How do content gaps and biases in medical education reflect cultural homophobia/transphobia, and what implications does that have for clinical practice with LGBTQ+ patients?
As society becomes more accepting of diverse gender identities and sexual orientations, healthcare providers are confronting an increasing need to provide culturally competent care to patients from marginalized communities such as lesbian, gay, bisexual, transgender, queer/questioning plus (LGBTQ+) individuals.
Research suggests that there may be significant gaps in medical curricula related to LGBTQ+ health issues. This can lead to unintentional bias in provider attitudes and behaviors, which can negatively impact patient outcomes. In this article, we will explore the nature of these gaps and biases and their potential consequences for LGBTQ+ patients seeking medical attention.
Content Gaps in Medical Education
The American Academy of Pediatrics recognizes the importance of educating healthcare professionals about the unique health needs of LGBTQ+ individuals, including gender identity and sexual orientation.
The authors of a recent study found that most pediatric residency programs lack comprehensive training in this area. The study surveyed 104 pediatricians-in-training at six institutions across the country and found that while 87% believed that they were adequately trained to care for LGBTQ+ youth, only 36% felt prepared to discuss sexual orientation with parents and guardians.
Only 29% felt comfortable discussing gender identity with patients' families, and less than half (45%) reported feeling confident in providing care for transgender youth.
This gap is concerning because LGBTQ+ youth face significant barriers to accessing quality healthcare due to stigma and discrimination within health systems.
Studies have shown that many LGBTQ+ youth delay or avoid routine preventive care because they fear discrimination from providers or experience harassment when attempting to access services. Providers who are not well-versed in LGBTQ+ issues may be less likely to provide appropriate care, increasing the likelihood of adverse health outcomes such as depression, anxiety, substance abuse, and suicide attempts.
Biases and Attitudes in Clinical Practice
Research suggests that provider attitudes towards LGBTQ+ individuals can also impact clinical practice. A study conducted by Dr. Obedin-Maliver et al. revealed that medical students hold negative beliefs about LGBTQ+ people even after completing mandatory cultural competency trainings. The researchers surveyed 276 students who had completed a required course on LGBTQ+ health during their first year of medical school. They found that despite receiving training, students still held negative stereotypes about LGBTQ+ individuals, including views that homosexuality was "unnatural" or that bisexual men were promiscuous. These biases could lead providers to make incorrect assumptions about patient behaviors and needs, potentially resulting in suboptimal care.
Clinical Implications
The gaps and biases described above have serious implications for LGBTQ+ patients seeking medical care. When providers lack knowledge about gender identity or sexual orientation, they may struggle to provide culturally competent care. This can result in misdiagnosis, mistreatment, or delays in treatment.
Transgender patients may face barriers to accessing hormone therapy or other transition-related treatments if their providers are not familiar with these interventions. Similarly, lesbian women may experience difficulty obtaining Pap smears or other gynecologic services if their provider is uncomfortable discussing intimate topics related to sexual activity.
Content gaps and biases in medical education reflect cultural homophobia/transphobia, which can negatively impact clinical practice with LGBTQ+ patients. To address this issue, healthcare institutions must prioritize the development of comprehensive LGBTQ+ curricula and foster an environment of inclusion within their organizations. Providers should also undergo ongoing training to ensure they remain up-to-date on best practices and avoid unconscious bias in clinical decision making.
Providing equitable access to high-quality care requires a concerted effort from all stakeholders, including patients, providers, and health system leaders.
How do content gaps and biases in medical education reflect cultural homophobia/transphobia, and what implications does that have for clinical practice with LGBTQ+ patients?
Medical education is often limited by the lack of comprehensive curriculum coverage regarding LGBTQ+ issues, which results in the formation of knowledge gaps about their health needs and challenges. These gaps are rooted in homophobic and transphobic attitudes within medicine, which are expressed through various forms of exclusion, such as the noninclusion of LGBTQ+ individuals in research studies, curricula, and clinical guidelines.