Discussing Sex and Gender Identity Across the Curriculum

STFM Scholarly Topic Lecture-Discussion Proposal

2018 Medical Student Education Conference

Title:  Discussing Sex and Gender Identity Across the Curriculum

Presenters:

Matthew Holley, PhD

Ruben Hernandez, MD

Juan Carlos Venis, MD, MPH

Jakoda Snider, MD

Abstract: 

Most medical schools teach the sexual history as part of the introduction to the medical interview – often incorporated into the social history without much thought or attention.  However, training learners about sex and sexuality requires specialized attention. Furthermore, much is left to be desired in the teaching of topics affecting trans and gender non-conforming patients. This session will share lessons learned at one institution to integrate sex, sexuality, and gender identity topics across the curriculum from medical school to residency training programs. Particular attention will be given to addressing the sexual health concerns of LGBTQ+ patients.  A description of common terminology used in the LGBTQ+ community will be given with emphasis on clarifying terminology around gender identity and expression.  Also, focus will be placed on how learners can be taught to take a sexual history using neutral language.

Learning Objectives:

As a result of attending this session, the participations should be able to:

1. Discuss the importance of learners practicing and obtaining a sexual history. 
2. Describe the various teaching approaches used with medical students and learners. 
3. Develop strategies for incorporating history taking of LGBT, gender nonconforming, and individuals with disorders of sexual development into existing curriculum. 
4. Discuss various methods for assessing competency and confidence. 

Relevance to Medical Student Education: 

The sexual history is taught most often in medical school as part of the patient’s social history.  However, sexual health is an important aspect of overall health and in practice is often underemphasized by clinicians. Furthermore, discussions with patients about their gender identity can be challenging to navigate without adequate training. While gender is in part determined by outward appearance and social norms (ie. expression), medical learners should not rely on these to come to assumptions about the patient’s gender identity. The ability to acquire this information in the medical history has a great role in promoting the patient’s overall health.  As a result, the sexual history often requires additional training in order for it to be approached in a knowledgeable and respectful way.  This becomes even more important when the training includes sensitivity to LGBTQ+ patients.  Even practicing physicians most commonly report inadequate training as a barrier to taking an adequate sexual history (Nusbaum & Hamilton, 2002; Tsimtsiou et al., 2006).  

Although the sexual history is often taught in medical school, existing literature on medical students, residents, and fellows frequently highlights low levels of comfort with taking sexual histories and managing sexual health issues with LGBTQ+ patients (Hayes, Blondeau & Bing-You, 2015).  Furthermore, the presence of LGBTQ+ topics in medical schools is often minimal.  Obedin-Maliver et al. (2011) surveyed medical school deans at 176 allopathic and osteopathic institutions across the United States and Canada. The findings showed that median time spent on LGBT-related topics was 5 hours; actual responses ranged from 0 to 32 hours. Furthermore, students were more likely to encounter LGBT topics during their pre-clinical hours as compared to clinical hours.  

On the other hand, LGBTQ+ patients perceive provider discomfort and trans patients are especially weary of “coming out” to their physicians.  Historical and societal factors make topics around sexuality and gender health particularly sensitive and ones that learners need to develop strong skills in navigating. Thus, even learning to comfortably elicit and then embrace a patient’s pronoun preference, for example, can have a huge implications for rapport-building and partnering to improve the patient’s health.  As result, this session highlights one institution’s approach to teaching the sexual history across the medical school and residency curriculum. 

References:

Hayes, V., Blondeau, W., & Bing-You, R. G. (2015).  Assessment of medical student and resident/fellow knowledge, comfort, and training with sexual history taking in LGBTQ patients.  Family Medicine, 47(5), 383-387. 

Nusbaum, M.R., & Hamilton, C. D. (2002).  The proactive sexual health history.  American Family Physician, 66, 1705-1712. 

Obedin-Maliver, J., Goldsmith, E. S., Stewart, L., White, W., Tran, E., Brenman, S., Wells, M., Fetterman, D. M., Garcia, G., & Lunn, M. R. (2011). Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education. Journal of the American Medical Association, 306(9), 971-977.

Tsimtsiou, Z., Hatzmouratidis, K., Nakopoulou, E., Kyrana, E., Salpigidis, G., & Hatzichristou, D. (2006).  Predictor of physicians’ involvement in addressing sexual health issues.  Journal of Sexual Medicine, 3, 583-588.