Attitudes, behaviour, and comfort of Canadian emergency medicine residents and physicians in caring for 2SLGBTQI+ patients

Kelly Lien^{1

2}, Branka Vujcic^{3

4}, Victor Ng^{5

3

6}

Affiliations

¹ Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada. Kelly.lien@lhsc.on.ca.
² Division of Emergency Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada. Kelly.lien@lhsc.on.ca.
³ Division of Emergency Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
⁴ Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
⁵ Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
⁶ The College of Family Physicians of Canada, Toronto, ON, Canada.

PMID: 34363194
DOI: 10.1007/s43678-021-00160-5

Attitudes, behaviour, and comfort of Canadian emergency medicine residents and physicians in caring for 2SLGBTQI+ patients

Kelly Lien et al. CJEM. 2021 Sep.

. 2021 Sep;23(5):617-625.

doi: 10.1007/s43678-021-00160-5. Epub 2021 Aug 7.

Authors

Kelly Lien^{1

2}, Branka Vujcic^{3

4}, Victor Ng^{5

3

6}

Affiliations

¹ Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada. Kelly.lien@lhsc.on.ca.
² Division of Emergency Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada. Kelly.lien@lhsc.on.ca.
³ Division of Emergency Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
⁴ Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
⁵ Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
⁶ The College of Family Physicians of Canada, Toronto, ON, Canada.

PMID: 34363194
DOI: 10.1007/s43678-021-00160-5

Abstract
in English, French

Objectives: Physicians working in the emergency department (ED) will interact with two-spirited, lesbian, gay, bisexual, transgender, queer/questioning and intersex (2SLGBTQI+) persons as colleagues and patients. These patients have unique healthcare needs and encounter negative experiences when seeking medical care, leading to poorer health outcomes and inequities. This study aims to explore the attitudes, behaviour, and comfort of Canadian emergency medicine (EM) physicians in caring for 2SLGBTQI+ patients.

Methods: An anonymous survey was distributed to EM staff physicians and residents through the Canadian Association of Emergency Physicians (CAEP) network and social media channels. Demographic information was collected, and participants were asked about their comfort, current knowledge, and desire to gain new knowledge in caring for 2SLGBTQI+ patients. Personal perceptions and practice patterns in treating cisgender heterosexual (cis-het) and 2SLGBTQI+ patients were analysed using five-point Likert scales. Residents were asked additional questions regarding availability of learning experiences during training.

Results: 266 surveys were included in the final analysis consisting of 229 (86%) staff physicians and 37 (14%) residents. 97% (n = 258) of all respondents believed 2SLGBTQI+ patients deserve the same quality care from medical institutions as other patients. Further, 83% (n = 221) respondents agreed that they would like to increase their knowledge in taking care of 2SLGBTQI+ patients, while 34% (n = 91) agreed that performing physical examinations on transgender or intersex patients was more challenging than on cis-het patients. Among resident respondents, 46% indicated a lack of didactic teaching devoted to 2SLGBTQI+ care during residency (n = 17/37), while 38% encountered discrimination towards 2SLGBTQI+ patients, with most comments from senior faculty and nursing staff.

Conclusions: This study suggests that Canadian EM physicians feel that 2SLGBTQI+ patients deserve equitable care when compared to cis-het patients. Future work should focus on educational needs and curricular enhancements in residency programs and continuing professional development for physicians to improve care for 2SLGBTQI+ patients in the ED.

RéSUMé: OBJECTIFS: Les médecins travaillant dans les services d'urgence interagiront avec des personnes bispirituelles, lesbiennes, gaies, bisexuelles, transgenres, queer/en questionnement et intersexes (2SLGBTQI+) en tant que collègues et patients. Ces patients ont des besoins uniques en matière de soins de santé et vivent des expériences négatives lorsqu'ils cherchent à obtenir des soins médicaux, ce qui entraîne des résultats moins bons en matière de santé et des inégalités. Cette étude vise à explorer les attitudes, les comportements et le confort des médecins d'urgence canadiens dans la prise en charge des patients 2SLGBTQI+. MéTHODES: Un sondage anonyme a été distribué aux médecins membres du personnel d’urgence et aux résidents par l'intermédiaire du réseau de l’Association canadienne des médecins d'urgence et des canaux de médias sociaux. Des informations démographiques ont été recueillies, et les participants ont été interrogés sur leur confort, leurs connaissances actuelles et leur désir d’acquérir de nouvelles connaissances sur la prise en charge des patients 2SLGBTQI+. Les perceptions personnelles et les modèles de pratique dans le traitement des patients cisgenre-hétérosexuels (cis-het) et 2SLGBTQI+ ont été analysés à l'aide d'échelles de Likert à cinq points. Des questions supplémentaires ont été posées aux résidents concernant la disponibilité des expériences d’apprentissage pendant la formation. RéSULTATS: 266 sondages ont été inclus dans l'analyse finale consistant en 229 (86 %) médecins du personnel et 37 (14 %) résidents. 97 % (n = 258) de tous les répondants pensent que les patients 2SLGBTQI+ méritent la même qualité de soins de la part des institutions médicales que les autres patients. En outre, 83 % (n = 221) des répondants ont convenu qu'ils aimeraient améliorer leurs connaissances dans la prise en charge des patients 2SLGBTQI+, tandis que 34 % (n = 91) ont convenu que la réalisation d’examens physiques sur des patients transgenres ou intersexes était plus difficile que sur des patients cis-het. Parmi les répondants résidents, 46 % ont indiqué un manque d’enseignement didactique consacré aux soins 2SLGBTQI+ pendant la résidence (n = 17/37), tandis que 38 % ont été victimes de discrimination à l’égard des patients 2SLGBTQI+, la plupart des commentaires provenant du corps professoral supérieur et du personnel infirmier. CONCLUSIONS: Cette étude suggère que les médecins d'urgence canadiens estiment que les patients 2SLGBTQI+ méritent des soins équitables par rapport aux patients cis-het. Les travaux futurs devraient se concentrer sur les besoins éducatifs et l'amélioration des programmes d'études dans les programmes de résidence et le développement professionnel continu des médecins afin d'améliorer les soins aux patients 2SLGBTQI+ dans les urgences.

Keywords: 2SLGBTQI+; Emergency medicine; Health equity.

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Comment in

LGBTQ + health: a failure of medical education.
Gisondi MA, Bigham B. Gisondi MA, et al. CJEM. 2021 Sep;23(5):577-578. doi: 10.1007/s43678-021-00185-w. Epub 2021 Sep 7. CJEM. 2021. PMID: 34491560 No abstract available.

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1. Bauer GR, Scheim AI, Deutsch MB, Massarella C. Reported emergency department avoidance, use, and experiences of transgender persons in Ontario, Canada: results from a respondent-driven sampling survey. Ann Emerg Med. 2014;63(6):713-720.e1. - DOI

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Attitudes, behaviour, and comfort of Canadian emergency medicine residents and physicians in caring for 2SLGBTQI+ patients

Affiliations

Attitudes, behaviour, and comfort of Canadian emergency medicine residents and physicians in caring for 2SLGBTQI+ patients

Authors

Affiliations

Abstract
in English, French

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References

MeSH terms

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Abstract in English, French

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References

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Abstract
in English, French