1. Standardized Patient Modules in Medical School with the Lesbian, Gay, Bisexual, and Transgender Patient in Mind.
Jacob Anderson, OMS-II; Ashley Jackson, OMS-II; Alexis Stoner, MPH; Ronald Januchowski, DO; Darlene Myles, DO
Methods
Introduction
Results
The Problem
Disparities in health care needs and access (mental, behavioral, and physical) exist between cis-gendered heterosexual populations and the Lesbian, Gay, Bisexual, and Transgender (LGBT) community (AAMC, 2014).
Initiatives to decrease health disparities of LGBT patient populations in the United States have called for an expansion of applicable research of LGBT populations (IOM, 2011; USDHHS, 2012).
Among the priority research topics suggested by the IOM, intervention research is specifically mentioned (IOM, 2011).
Intervention of medical education curriculum could be of benefit since, in many schools, only few hours are spent on topics concerning LGBT health. This includes a lack of case studies that consider sexual orientation and gender identity (Turbes et al., 2002; Juno Obedin-Maliver et al., 2011; AAMC, 2014).
Systematic evaluations of schools that have incorporated LGBT health studies into their Standardized Patient (SP) evaluations are limited to a few case studies (Eckstrand et al., 2012; Huang et al., 2014; Lee and Butterfield, 2014).
Our Study
Our study was designed to address the problem of potential exclusivity in medical school curricula by evaluating a Self-Directed Learning module of LGBT health at Edward Via College of Osteopathic Medicine (VCOM).
Measurements were done by comparing results of Attitude Surveys, Knowledge Surveys, and Sensitive Language Evaluations from SP encounters. VCOM-Carolinas students served as the exposure group while VCOM-Virginia served as the control group.
Health Knowledge
(Figure 1)
Improvements were seen in medical knowledge as Carolinas students’ average post-test knowledge scores (10.2 +/- 0.4) exceeded average pre-test scores (7.9 +/- 0.3), while the average pre and post test scores in Virginia remained at 7.8 +/- 0.4 (χ2 = 2.61 , P = 0.11 , DF = 1 ).
Subjects from the exposure group (VCOM-CC) and control group (VCOM-VC) took a pre-survey for qualitative measures of student knowledge and attitudes regarding LGBT health (Sanchez et al., 2006). Each participating subject received a random, de-identifying number from the Associate Dean for Curriculum on each campus, allowing the investigators to link pre-post test results with SP evaluation results.
Students of the exposure group were given access to the "The Sexual History Examination and the LGBT Patient" self-directed learning module via during their reproductive health block of school. The module consisted of definitions, case-studies, and videos to address health disparities and sexual history gathering including sexual orientation and identity (AAMC, 2014).
Subjects from the exposure group (N=51) and control group (N=18) were offered a post-survey with the same questions as the baseline survey to obtain a comparison of LGBT health knowledge and attitudes between groups.
Standardize Patients evaluated medical students on their sensitivity during the sexual history examination based on meeting 0, 1, 2, or 3 of the following criteria (questions from NACHC algorithm, 2014 and Sullivan et al., 2013):
Was gender-neutral language used throughout the SP encounter?
Did the student allow the patient to self-identify their sexual orientation?
If the SP answers “yes” to being sexually active, did the student ask, “do you have sex with men, women, or both?”
Results from the pre-post surveys were matched with SP performance evaluations and were used to compare the results between campuses as a whole, and between individual subjects.
Figure 1
Comparison of the average students’ scores on the health knowledge pre- and post- tests at VCOM-CC (exposure group) and VCOM-VC (control group). Passing was defined as a score ≥ 50% correct.
Conclusions
We found both VCOM campuses scored an average >60% on the attitudes scale, which agrees with a recent assessment of six other Osteopathic medical schools (Lapinski et al., 2014) where attitudes tended to be well.
Similar to assessments of LGBT clinical health knowledge of Medical Students and Residents; doctors in training tended miss a fair amount of knowledge-based questions (Sanchez et al., 2006; Lapinski et al., 2014).
Additionally, our intervention module increased clinical knowledge unique to LGBT populations.
Results
Objectives
Discussion
Attitudes
Overall, baseline LGBT attitudes scores (max = 65) were similar between both the Carolinas and Virginia campuses (Carolinas mean +/- se of /- 0.9; and Virginia /- 1.5). Attitude scores did not significantly change with the intervention (Carolinas /- 0.9), nor in the control group (Virginia /- 1.7; χ2 = 0.23 , P = 0.63 , DF = 1).
Sensitive Language
Overall, use of the 3 “sensitive language” measures during SP encounters were similar between both the Carolinas and Virginia campuses (Carolinas 2.2 +/- 0.9; and Virginia 2.7 +/- 0.1). Additionally, use of sensitive language did not seem to be significantly correlated with a higher attitudes or knowledge score of individual students on either campus.
Main Objective: to assess the efficacy of LGBT cultural and health competency learning modules on improving standardized patient encounters of LGBT patients at a medical school.
Can learning modules for medical students increase cultural and medical competence concerning LGBT patient populations?
Can standardized patient encounters be used to effectively evaluate and improve humanism towards LGBT patient populations?
Will this improve the skills of future physicians in a clinical setting?
The results of our study failed to show that a single module significantly changed the sensitivity and attitudes of student doctors at VCOM towards LGBT populations. This may be due to the low participation and high drop-out rates, however it may reflect a need for integrating LGBT-relevant cases throughout medical education (Cooke et al., 2010).
There may have been a degree of selection bias (e.g., students with positive attitudes chose to participate) and social desirability bias (e.g., students not answering honestly) present in our study.
Acknowledgements: Jennifer Januchowski, RN; Natalie Fadel, PsyD; Renee Prater, PhD; Reed Allison; Kay Lucas, RN; Ed Magalhaes, PhD; VCOM Institutional Review Board (James E. Mahaney, PhD, Eryn Perry, Stephanie Hurt); Nelson Sanchez, MD