How Family Medicine Education Can Bolster Curriculum to Meet the Needs of the LGBT Community

This is part of a series by the STFM Group on LGBT Health for LGBT Pride Month.

By Eli Pendleton, MD; Susan Sawning, MSSW, and Stacie Steinbock, MEd

My male-to-female transgender patient is in her mid-50s. She has a well-established relationship with a sex therapist, who has written a thorough letter of explanation and support. Her wife is engaged and supports her decisions. The patient comes to me hoping to begin her hormonal transition.

Why me? I’m not an expert endocrinologist, nor do I have formal training in transgender health. However, I do have two qualities that are important to her—I’m affirming and willing. She saw an endocrinologist about the issue, but they tried to talk her out of transitioning, which left her stunned and understandably frustrated.

Here she is at my University of Louisville Family Medicine office—my fourth transgender patient looking for help with hormones. Through trial and error, countless Internet and literature searches, and frank conversations about my lack of knowledge with others who helped me find the information I needed, I now feel armed with knowledge of the proper meds to use, labs to check, questions to ask, and allies to go to for help. Today, I feel ready to help her and others who set out on this brave journey.

My hope is that out of this time-consuming and often humbling experience I, along with a core group of allies, can help make sure other family physicians and health professionals have the training they need to work expertly with this vibrant group of patients.

Right now we’re playing a bit of catch-up here in Louisville, but with any luck we can move to the front of the pack. The major thrust of this effort is a truly unique curricular component as well as outreach to our health professional community.

The University of Louisville School of Medicine (ULSOM) will serve as the nation’s pilot site for implementing new AAMC competencies into a medical school curriculum in order to better equip future physicians to meet the unique health care concerns and issues encountered by people who are lesbian, gay, bisexual, transgender (LGBT), gender nonconforming, or born with differences of sex development (DSD).

This is a much-needed pilot, as the average time dedicated to teaching LGBT-related content in North American medical schools across the entire curriculum is approximately 5 hours, meaning that in many schools it is much lower. The Institute of Medicine, The Joint Commission, the US Department of Health and Human Services, the Association of American Medical Colleges, and the American Academy of Family Physicians have all recently emphasized the need for increased provider education in LGBT health.

An interdisciplinary team at the University of Louisville made up of the LGBT Center, the School of Medicine’s Undergraduate Medical Education (UME) Office, and the Health Sciences Center’s Office of Diversity and Inclusion have partnered to initiate eQuality: Leading Medical Education to Deliver Equitable Quality Care for all People, Regardless of Identity, Development, or Expression of Gender/Sex/Sexuality. The mission of eQuality is to implement a comprehensive medical school curriculum that requires students to learn, practice, and demonstrate mastery of skills, knowledge, and attitudes required for excellent care of patients who are LGBT, gender non-conforming, and/or born with disorders of sex development.

However, this project endeavors to not only provide much-needed training to medical students and faculty but to also engage the community to improve LGBT health care. The kick-off happened on June 11, when ULSOM hosted a local community conference of interested providers and transgender community members and allies. The conference featured a Medical Education Grand Rounds open to the community on “Best Practices for Interprofessional Care of Transgender Patients” and then a Community Forum to discuss the current state of affairs of transgender health care in the Louisville area and how to improve it.

Our dream is that of a multidisciplinary University of Louisville LGBT clinic that integrates the clinical efforts and expertise of various clinical departments from the SOM and other colleges within the health sciences. It will not only provide much needed care for the underserved LGBT population here in Louisville but will also serve as a clinical training site for our students and residents.

If you would like to learn more about the eQuality Project at the University of Louisville, please contact one of our Steering Committee Members:

• Stacie Steinbock, MEd, director of U of L’s LGBT Center’s satellite office on the Health Sciences Center (steinbock@louisville.edu)
• Amy Holthouser, MD, associate dean for medical education at the U of L School of Medicine (holthouser@louisville.edu)
• Faye Jones, MD, PhD, MSPH, assistant vice president for health affairs-diversity initiatives at U of L’s Office of Diversity and Inclusion (vfjone01@louisville.edu)

Care for LGBT patients is a present and real need in all communities and a need that can be met by other willing and affirming family physicians. All it takes is time and interest, and it can be wonderfully rewarding for both you and your patients. Some helpful resources to consider:

• University of California, San Francisco Center of Excellence for Transgender Health: http://transhealth.ucsf.edu/
• GLMA: Health Professionals Advancing LGBT Equality: http://www.glma.org/
• World Professional Association for Transgender Health: http://www.wpath.org/

We look forward to giving STFM Blog readers an update on the project!