Lesbian, gay, bisexual, transgender, queer/questioning, intersex, and other gender identity and sexual orientation identities (LGBTQ+) individuals face unique challenges in their daily lives due to oppression, stigma, and discrimination (Das et al., 2023; James et al., 2016; Rankin et al., 2019). These LGBTQ+ populations face barriers and experience disparities in healthcare as patients and in higher education as students. Disparities for LGBTQ+ students include increased odds of not succeeding in higher education, challenges with cultural safety in classrooms and on campus, and hostile and non-inclusive classroom culture and climate (Raja et al., 2023; Rankin et al., 2019). As patients, LGBTQ+ individuals face discrimination, non-inclusive care, refusal of care, and increased odds of certain diseases and conditions because of societal stigma and discrimination (Casanova-Perez et al., 2021; Das et al., 2023; James et al., 2016). Despite this, most faculty in higher education have not received formal and extensive training in LGBTQ+ health needs, cultural competency, or inclusive teaching practices (Rankin et al., 2019). Likewise, most health practitioners have not received adequate education about health equity/health disparities or cultural competency in LGBTQ+ health (Rowe et al., 2017). To address these gaps in education and practice, the authors created an interdisciplinary professional development (PD) program in sexual and gender minority (SGM) education and training. The program was developed for faculty in myriad disciplines in undergraduate and graduate programs, including health disciplines like medicine, nursing, physical therapy and occupational therapy (OT), etc., as well as non-health disciplines like fashion design, architecture, and business. This broad inclusion was intentional to address the entire campus culture/climate and academic experience for students at the University/Enterprise.

This program was unique because it took place at an undergraduate and graduate university that includes professional healthcare education programs, non-health related programs, and an integrated health system. The need for this program was identified through numerous feedback mechanisms including patient experience, student experience, and faculty discussions; educators and practitioners had a significant gap in knowledge and skillsets in LGBTQ+ content, cultural safety, and health needs. With that needs assessment and the literature in best practice PD design, this interdisciplinary program was created to mitigate some of the biases and lack of knowledge, awareness, and skills in working with LGBTQ+ students and patients.

The language and terminology associated with these communities is constantly evolving (Morgan et al., n.d.; Zamani-Gallaher et al., 2019). This paper uses the term LGBTQ+ synonymously with SGM and sexual and gender diverse (SGD). SGM is consistent with the National Institute of Health’s (NIH) Sexual and Gender Minority Research Office (SGRMO) (NIH - Sexual & Gender Minority Research Office, n.d.) and includes but is not limited to lesbian, gay, bisexual, asexual, transgender, Two-Spirit, queer, and/or intersex individuals and non-binary constructs of sexual orientation, gender, and/or sex (National LGBTQIA+ Health Education Center, n.d.). Using inclusive language that encompasses all populations is crucial. The evidence presented in this paper may showcase specific subpopulations within SGM such as “LGBT,” and the authors honor the populations that are reported. This program focused on SGMs as a larger population and each of these subgroups independently. The information was often compared to heterosexual (identity that describes attraction to the opposite binary gender) and cisgender (identity that describes a gender identity that aligns with the sex assigned at birth) populations/experiences (National LGBTQIA+ Health Education Center, n.d.).

The purpose of this paper is to: 1.) articulate the challenges of LGBTQ+ students navigating higher education and the barriers of LGBTQ+ patients; 2.) describe a pilot PD program specific to LGBTQ+ inclusivity; 3.) share changes in knowledge, attitudes, and skills using pre-post program assessment data; and 4.) demonstrate participant reported changes seven months after the program.

Literature Review

The following literature review addresses multiple areas important to the development and implementation of Sexual and Gender Minority Education and Training (SGMET). This literature review provides some perspective on the various concepts that underscore the environments that SGMET targets. Detailing the links between bias/attitudes and campus/classroom climate and culture is beyond the scope of this paper; however, higher education brings together diverse perspectives and sets the stage for challenges in the classroom, on campus, in healthcare, etc. Further, the link between what is taught in the classroom and what that learner accomplishes in their future is clear.

