Louisville School of Medicine Tackles LGBT Health Disparity with Competency Training

Photos courtesy of Tom Fougerousse and University of Louisville

At the University of Louisville School of Medicine, preparing students to provide the best quality care will soon go beyond textbooks to address inherent human bias and a lack of sensitivity.

“I think, as we look at our roles as physicians, it’s really important that we provide high-quality, compassionate, competent care to our patients,” says Dr. Toni Ganzel, dean of the School of Medicine. “And certainly, what we hear from some of our LGBT patients about their experience is that they still continue to experience bias.”

With the implementation of a new pilot program, Louisville’s School of Medicine will be the first institution of higher education in the nation to directly address the healthcare issues faced by the LGBT, gender nonconforming, and differences of sex development (DSD) population. The program will train medical students on the unique concerns faced by these communities in order that they may provide culturally competent, sensitive care to all patients.

“It was coming up again and again that treating LGBT patients and providing them with competent care really takes a certain set of skills, most especially around having conversations about identity, using inclusive questions, and thinking about who people are — what they might bring with them to their appointments,” says Brian Buford, assistant provost for diversity and director of the LGBT Center at the University of Louisville.

The program is based on standards developed by a subcommittee of the Association of American Medical Colleges (AAMC). In November, the AAMC’s Advisory Committee on Sexual Orientation, Gender Identity, and Sexual Development released a list of 30 competencies physicians must master in order to confront LGBT health disparities. The list was adapted from the Physician Competency Reference Set, a list of 58 competencies that all physicians should master.

(From left to right) University of Louisville’s David Wiegman, associate vice president for health affairs; Stacie Steinbock, director of the LGBT Center’s satellite office; Dr. Toni Ganzel, dean of the School of Medicine; and Brian Buford, assistant provost for diversity and director of the LGBT Center pose during the university’s 2014 Pride Week celebration.
(From left to right) University of Louisville’s David Wiegman, associate vice president for health affairs; Stacie Steinbock, director of the LGBT Center’s satellite office; Dr. Toni Ganzel, dean of the School of Medicine; and Brian Buford, assistant provost for diversity and director of the LGBT Center pose during the university’s 2014 Pride Week celebration.

“These competencies address knowledge, they address attitudes, and they address the skills that are needed to operate within the healthcare system to support patients who are LGBT, gender nonconforming, or who have been born with DSD,” says Kristen Eckstrand, chair of the AAMC subcommittee and fourth-year medical student at Vanderbilt University School of Medicine. “I think, first and foremost, these competencies will help people see their patients as a whole person.”

The pilot program at Louisville came about as a result of conversations between Stacie Steinbock, director of the University of Louisville LGBT Center’s satellite office, and co-authors of the competencies, Eckstrand and Jennifer Potter, MD — who are both assisting with the development of the training.

The School of Medicine, the LGBT Center, and the Health Science Center Office of Diversity and Inclusion are working together to develop the curriculum for the pilot program, which will launch with incoming students in the 2015-2016 academic year. The university hopes to have the training fully integrated into the curriculum by the following year.

Instead of exposing students through a one-time course, the training will permeate all learning and cover a wide range of topics across eight domains, says Steinbock.

“It will actually be integrated throughout the curriculum as a thread,” she says. “What’s really cool about that is it means we get to train faculty and staff along the way. So [students] will be hearing about LGBT health from everywhere — from their first-year courses in basic sciences to when they’re doing their rotations. It’s actually, I think, a much more powerful message to have it integrated throughout the curriculum.”

The impetus for the program was the result of a lack of knowledge and an increasing need to know expressed by students.

At the LGBT Center, Buford has been accustomed to receiving regular requests for physician referrals from students who have had negative experiences and are looking for an LGBT-friendly provider. These experiences have included everything from a subtle lack of sensitivity to more blatant discrimination.

“Their identity has been misunderstood or they’ve been treated badly,” Buford says. “[Or] it can be there’s no place on the form to indicate that you have a partner or nowhere to indicate the gender that you identify with. So from the community, the interest in this project is tremendous because they’ve all suffered at some point in their lives from a lack of competent care.”

More often than not, Buford says, issues center on miscommunication. Experiences like these can — and often do — result in an unwillingness to seek out healthcare, even when it’s most needed, putting LGBT, gender nonconforming, and DSD patients more at risk.

Steinbock hopes the competency training will help diminish the health disparity problem while covering specific techniques for providing patient-centered care. These techniques will include everything from how to take a complete health history and do a thorough physical exam to recognizing biases.

“So when you’re taking a sexual history with a patient, you need to be open to the different kinds of sexual practices someone might be involved with and be comfortable talking about those,” Steinbock says. “Another piece of the curriculum will be ethics, which has to do with coming up with specific scenarios in which students need to recognize the ethical quandary they may face as medical providers for an LGBT population. So they’ll be kind of recognizing their own biases and also figuring out how to provide the best care.”

As dean of the School of Medicine, Ganzel is hoping that the program will serve as a model for schools across the country so that one day, providing culturally competent care to all people — no matter their background — will be second nature.

“I guess what I hope is that at some point it’s not necessary to have something special like this because it’s just going to be infiltrated into how we train our students … and how we care for patients,” she says. “We hope and dream that some day there will be widespread health equity across all populations, but at this point, there’s not. And so, until there is, we need to be very conscious and intentional about it.”●

Alexandra Vollman is the editor of INSIGHT Into Diversity.