Author Insights: Medical Schools Offer Little Training on Caring for LGBT Patients

In a study initiated at Stanford University School of Medicine, Mitchell R. Lunn, MD (now a resident Brigham and Women’s Hospital and a clinical fellow at Harvard University) and colleagues found that medical schools offer little training in the health needs of lesbian, gay, bisexual, and transgender individuals. (Image: Madika Bryant)

Most US medical schools report dedicating only 5 hours to educate physicians-to-be about the health needs of patients who are lesbian, gay, bisexual, or transgender (LGBT), according to the results of a survey published today in JAMA. And about one-third offer no such clinical training at all.

A recent Institute of Medicine report highlighted the need for physicians and clinical researchers to pay closer attention to the health needs of patients who are part of the LGBT community, which historically has been underserved by the medical establishment. To correct this disparity, the report noted, physicians must be aware of the health issues that may affect LGBT individuals, such as higher rates of depression or substance use among youths, lower rates of cervical cancer screening among lesbian women, and increased risk of sexually transmitted infections among men who have sex with men. But there have been limited data available about coverage of LGBT health care in medical education.

To help close this gap, in 2007, Mitchell R. Lunn, MD, then a medical student at Stanford University School of Medicine, Stanford, California, and colleagues founded the Lesbian, Gay, Bisexual, and Transgender Medical Education Research Group; they surveyed 176 US medical schools, receiving complete responses from 132 (75%) of them. Lunn, now a resident at Brigham and Women’s Hospital and a clinical fellow at Harvard University, discussed the group’s findings.

news@JAMA: Why is it important for physicians to learn about disparities in health care for LGBT individuals?

Dr Lunn: A lot of health disparities in the LGBT community relate to access to care. Every time a patient comes to a new doctor, that individual effectively has to “come out” again. There is a lot of fear about how that is going to go. The fear of discrimination has pushed some people away from the doctor and some never return.

news@JAMA: What kind of training do physicians need to provide better care for these individuals?

Dr Lunn: For the most part, [physicians need to learn] how to ask questions, what to ask, and how to be comfortable asking the questions. We found that 97% of physicians are being taught to ask patients if they have sex with men, women, or both. How [identity or behavior] relates to a patient’s physical and mental health are also important for physicians to learn.

news@JAMA: What did the survey tell you about the training physicians are currently receiving in this area?

Dr Lunn: It is an area needing improvement. The fact that we had such a good response rate also indicated it is an area of interest to deans.

news@JAMA: How are the schools that address LGBT issues integrating it in their curriculum?

Dr Lunn: It’s done in a variety of ways. I think schools are being pretty innovative in the ways they are bringing it in and doing it in ways that break stereotypes. They are showing trainees that every single physician, no matter where they practice in the country, will see LGBT patients.

Categories: Depression, HIV/AIDS, Medical Education, Patient-Physician Relationship, Sexually Transmitted Diseases