Bias/Attitudes

Education and training are needed to combat explicit and implicit biases being reported by health professional students, providers, and patients. Explicit bias exists within our conscious control (Burke et al., 2015), whereas implicit or unconscious bias is automatic and can reflect prejudice or stereotypes. Implicit bias may be unintentional, but it still causes discomfort, trauma, and/or harm for the recipient (FitzGerald & Hurst, 2017).

Higher Education

Bias and Negativity

Students who identify within the LGBTQ+ communities have been largely ignored, even invisible, within the heterosexism and cisgenderism that permeate higher education. These systemic ideologies contribute to the denial, denigration, or pathologizing of SGM individuals (Zamani-Gallaher et al., 2019), which leads to increased mental health conditions and unhealthy behaviors (i.e., increased use of alcohol, eating disorders, etc.) (Rankin et al., 2019). Disruptions in higher education for SGM individuals are not unusual (Rankin et al., 2019); learning and living under constant stress, feeling isolated, and living in fear of being discovered is difficult (Crane et al., 2022; Rankin et al., 2019). LGBTQ+ students experience discrimination and harassment and are physically assaulted at an increased rate when compared to majority (heterosexual and cisgender) identities (Bowling et al., 2020; Zamani-Gallaher et al., 2019). Furthermore, Conron et al. (2022) found that 32.6% of LGBTQ undergraduates experienced bullying, harassment, or assault at college, compared to 18.9% of non-LGBTQ undergraduates.

Campus Climate

Campus climate refers to the various environments such as classrooms; departments; and college campus offices (housing, financial resources, athletics, student organizations, service opportunities, religious groups, etc.) that a student must navigate to graduate. Many educators and administrators do not understand how inclusive policies can enhance academic performance. Rankin et al. (2010) found that LGBQ respondents were significantly less likely to feel comfortable with the campus climate compared to their heterosexual counterparts. Difficulties with roommates and feeling stressed, depressed, and anxious are also documented (Rankin et al., 2019). LGBTQ+ students often fear for their physical and mental safety if they are outed or remain silent as they navigate the heterosexual, cisgender environment (Coulter & Rankin, 2020; Crane et al., 2022).

The faculty and student relationship also critically impacts campus climate (Linley et al., 2016; Zamani-Gallaher et al., 2019). LGBTQ+ students need allies and LGBTQ+ role models (faculty/administrators) to share their experiences and provide advisement and security. Faculty must establish a welcoming environment and ground-rules so peers are open-minded (Linley et al., 2016; Zamani-Gallaher et al., 2019 ). LGBTQ+ students also need to learn LGBTQ+ topics throughout their curriculum and benefit from support services like counseling and peer programming (Linley et al., 2016; Raja et al., 2023; Zamani-Gallaher et al., 2019). These strategies validate their attitudes, beliefs, and actions, alongside specialized programs to nurture them to feel secure and safe (Zamani-Gallaher et al., 2019).

Retention of LGBTQ+ students is at risk when they have difficulty navigating college (Legg et al., 2020; Rankin et al., 2019). Crane et al. (2022) reported that LGBTQ students experienced more discomfort in the classroom because of sexuality-based microaggressions and were more likely to consider leaving the institution. Sanlo (2004) highlighted the need to collect retention rates for SGM college students; sixteen years later, LGBT retention is still not being addressed (Legg et al., 2020). LGBTQ+ students are often not receiving the necessary support and resources to thrive and graduate from college (Zamani-Gallaher et al., 2019).

Medical/Health Education

Curriculum: Knowledge and Skills Training

Students obtaining health/medical degrees do not have enough LGBTQ+ professional education and training (Das et al., 2023; Nowaskie et al., 2020). LGBTQ+ content and training are limited or non-existent in medical/health educational curricula (Brown et al., 2020; Korpaisarn & Safer, 2018; Rowe et al., 2017), and new policies restrict LGBTQ+ care in some parts of the country (Das et al., 2023). Professional education and specialized training is meant to help students gain content expertise and make data-driven decisions with their patients so they can be healthy and receive the necessary care. Students need to have a safe, non-judgmental practice space to become comfortable in their professional role while being exposed to marginalized populations during their education, including simulation with standardized patients and clinical experiences (Pittiglio & Lidtke, 2021; Zajac et al., 2023). Exposure, practice, feedback, and reflection can influence inclusive practitioner behaviors (McGaghie et al., 2011; Ramani et al., 2019). Unfortunately, literature addressing transgender health education initiatives within the health professions is lacking. Korpaisarn and Safer (2018) found only seven studies published between 2013 and 2018 addressing transgender health among students (medical, nursing practitioner, pharmacy, dentistry, physical therapy); interns (medical, pediatric interns, psychiatry); or resident physicians. Graduate students from OT, social work, nursing, and psychology reported lower levels of exposure to transgender content within their professional curricula (Acker, 2017). Similar findings were found with medical students (Khaleghi et al., 2023; Korpaisarn & Safer, 2018).

