Creating a Rainbow of Inclusion

Background: The Lesbian, Gay, Bisexual and Transgender (LGBT) population is disproportionately affected by healthcare disparities and youth are at a greater risk for violence, high risk sexual behaviors, mental health concerns, and use of tobacco, drugs, and alcohol. There have been limited advances improving these disparities. One study reported 67% of providers were not addressing these topics given discomfort. The demand for trained allies in the medical field has been proven time and time again. The goal was to develop a curriculum educating pediatric residents on disparities, patient care, and LGBT resources.

Methods: Sexual Orientation and Gender Identity and Expression definitions and LGBT healthcare issues were identified as areas of improvement. A one hour module was created to provide education on terminology, health screening, empathy, and communications with a pre and post survey to assess effectiveness. All participants completed de-identified surveys to report their confidence in talking about sexual health with patients who identify as heterosexual, lesbian, gay, bisexual, transgender, or undecided (0 being not at all confident and 4 being very confident) as well as their ability to identify LGBT resources. Statistical analysis was analyzed using paired T tests.

Results: The average number of resources named prior to the module was 0.5 which increased to 2.8 (p-value of <0.0001). The average confidence level discussing sexual health increased (2.86 to 3.14) for heterosexuals and was not statistically significant (P-value 0.24). However, the focus categories showed a statistically significant increase in average confidence with lesbian 2.32 to 2.89 (P-value 0.0028), gay 2.36 to 2.86 (P-value 0.0025), bisexual 2.14 to 2.79 (P-value 0.0006), transgender 1.43 to 2.57 (P-value 0.0001), and undecided 1.71 to 2.46 (P-value 0.0034).

Conclusion: The LGBT educational module demonstrated both an increase in confidence throughout all LGBT categories and an increase in the number of known LGBT resources. The only category that did not demonstrate statistically significant data was the heterosexual group which was used as a control. Providing a basic understanding of youth LGBT healthcare can lead to an improvement in provider comfort and translate into better care. In the upcoming month, a second module will be completed that will look at retention of knowledge and expand upon key concepts of LGBT healthcare after a year assessing similar parameters. Future directions will include simulation work and adaptations to expand education to other healthcare professionals.