Interprofessional Education to Enhance Health-Related Outcomes for LGBT Clients: How One Academic Medical Center is Leading the Way

Healthy People 2020 and the Institute of Medicine are among recent reports that underline the need for culturally competent healthcare for lesbian, gay, bisexual, and transgender (LGBT) individuals. In November of 2014, the Association of American Medical Colleges (AAMC) released guidelines for training physicians to care for people who are LGBT, gender nonconforming, or born with differences of sex development. This is the first set of formal comprehensive standards to help medical schools and health care organizations train providers in the health care needs of these patients.  The American Nurses Association (ANA) concurs through their Diversity Awareness in Professional Nursing. In order to provide appropriate care, it is necessary to properly educate health professions students in the academic and clinical setting. Biases held by students must be addressed during their educational careers if these individuals are to become effective providers. Currently, in Canada and the United States medical and nursing students report only 5 hours of LGBT content in school. Gaps in LGBT related content create barriers and inhibit a beneficial patient-provider relationship.

Rush University has been formally educating medical and nursing students to work with individuals who identify as lesbian, gay, bisexual and transgender (LGBT) since 2011. Curriculum focuses on the historical context of identifying and livings as LGBT, healthcare barriers and disparities experienced by the LGBT population, sex and sexuality, legal concerns, association with youth experiencing homelessness and exploitation, risks of suicide and substance abuse, the transgender community, HIV /STIs, and strategies to promote engagement and retention in healthcare. Students also meet self-identified gay faculty members, students, and patients through panel presentations.

In the College of Medicine, LGBT content is introduced in the first week of medical school during clinical skills intensive. It is also included in the social determinants of medicine, “Physicianship” modules during student’s M1 and M2 year. Prior to the M2 module, medical students complete the Implicit Association Test for sexuality, race, and a third test of their choosing. In the most recent cohort, over 98% of students attending the classes reported they were able to identify challenges in obtaining appropriate healthcare experienced by sexual minorities. In addition the medical school uses simulated patient extensively. In a random fashion, simulated patients will identify as LGBT to help the student become comfortable and to learn not to assume a patients LGBT status is necessarily connected to their clinical complaint.

In the College of Nursing, LGBT content has been integrated into several courses including Mental Health Nursing, Community and Public Health Nursing and is being added to the Advanced Health Assessment course. Students meet LGBT faculty during the first week of nursing school as part of their introduction to diverse populations. During the third term, in Mental Health nursing, students attend a 6-hour Health Education about LGBT Elders (HEALE) cultural competency curriculum. To date, over 250 individuals, largely Generalist Entry-level Masters’ nursing students, have attended these sessions. Remarks are overwhelmingly positive with comments speaking to the great need for this type of education for example “I never knew how to address patients who were transgendered-now I know how to do that”.  In Community and Public Health, students are asked to formulate questions for an expert panel discussion and report they appreciate the candid responses panel members share. Students are tested about LGBT related content in each course.

Moving forward, Rush University is working with the curricular recommendations of the AAMC  and ANA and to fully integrate LGBT content into our course with an emphasis on interprofessional education. Physicians and nurses, working together, with education based on a common set of knowledge, attitudes, and skills are most able to provide the highest standard of care in a safe, non-judgmental environment.