Healthcare providers have described LGBT-care barriers and a need to increase awareness, receptivity, and education (Brown et al., 2020; Korpaisarn & Safer, 2018). Rowe et al. (2017) found that 51% of outpatient primary care providers reported that their medical training was insufficient to address LGBT healthcare. A discrepancy also existed between perceived competence and actual subject matter knowledge. Rowe et al. (2017) found that 51% of respondents agreed that they were competent to provide LGBT care, yet only 29% reported that their medical training was adequate. The same group completed LGBT-knowledge questions, and less than half of respondents correctly answered questions about the higher prevalence of specific health-related behaviors (tobacco use) or diseases (Rowe et al., 2017).

Medicine/Health: Bias and Negativity

Health provider bias impacts LGBTQ+ patients’ experiences (Casanova-Perez et al., 2021; FitzGerald & Hurst, 2017). Biases influence health providers’ decision-making, leading to inadequate care, and interactions with patients, leading to poor patient-provider experiences, such as power inequity, transactional care, and unprofessional and negative verbal and non-verbal comments and cues (Burke et al., 2015; Casanova-Perez et al., 2021).

Biases exist against SGMs, who often face stigmatization and inadequate health care (James et al., 2016; Sabin et al., 2015). In one study, almost half of surveyed heterosexual U.S. medical students expressed some explicit bias against gay and lesbian individuals, and 82% held some degree of implicit bias (Burke et al., 2015). Acker (2017) found moderate to high levels of transphobia were reported in 45% of the respondents, including OT, social work, nursing, and psychology graduate students. Other studies had similar findings with healthcare providers (Brown et al., 2020; Casanova-Perez et al., 2021; Nowaskie et al., 2020). These biases must be addressed to ensure quality inclusive care and improve health and well-being for patients. Inclusive care can be achieved through intentionally crafted PD education and training programs, a curiosity to learn more, and a willingness to change (Ramani et al., 2019; Steinert et al., 2016).

Professional Development

PD is crucial to enhance instructors’ preparedness and ability to provide effective, relevant, and engaging education and training (Harrison-Bernard et al., 2020; Lancaster et al., 2014). The gaps in LGBTQ+ knowledge (Nowaskie et al., 2020; Ramani et al., 2019; Rankin et al., 2019) suggest that faculty, clinicians, and administrators require education to develop inclusive and supportive policies, deliver inclusive teaching practices, and include LGBTQ+ content in the health and general curriculum and student experience. Educators must also navigate challenges productively and inclusively when they arise (Raja et al., 2023; Zamani-Gallaher et al., 2019). Clinicians need training regarding inclusivity in patient care, acknowledging the intersectionality of their patient. In both settings, administrators must create inclusive environments to enhance student, patient, and employee engagement and productivity (Das et al., 2023; Raja et al., 2023; Zamani-Gallaher et al., 2019).

The objective of PD programs should be to increase participant confidence in disseminating this information and implementing practices into the classroom and patient care (Ramani et al., 2019; Steinert et al., 2016). Higher education should take a structured approach to creating inclusive learning environments that allow for deeper understanding, discussion, and exploration of the complex issues around social, structural, and political determinants of health and inequities for LGBTQ+ communities (Harrison-Bernard et al., 2020). Deliberate practice is a thoughtful, pedagogically-informed space providing opportunities to explore these inclusive behaviors and skills prior to entering the classroom or clinical setting with their learners or patients (McGaghie et al., 2011; Owen et al., 2017); this instructional method reduces the risk of harm (accidental or otherwise) to a learner or patient. This cultural competency-based education is crucial to learn in advance rather than from a mistake that has hurt a patient, student, or others (Das et al., 2023; McGaghie et al., 2011; Ramani et al., 2019).

