity. He has been in a monogamous relationship with a 50 year old male partner for the past 6 months. Case #3:  Case #3 A 16 year old girl is brought to your continuity clinic by her mother for a rash on her chest. When you enter the exam room, you encounter a thin, androgynous-appearing young woman who seems quiet and nervous, and her well-dressed mother. Your initial history reveals that the patient and her family moved from another city four months ago. The mother notes that since their move her daughter has been more withdrawn and secretive, with poor appetite and sleep patterns. A week prior, the patient’s mother noticed that her daughter has a severe rash on her chest. Case #3, continued:  Case #3, continued Once you have politely asked the mother to leave the room and questioned the young woman sensitively, she reveals to you that she has been binding her breasts every day before school with Ace bandages and duct tape. Initial examination of the patient reveals a diffuse, erythematous rash over the anterior chest wall sparing the breasts but extending onto the lateral torso. The rash is entirely consistent with a contact dermatitis caused by adhesive tape. Further careful questioning reveals that your patient has self-identified as a boy since a very young age. Since moving to your city, he has begun ‘passing’ as male outside of school and the home. He calls himself David and feels strongly that he must be transsexual. However, he is afraid to tell his parents and friends about his gender identity. Methods: Survey:  Methods: Survey We sought and received approval from the Committee on Human Research to survey students before and after teaching Students’ participation was entirely voluntary; each received an informed consent form with information about the intentions and structure of the study Each participant received a lottery ticket as compensation Methods: Survey:  Methods: Survey Prior to the teaching day, students received a questionnaire concerning knowledge, attitudes and beliefs about LGBT populations and health issues Questionnaires were coded by last 3 digits of cell phone numbers so they could be paired with follow-up surveys Entrance surveys included demographic information about each student Methods: Survey:  Methods: Survey Students were asked to fill out an identical questionnaire just after the completion of the two hour teaching module Exit questionnaires also included information about attendance, syllabus reading and students’ other sources of knowledge in the subject area Surveys were locked until all grades were completed Student Participation:  Student Participation Percentage of current total student body participating in the Survey: 52% Survey participants who attended the Patient Panel: 64/75 (85%) Survey participants who read the Syllabus prior to class: 60/75 (80%) Survey participants who attended the small group sessions: 100% Demographics: Gender Distribution:  Demographics: Gender Distribution Study Group Total Students 66% 33% 59% 41% Demographics: Ethnicity:  Demographics: Ethnicity Study Group Total Students Demographics: Sexual Orientation:  Demographics: Sexual Orientation Study Population 94.7% 4% 1.3% Data not available for total student population. Results: Student Evaluations:  Results: Student Evaluations “ The syllabus helped to educate me about LGBT issues.” 1=strongly agree, 2=agree, 3=uncertain, 4=disagree, 5=strongly disagree Results: Student Evaluations:  Results: Student Evaluations “The patient panel helped to educate me about LGBT issues.” 1=strongly agree, 2=agree, 3=uncertain, 4=disagree, 5=strongly disagree Results: Student Evaluations:  Results: Student Evaluations “The cases/small groups helped to educate me about LGBT issues.” 1=strongly agree, 2=agree, 3=uncertain, 4=disagree, 5=strongly disagree Results: Survey:  Results: Survey “Access to healthcare is the same for LGBT persons as for other members of the population.” 1=strongly agree, 2=agree, 3=uncertain, 4=disagree, 5=strongly disagree Paired T-test: 4.544 P<0.001 Results: Survey:  Results: Survey “ LGBT people are less likely than heterosexual people to be in long-term monogamous relationships.” 1=strongly agree, 2=agree, 3=uncertain, 4=disagree, 5=strongly disagree Paired T-test: 3.421 P=0.001 Results: Survey:  Results: Survey “As a physician, I feel it is important for me to know about my patients’ sexual orientation, sexual practices and gender identity.” 1=strongly agree, 2=agree, 3=uncertain, 4=disagree, 5=strongly disagree Paired T-test: 4.175 P<0.001 Results: Survey:  Results: Survey “I would prefer not to treat patients with gender identity issues.” 1=strongly agree, 2=agree, 3=uncertain, 4=disagree, 5=strongly disagree Paired T-test: 3.374 P=0.001 Results: Student Knowledge Base:  Results: Student Knowledge Base 1=strongly agree, 2=agree, 3=uncertain, 4=disagree, 5=strongly disagree P=0.153 Results: Student Knowledge Base:  Results: Student Knowledge Base 1=strongly agree, 2=agree, 3=uncertain, 4=disagree, 5=strongly disagree P=0.804 Results: Student Knowledge Base:  Results: Student Knowledge Base 1=strongly agree, 2=agree, 3=uncertain, 4=disagree, 5=strongly disagree P=0.115 Results: Student Knowledge Base:  Results: Student Knowledge Base 1=strongly agree, 2=agree, 3=uncertain, 4=disagree, 5=strongly disagree P=0.291 Results: Student Experiences:  Results: Student Experiences 1=strongly agree, 2=agree, 3=uncertain, 4=disagree, 5=strongly disagree P=0.901 Results: Student Experiences:  Results: Student Experiences 1=strongly agree, 2=agree, 3=uncertain, 4=disagree, 5=strongly disagree P=0.072 Results: Student Experiences:  Results: Student Experiences 1=strongly agree, 2=agree, 3=uncertain, 4=disagree, 5=strongly disagree P=0.270 Results: Student Experiences:  Results: Student Experiences 1=strongly agree, 2=agree, 3=uncertain, 4=disagree, 5=strongly disagree P=0.272 Results: Student Experiences:  Results: Student Experiences 1=strongly agree, 2=agree, 3=uncertain, 4=disagree, 5=strongly disagree P=0.165 Results: Student Attitudes:  Results: Student Attitudes 1=strongly agree, 2=agree, 3=uncertain, 4=disagree, 5=strongly disagree P=0.442 Results: Student Attitudes:  Results: Student Attitudes 1=strongly agree, 2=agree, 3=uncertain, 4=disagree, 5=strongly disagree P=0.770 Results: Student Attitudes:  Results: Student Attitudes 1=strongly agree, 2=agree, 3=uncertain, 4=disagree, 5=strongly disagree P=0.829 Student Comments:  Student Comments “Extremely helpful and got me thinking about better approaches to treating/interviewing LGBT patients.” “A helpful module—the right amount of time and interesting/educational issues.” “Great session, especially small groups!” “I found it useful in identifying some of my unconscious prejudices.” “Very helpful and informative, especially to hear personal stories from patients and physicians.” “Excellent!!” Student Comments:  Student Comments “I have a hard time with some of the therapies we employ for gender reassignment when they haven’t been scientifically studied, [and] we don’t know the long-term risks and benefits.” “I would have liked some role plays.” “Very well taught, but the small group needs more time to cover all the material.” “Would like more time!” Discussion:  Discussion Inclusion of LGBT issues in the standard curriculum at UCSF came about through student initiative Curriculum development was site-specific, as no national clearinghouse for LGBT educational materials exists Classroom time required for this effective intervention was minimal Discussion:  Discussion Cultural competency among physicians requires a broad understanding of human diversity Medical school represents a critical opportunity for intervention and education Curriculum developments offer the opportunity to measurably impact the attitudes and behavior of young physicians

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