Fifth year medical students’ education, confidence and learning needs related to healthcare provision for sexual and gender minority patients: a cross-sectional survey
Rona Carroll
1 * , Sally B. Rose 1 , Susan M. Garrett 1 , Lesley Gray 1
1 Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand.
Journal of Primary Health Care 15(2) 122-127 https://doi.org/10.1071/HC22082
Published: 21 December 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Introduction: Education on health care for patients with diverse sexual orientation, sex characteristics and gender identities is lacking in Aotearoa’s medical schools.
Aim: This study surveyed fifth-year medical students at the University of Otago Wellington (UOW) about confidence in providing health care to lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA+) patients to identify learning needs.
Methods: This anonymous cross-sectional survey was designed with input from an advisory group (community members, education, research and subject matter experts). It was administered on paper during class, using Likert scales (level of agreement) and open-ended questions. All fifth-year medical students at the UOW campus were invited to participate in May 2021. Data were analysed in Microsoft Excel (Microsoft Corporation) and free-text comments were analysed using template analysis.
Results: In total, 74.7% (71/95) of students completed a survey. Participants lacked knowledge and confidence in their consultation skills with LGBTQIA+ patients and did not feel they had enough teaching in this area. Most (≥78.8%) were comfortable with common terms, but half or fewer could explain intersex, gender affirmation and Takatāpui. Free-text comments revealed learning needs relating to consultation skills, ways to approach this topic with sensitivity, and a desire to learn more about the cultural context.
Discussion: Medical students view LGBTQIA+ health care as an important topic and want opportunities to improve knowledge and confidence in this area. Students lack confidence in consulting with LGBTQIA+ patients, suggesting that more education focused on practical experience and interactions with real patients would be of benefit.
Keywords: communication skills, healthcare, LGBTQIA+, medical education, medical education research, primary care, survey, undergraduate.
References
[1] New Zealand Human Rights Commission. Prism: Human rights issues relating to Sexual Orientation, Gender Identity and Expression, and sex characteristics (SOGIESC) in Aotearoa New Zealand. Wellington, New Zealand: Human Rights Commission; 2020.[2] Tan KKH, Ellis SJ, Schmidt JM, et al. Mental health inequities among transgender people in Aotearoa New Zealand: findings from the Counting Ourselves Survey. Int J Environ Res Public Health 2020; 17 2862
| Mental health inequities among transgender people in Aotearoa New Zealand: findings from the Counting Ourselves Survey.Crossref | GoogleScholarGoogle Scholar |
[3] Clark BA, Veale JF, Greyson D, et al. Primary care access and foregone care: a survey of transgender adolescents and young adults. Fam Pract 2018; 35 302–6.
| Primary care access and foregone care: a survey of transgender adolescents and young adults.Crossref | GoogleScholarGoogle Scholar |
[4] Kelley L, Chou CL, Dibble SL, et al. A critical intervention in lesbian, gay, bisexual, and transgender health: knowledge and attitude outcomes among second-year medical students. Teach Learn Med 2008; 20 248–53.
| A critical intervention in lesbian, gay, bisexual, and transgender health: knowledge and attitude outcomes among second-year medical students.Crossref | GoogleScholarGoogle Scholar |
[5] Safer JD, Pearce EN. A simple curriculum content change increased medical student comfort with transgender medicine. Endocr Pract 2013; 19 633–7.
| A simple curriculum content change increased medical student comfort with transgender medicine.Crossref | GoogleScholarGoogle Scholar |
[6] Taylor O, Rapsey CM, Treharne GJ. Sexuality and gender identity teaching within preclinical medical training in New Zealand: content, attitudes and barriers. N Z Med J 2018; 131 35–44.
[7] Sanchez AA, Southgate E, Rogers G, et al. Inclusion of lesbian, gay, bisexual, transgender, queer, and intersex health in Australian and New Zealand medical education. LGBT Health 2017; 4 295–303.
| Inclusion of lesbian, gay, bisexual, transgender, queer, and intersex health in Australian and New Zealand medical education.Crossref | GoogleScholarGoogle Scholar |
[8] Ministry of Health. HISO 10001:2017 Ethnicity Data Protocols. Wellington: Ministry of Health; 2017. Available at https://www.health.govt.nz/publication/hiso-100012017-ethnicity-data-protocols [Accessed 12 March 2021].
[9] King N. Doing template analysis. In: Symon G, Cassell C, editors. Qualitative organizational research: core methods and current challenges. Vol. 426. SAGE Publications, Inc.; 2012. pp. 77–101.
| Crossref |
[10] Kerekere E. Takatāpui: Part of the Whānau, 2nd edn. Auckland: Tiwhanawhana Trust and Mental Health Foundation; 2016.
[11] Arthur S, Jamieson A, Cross H, et al. Medical students’ awareness of health issues, attitudes, and confidence about caring for lesbian, gay, bisexual and transgender patients: a cross-sectional survey. BMC Med Educ 2021; 21 1–8.
| Medical students’ awareness of health issues, attitudes, and confidence about caring for lesbian, gay, bisexual and transgender patients: a cross-sectional survey.Crossref | GoogleScholarGoogle Scholar |
[12] Carroll R, Gray L. Diversifying clinical education case studies. Clin Teach 2021; 18 494–6.
| Diversifying clinical education case studies.Crossref | GoogleScholarGoogle Scholar |
[13] Canty J, McBain L, Gray L. Simulating ‘that jaw drop moment’: challenging heteronormative assumptions in a novel clinical consultation skills session with undergraduate medical students. MedEdPublish 2021; 10
| Simulating ‘that jaw drop moment’: challenging heteronormative assumptions in a novel clinical consultation skills session with undergraduate medical students.Crossref | GoogleScholarGoogle Scholar |
[14] Bunting SR, Calabrese SK, Spigner ST, et al. Evaluating medical students’ views of the complexity of sexual minority patients and implications for care. LGBT Health 2022; 9 348–58.
| Evaluating medical students’ views of the complexity of sexual minority patients and implications for care.Crossref | GoogleScholarGoogle Scholar |
[15] Nowaskie DZ, Patel AU. How much is needed? Patient exposure and curricular education on medical students’ LGBT cultural competency. BMC Med Educ 2020; 20 1–8.
| How much is needed? Patient exposure and curricular education on medical students’ LGBT cultural competency.Crossref | GoogleScholarGoogle Scholar |
[16] Treharne GJ, Blakey AG, Graham K, et al. Perspectives on expertise in teaching about transgender healthcare: a focus group study with health professional programme teaching staff and transgender community members. Int J Transgend Health 2021; 23 1–27.
| Perspectives on expertise in teaching about transgender healthcare: a focus group study with health professional programme teaching staff and transgender community members.Crossref | GoogleScholarGoogle Scholar |
[17] Hayward M, Treharne GJ. Clinical psychology students’ perspectives on involving transgender community members in teaching activities within their training in Aotearoa New Zealand. Psychol Sex Orientat Gend Divers 2022; 9 309–20.
| Clinical psychology students’ perspectives on involving transgender community members in teaching activities within their training in Aotearoa New Zealand.Crossref | GoogleScholarGoogle Scholar |
