Sexual and gender minority content in undergraduate medical education in the United States and Canada: current state and changes since 2011

Abstract

Purpose: To characterize current lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI +) health-related undergraduate medical education (UME) curricular content and associated changes since a 2011 study and to determine the frequency and extent of institutional instruction in 17 LGBTQI + health-related topics, strategies for increasing LGBTQI + health-related content, and faculty development opportunities.

Method: Deans of medical education (or equivalent) at 214 allopathic or osteopathic medical schools in Canada and the United States were invited to complete a 36-question, Web-based questionnaire between June 2021 and September 2022. The main outcome measured was reported hours of LGBTQI + health-related curricular content.

Results: Of 214 schools, 100 (46.7%) responded, of which 85 (85.0%) fully completed the questionnaire. Compared to 5 median hours dedicated to LGBTQI + health-related in a 2011 study, the 2022 median reported time was 11 h (interquartile range [IQR], 6-16 h, p < 0.0001). Two UME institutions (2.4%; 95% CI, 0.0%-5.8%) reported 0 h during the pre-clerkship phase; 21 institutions (24.7%; CI, 15.5%-33.9%) reported 0 h during the clerkship phase; and 1 institution (1.2%; CI, 0%-3.5%) reported 0 h across the curriculum. Median US allopathic clerkship hours were significantly different from US osteopathic clerkship hours (4 h [IQR, 1-6 h] versus 0 h [IQR, 0-0 h]; p = 0.01). Suggested strategies to increase content included more curricular material focusing on LGBTQI + health and health disparities at 55 schools (64.7%; CI, 54.6%-74.9%), more faculty willing and able to teach LGBTQI + -related content at 49 schools (57.7%; CI, 47.1%-68.2%), and more evidence-based research on LGBTQI + health and health disparities at 24 schools (28.2%; CI, 18.7%-37.8%).

Conclusion: Compared to a 2011 study, the median reported time dedicated to LGBTQI + health-related topics in 2022 increased across US and Canadian UME institutions, but the breadth, efficacy, or quality of instruction continued to vary substantially. Despite the increased hours, this still falls short of the number of hours based on recommended LGBTQI + health competencies from the Association of American Medical Colleges. While most deans of medical education reported their institutions' coverage of LGBTQI + health as 'fair,' 'good,' or 'very good,' there continues to be a call from UME leadership to increase curricular content. This requires dedicated training for faculty and students.

Keywords: LGBTQ persons; Undergraduate medical education.

Fig. 1

Proportion of 2022 respondents (n = 92) teaching LGBTQIA + Related Topics in the Required Curriculum. DSD: Differences in sex development; HIV: Human immunodeficiency virus; PrEP: Pre-exposure prophylaxis; SOGI: Sexual orientation and gender identity; STIs: sexually transmitted infections

Fig. 2

Cumulative Number of LGBTQI + Health-Related Topics Taught in the Required Curriculum, Comparing 2011 (n = 132) and 2022 (n = 92) Responses*. *2022 Survey had higher total number of topics possible (17 topics) than 2011 survey (16 topics)

Fig. 3

Proportion of 2022 respondents (n = 92) reporting “introductory (limited knowledge)” of each of 17 LGBTQI + -Related Topics at Their Institution. DSD: Differences in sex development; HIV: Human immunodeficiency virus; PrEP: Pre-exposure prophylaxis; SOGI: Sexual orientation and gender identity; STIs: sexually transmitted infections