Attitudes and Knowledge of Medical Students Towards Healthcare for Lesbian, Gay, Bisexual, and Transgender Seniors: Impact of a Case-Based Discussion With Facilitators From the Community

Abstract

Background: Lesbian, gay, bisexual, and transgender (LGBT) seniors are generally a medically underserved population that faces unique healthcare challenges. When compared to younger patients, LGBT seniors are at a greater risk for social isolation and have higher rates of smoking, disability, physical and mental distress, and lack of access to healthcare services. They are often reluctant to discuss their sexual orientations and gender identities with healthcare providers due to fear of discrimination and receiving inferior care based on prior unsatisfactory experiences with untrained or insensitive healthcare providers. Furthermore, recent research has revealed that only about 50% of primary care providers indicated confidence in providing culturally competent LGBT healthcare, highlighting the need for more LGBT proficiency training in medical school curricula.

Objectives: The aim of this study was to provide early intervention training to first-year medical students regarding best practices for equitable healthcare for LGBT seniors through integrative, small group, case-based discussions. The impact of this activity on the knowledge and attitudes of medical students regarding LGBT healthcare was also assessed.

Methods: First-year medical students participated in a two-hour small group, case-based discussion. Each group consisted of seven to eight students with one of seven facilitators who were invited members of the LGBT community. Students were provided with two clinical case scenarios related to treatment of LGBT senior patients. Students were given a pre/post-session knowledge and attitude survey to assess the impact of the session on their attitudes and understanding of the importance of providing equitable healthcare to LGBT patients. A rubric was also used by facilitators to evaluate level of student engagement and professionalism.

Results: A total of 51 first-year medical students attended the session and 38 (74.5%) completed the pre/post surveys. There was diverse representation in our student demographic with 5.2% of respondents identifying as LGBT. Survey results showed a significant increase in knowledge confidence and attitudes following the session. Students' attitudes regarding determinants of health status changed significantly for nine of the 13 (69%) survey items. In addition, their confidence in knowledge regarding healthcare barriers, health issues, and practices for LGBT culturally competent care significantly increased post-session. Data from our assessment rubrics also show that students were highly professional and engaged with the LGBT facilitators.

Conclusion: Our study provides some evidence that case-based training of medical students regarding issues that affect health of LGBT seniors can improve attitudes and sensitize them to the unique needs of this population. Through this activity, the students indicated their desire to learn more about the topics covered and to receive further training in this field of study. While the study was somewhat limited by a small participant number, the significance of the data demonstrates the effectiveness of the approach involving members of the LGBT community as facilitators. Future work with these students as part of a longitudinal curriculum will include additional LGBT proficiency training to be offered in the subsequent blocks of instruction. Additionally, this intervention could potentially be adapted by other medical schools.

Keywords: case-discussions; diversity; healthcare; lgbt; lgbt seniors; sensitization; undergraduate medical education.

Figure 1. Change in student attitude

Range of significance of results of the pre/post survey responses (n=38) to the following prompt: 'Please indicate the extent to which you agree or disagree that each of the following factors is a strong determinant of the health status of an individual or population.' Students responded on a 5-point Likert scale with 5 = strongly agree, 4 = agree, 3= undecided, 2 = disagree, 1 = strongly disagree. Data are represented as the average response from the Likert scale +/- the standard deviation. * represents p-value of < 0.05 ** represents p-value < 0.01 *** represents p-value < 0.001

Figure 2. Change in student confidence

Results of the pre/post survey responses  (n=38) to the following statements:​ Statement 1: I am confident in my knowledge about the systemic barriers to health faced by LGBT individuals.​; Statement 2: I am confident in my knowledge about the unique health issues and disparities for LGBT individuals.​; Statement 3: I am confident in my knowledge about good practices for promoting culturally competent care for LGBT individuals.​; Statement 4: I am confident in my knowledge about common inappropriate practices that prevent culturally competent care for LGBT individuals.​ Students responded on the following Likert scale: ​ 5 = strongly agree, 4 = agree, 3= undecided, 2 = disagree, 1 = strongly disagree. ​Data is represented as the average response from a Likert scale +/- the standard deviation. *** represents p-value < 0.001.