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      LGBT+ Health Teaching within the Undergraduate Medical Curriculum

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          Abstract

          Introduction: The lesbian, gay, bisexual, and transgender (LGBT+) population experience health and social inequalities, including discrimination within healthcare services. There is a growing international awareness of the importance of providing healthcare professionals and students with dedicated training on LGBT+ health. Methods: We introduced a compulsory teaching programme in a large London-based medical school, including a visit from a transgender patient. Feedback was collected across four years, before (n = 433) and after (n = 541) the session. Student confidence in using appropriate terminology and performing a clinical assessment on LGBT+ people was assessed with five-point Likert scales. Fisher exact tests were used to compare the proportion responding “agree” or “strongly agree”. Results: Of the students, 95% (CI 93–97%) found the teaching useful with 97% (96–99%) finding the visitor’s input helpful. Confidence using appropriate terminology to describe sexual orientation increased from 62% (58–67%) to 93% (91–95%) (Fisher p < 0.001) and gender identity from 41% (36–46%) to 91% (88–93%) ( p < 0.001). Confidence in the clinical assessment of a lesbian, gay or bisexual patient increased from 75% (71–79%) to 93% (90–95%) ( p < 0.001), and of a transgender patient from 35% (31–40%) to 84% (80–87%) ( p < 0.001). Discussion: This teaching programme, written and delivered in collaboration with the LGBT+ community, increases students’ confidence in using appropriate language related to sexual orientation and gender identity, and in the clinical assessment of LGBT+ patients.

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          Most cited references20

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          Health Care Disparities Among Lesbian, Gay, Bisexual, and Transgender Youth: A Literature Review

          About 3.5% Americans identify themselves as lesbian, gay, or bisexual while 0.3% identify themselves as transgender. The LGBT (lesbian, gay, bisexual, and transgender) community belongs to almost every race, ethnicity, religion, age, and socioeconomic group. The LGBT youth are at a higher risk for substance use, sexually transmitted diseases (STDs), cancers, cardiovascular diseases, obesity, bullying, isolation, rejection, anxiety, depression, and suicide as compared to the general population. LGBT youth receive poor quality of care due to stigma, lack of healthcare providers’ awareness, and insensitivity to the unique needs of this community. The main objective of this literature review is to highlight the challenges faced by the LGBT youth and to enhance the awareness among physicians about the existing disparities in order to provide a more comprehensive, evidence-based, and humane medical care to this community.
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            Do Contact and Empathy Mitigate Bias Against Gay and Lesbian People Among Heterosexual First-Year Medical Students? A Report From the Medical Student CHANGE Study.

            A recent Institute of Medicine report concluded that lesbian and gay individuals face discrimination from health care providers and called for research on provider attitudes. Medical school is a critical juncture for improving future providers' treatment of sexual minorities. This study examined both explicit bias and implicit bias against lesbian women and gay men among first-year medical students, focusing on two predictors of such bias, contact and empathy.
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              Health Disparities by Sexual Orientation: Results and Implications from the Behavioral Risk Factor Surveillance System.

              Until recently, population-based data for monitoring sexual minority health have been limited, making it difficult to document and address disparities by sexual orientation. The primary objective of this study was to examine differences by sexual orientation in an array of health outcomes and health risk factors using one of the nation's largest health surveys. Data for this study came from 8290 adults who identified as lesbian, gay, or bisexual (LGB) and 300,256 adults who identified as heterosexual in the 2014-2015 Behavioral Risk Factor Surveillance System (BRFSS). Logistic regression models were used to compare physical and mental health outcomes, health condition diagnoses, and health risk factors by sexual orientation, controlling for demographic and socioeconomic status. Controlling for sociodemographic characteristics, gay and bisexual men reported higher odds of frequent mental distress [odds ratio (OR) 1.71, P = 0.001; OR 2.33, P < 0.001] and depression (OR 2.91, P < 0.001; OR 2.41, P < 0.001), compared with heterosexual men. Lesbian and bisexual women had higher odds of frequent mental distress (OR 1.53, P < 0.001; OR 2.08, P < 0.001) and depression (OR 1.93, P < 0.01; OR 3.15, P < 0.001), compared to heterosexual women. Sexual minorities also faced higher odds of poor physical health, activity limitations, chronic conditions, obesity, smoking, and binge drinking, although these risks differed by sexual orientation and gender. This study adds to the mounting evidence of health disparities by sexual orientation. Community health practitioners and policymakers should continue to collect data on sexual orientation in order to identify and address root causes of sexual orientation-based disparities, particularly at the community-level.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                28 June 2019
                July 2019
                : 16
                : 13
                : 2305
                Affiliations
                [1 ]Department, University College London Medical School, London WC1E 6JL, UK
                [2 ]Royal Free London NHS Foundation Trust, London NW3 2QG, UK
                [3 ]Groundwork London, London SE1 7QZ, UK
                [4 ]UCL Institute of Health Informatics, London NW1 2DA, UK
                Author notes
                Author information
                https://orcid.org/0000-0003-2603-2759
                https://orcid.org/0000-0002-6200-8804
                Article
                ijerph-16-02305
                10.3390/ijerph16132305
                6651354
                31261831
                8206eb3f-0b73-44da-a017-3454da4095ff
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 13 June 2019
                : 27 June 2019
                Categories
                Article

                Public health
                lgbt,gay,lesbian,transgender,undergraduate medical education,decolonizing the curriculum,medical education,curriculum development

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