1. MS1: PRE-CLINICAL COURSEWORK SeptOctNovDecJanFebMarAprMay Anatomy & Embryology ImmunologyNeuroanatomy HistologyMusculoskeletal Anatomy Microbiology Medical Information for Decision Making Cell Physiology Systems of Human Behavior Biochemistry Introduction to Clinical Medicine I Non-clinical selectives Preceptorship (required in first year)

2. MS2: PRE-CLINICAL COURSEWORK SeptOctNovDecJanFebMarAprMay Pathology II APathology II BPathology II C Pharmacology IHematologyPharmacology II Urinary SystemRespiratory System Hormones and NutrientsSkin System EthicsCardio System Medicine, Health, and Society Reproduction System GeneticsGI System OSCE AEpidemiologyBrain & Behavior Problem Based LearningOSCE B Introduction to Clinical Medicine II Non-clinical selectives Preceptorship (optional in second year)

3. MS-3 Required ClerkshipsMS-4 Required Clerkships PsychiatryNeurology SurgeryEmergency Medicine PediatricsChronic Care/Rehabilitation Medicine Internal MedicineSurgery Selective OBGYNCapstone to Residency Family Medicine MS3 – CLINICAL COURSEWORK

4. GENERAL CCC RECOMMENDATIONS CCC’s: Inserted throughout curriculum -Each course has CCC requirements that must be met, Seattle and WWAMI sites -One slide identifying various disproportionately impacted populations -One slide exploring reasons for disparity -Effort by lecturer to discuss stigmatized populations without further stigmatizing them -Include diverse dermatologic imaging -Set minimum proportion of exam questions that meet CCC criteria -Prioritize types of cases that should appear throughout the curriculum -Designate non-clinical CCC selectives and require a minimum number of CCC credits for completion of non-clinical requirements -Service learning requirement

5. LEARNING OBJECTIVES - LGBTQI 1. Identify basic information and terminology regarding lesbian, gay, bisexual, transgendered, and queer (LGBTQ) individuals, families, and communities; 2. Describe the current health status and the disparities that exist within the LGBTQ community and LGBTQ “special populations” (ethnic and racial minorities, youth, elderly, same sex parents, and abuse survivors). 3. Review the historical perspective of health care provision for the LGBTQ community; 4. Demonstrate awareness of one’s own LGBTQ related biases and address them effectively; 5. Explain the complexities and diversity of LGBTQ identities as they relate to health and wellness; 6. Identify the most common issues, problems, and challenges that LGBTQ individuals face in the health care setting; 7. Recognize the major barriers and social determinants to health care for LGBTQ populations; 8. Describe the impact that homophobia and transphobia have on the health and wellness for LGBTQ patients; 9. Apply effective skills to create a welcoming environment of inclusion and culturally competent care for LGBTQ patients; 10. Identify the assets and strengths of the LGBTQ community that have enabled it thrive and survive in oppressive environments.

6. ANATOMY Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY -Doctors make decisions at birth around a child's "gender" as 1% of live births exhibit sexual ambiguity and 0.1% to 0.2% become the subject of specialist medical attention and are often surgically altered to hide their sexual ambiguity ("How common is intersex? | Intersex Society of North America". Isna.org. http://www.isna.org/faq/frequency. Retrieved 2009-08- 21).http://www.isna.org/faq/frequency CULTURAL COMPETENCY -All medical students should have an exposure to and basic understanding of structural differences in genitalia beyond simplified male/female binary, emphasizing that they are biologically understandable while statistically uncommon. -Understand the difference between intersex patients and transgender patients SPECIAL CONSIDERATIONS -De-mystify variations in sex development to improve future care of intersex patients, especially newborns -Recommend intersex and ambiguous genitalia content in week 5’s urogenital discussion, embryologic discussion of genital development

7. HISTOLOGY Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

8. ICM I Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

9. MIDM Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

10. SHB Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

11. BIOCHEMISTRY Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

12. IMMUNOLOGY Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

13. MUSCULOSKELETAL Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

14. CELL PHYSIOLOGY Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

15. MICROBIOLOGY Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

16. NEUROANATOMY Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

17. PHARMACOLOGY Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY - Marked increase in sexual risk-taking in MSM populations using amphetamines and viagra (Fisher, DG, Reynolds, GL et. al. Methamphetamine and Viagra use: relationship to sexual risk behaviors. Arch Sex Behav. 2011 Apr;40(2):273-9.)

18. ICM II Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

19. CARDIOLOGY Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

20. PATHOLOGY Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

21. MHS Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

22. EPIDEMIOLOGY Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

23. PBL Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

24. GENETICS Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

25. HEMATOLOGY Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

26. HORMONES Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

27. BRAIN & BEHAVIOR Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY LGBT youth experience depression 2x more than heterosexual youth and 3x more suicdality, may be influenced by negative experiences including discimination and victimization. ( Suicidality and Depression Disparities Between Sexual Minority and Heterosexual Youth: A Meta-Analytic Review. Marshal M, et. al. Journal of Adolescent Health, (49) 115-123, 2011.) CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

28. GI SYSTEM Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

29. SKIN SYSTEM Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY CULTURAL COMPETENCY SPECIAL CONSIDERATIONS

30. REPRODUCTION Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex DISPARITY: Transgender Youth GnRH agonist to block puberty onset for transgender youth -Puberty block gives youth time to delay decision and onset of irreversible secondary sex characteristics (puberty block itself is reversible, youth will go through puberty) -“A way of sticking your toes in the water without going for a swim” -Lupron -Histrelin subdermal implant blocks puberty onset for 1 year, costly (J Clin Endocrinol Metab. Efficacy and safety of histrelin subdermal implant in children with central precocious puberty. J Clin Endocrinol Metab. 2007; 92(5): 1697-704.) CULTURAL COMPETENCY: SPECIAL CONSIDERATIONS:

31. PRECLINICAL ELECTIVES Key Population Identity: Lesbian, Gay, Bisexual, Transgender, Intersex FAMED 561: LGBT Health and Health Disparities (1 cr) CONJ 553: Clinical Management of HIV/STIs (3 cr) MED 530: AIDS: A Multidisciplinary Approach (2 cr)