“I love your socks!”
My patient flashed me a toothy grin, pointing at the rainbow socks peeking out from the cuff of my scrub pants. It was another hectic day at the pediatrics clinic, and I had just asked my 17-year-old patient’s mother to step out so I could delve into the more personal questions of our wellness visit.
“Actually,” he leaned in a bit closer. “I was hoping there would be someone here who I could talk to about PrEP. Can you help me?”
For many doctors who attended US medical schools, the answer would have been no.
The Liaison Committee on Medical Education, which establishes content guidelines for medical curriculum, does not require medical schools to teach topics relevant to the healthcare of LGBTQ+ patients for accreditation. A 2017-2018 Association of American Medical Colleges (AAMC) Curriculum Inventory found that 76% of participating schools reported including some LGBTQ+ themes in their medical education, with half reporting three or fewer learning activities. This indicates that such teaching is sparse if not completely absent. While many medical schools have adapted their curriculum to address important health disparities based on race, socio-economic status, and other social determinants of health, there is no standard for medical school curriculum that focuses on providing care to gender and sexual minorities.
According to a 2022 Gallup survey, nearly 11% of millennials and 21% of Gen Z adults self-identify as LGBTQ+. Meanwhile, according to a poll conducted by NPR in partnership with the Robert Wood Johnson Foundation and the Harvard TH Chan School of Public Health, 20% of adults identifying as LGBTQ+ reported avoiding medical care at some point due to fear of discrimination. Amongst LGBTQ+ youth specifically, the CDC identified a much higher risk of mental health issues, suicide, substance use, and harassment.
Despite this growing population and documented evidence of relevant health disparities, medical schools are failing to properly prepare future physicians to care for LGBTQ+ people. In 2018, a survey of 658 medical students revealed that most respondents felt “not competent” or “something not competent” with medical treatment of gender minority patients (76.7%) and patients with a difference in sex development (81%). A 2011 study with complete responses from 132 medical schools found that the median amount of time spent on LGBTQ+ health topics in medical education was 5 hours, with the content of this education varying widely. Sexual orientation, gender identity, and safe sex practices were among the most common, while topics such as transgender healthcare and chronic disease risk were rarely offered. Further, a recent study in JAMA highlighted how this lack of education results in negative health outcomes for patients. This survey of transgender, nonbinary, and genderqueer people indicated that those who felt their clinicians lacked knowledge of transgender care experienced significantly higher levels of psychological distress and worse self-reported health compared to individuals with knowledgeable providers.
Even at institutions such as my own that are already at the forefront of the movement to provide LGBTQ+ healthcare education, the information is frequently offered via optional sessions, which are often taught by knowledgeable students rather than faculty. While important and useful, teaching LGBTQ+ health in this way sends a message that caring for this population is somehow voluntary, and can contribute to the detrimental perception that these issues are fundamentally different from essential clinical training. This is not good enough for future physicians or our patients.
Medical schools have an urgent obligation to equip aspiring doctors with the necessary education to not only provide appropriate care to our LGBTQ+ patients but to support and advocate for them. Many experts in LGBTQ+ health recommend curricular reform that integrates LGBTQ+ health topics into relevant courses — for example, studying transgender care in endocrinology or learning how to diagnose gender dysphoria in the psychiatry block. In addition, a recent perspective piece in the New England Journal of Medicine emphasizes the responsibility of academic institutions to teach issues that impact LGBTQ+ patients at all levels of medical training. Evidence over the years has indicated that more training in these topics reduces provider discomfort and can improve the quality of healthcare for LGBTQ+ patients. The time for reform is now.
For me, rainbow socks opened the door to an important conversation about health with my patient, and the education I sought out provided me with the tools I needed to help him. Inclusivity in medicine matters, and pride is not just for June. Especially now, at a time where the right of LGBTQ+ people to access necessary, lifesaving care is being threatened in our political institutions, it is time for medical schools to adequately train physicians to provide compassionate, informed healthcare to LGBTQ+ patients.
Olivia Viscuso is a medical student at Dell Medical School, and an MBA student at the McCombs School of Business at University of Texas at Austin. Kristie Loescher, MPH, DBA, is the assistant dean for Instructional Innovation and an associate professor of Instruction at the McCombs School of Business at the University of Texas at Austin.