Best practice literature on effective PD indicates prolonged duration and multiple learning sessions are necessary to revisit, process, and sustain behavioral change (Darling-Hammond et al., 2017; Ramani et al., 2019). Although short-term PD related to diversity, equity, and inclusion has an impact on knowledge (Harrison-Bernard et al., 2020), long-term training programs have a greater effect on an individual’s long-term behavior (Lancaster et al., 2014). Effective PD includes adult learning strategies; content-focused active learning; collaboration; job-embedded contexts; models and modeling; coaching and expert support; materials and resources; feedback and reflection; and sustained duration (Darling-Hammond et al., 2017; Steinert et al., 2016).

Methods

Sexual and Gender Minority Education and Training (SGMET): Professional Development Program

Program Design

This pilot program was developed in collaboration with a community organization that is nationally recognized for delivering medical and behavioral health needs to the LGBTQ+ community. The curriculum included: 1.) modeling how theories of cultural competence and humility inclusive to SGM populations integrate into roles and practice standards such as intersectionality (McConnell, 2018; Rich et al., 2020) and minority stress (Rich et al., 2020); 2.) establishing a foundational understanding of respectful terminology to optimize trust and respect when conversing with/about individuals within these populations; and 3.) providing education on inclusive practices and behaviors to be used when interacting with SGM populations as patients, peers, and students. SGMET allowed participants to 1.) explore their personal attitudes, beliefs, unconscious bias, and knowledge; 2.) examine their current pedagogical understanding and curricular content related to these populations; and 3.) share current and past experiences with these populations.

Using video conferencing, the six-month program included six structured learning sessions (1x month) followed by a 30-minute small group meeting. Structured learning sessions included lectures/presentations; small-group case-based learning; asynchronous recorded discussions; live panel as a cultural encounter; and a virtual tour of an LGBTQ+ community center. Small group sessions provided opportunities for reflection, sharing experiences, and brainstorming solutions. The program utilized experts within the university and local community partners.

Participants

Participants for this study were recruited within the Jefferson Enterprise. Interested faculty, administrators, clinicians, and staff completed an electronic application, which included demographic information related to their role and a rationale for participation. All (N=36) applicants were selected to participate. Three individuals withdrew before the program. While 33 participants completed the program, only 20 completed demographic information from the initial questionnaire (Table 1).

Table 1 Participant Demographics
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Study Design

We used validated, standardized surveys in a pre- and post-program design to analyze the impact. We collected qualitative and quantitative data anonymously before and after training using Qualtrics, a password-protected, web-based platform (Qualtrics, 2005). Seven months after the program, additional survey data were collected to describe the changes they had made in their roles.

Ethics

Approval for the program and research process was sought and obtained from the program university’s Institutional Review Board (IRB# 19E.023, March 7, 2019).

Measures

Participants consented before the program and completed a demographic intake form, assessment instruments, a post-program evaluation, and a seven-month post-program survey to collect information about the program’s impact on participants’ role(s). Standardized assessments, which included the modified The Faculty Knowledge, Experience, and Readiness to Teach LGBT Health Survey (FKER to Teach Survey) (Lim et al., 2015) and Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS) (Bidell, 2017), were issued at the beginning and end of the program to discern changes in participants’ knowledge, skills, attitudes, and readiness. All surveys were administered through Qualtrics and collected anonymously (Qualtrics, 2005).

All standardized assessments were originally designed for health professionals; therefore, some questions are disease-oriented (i.e., HIV) and may not apply to all participants. Participants were instructed to answer questions in a broad sense related to their roles.

Demographic Intake Form

Participants were asked their current academic title, highest academic degree earned, years of experience as a professional, academic employment status (including full or part time and College), age, gender identity, sexual orientation, and ethnicity. These were de-identified in data collection and analysis.

Faculty Knowledge, Experience, and Readiness to Teach LGBT Health Survey (FKER to Teach Survey)

The FKER to Teach Survey assessed readiness to incorporate SGM content into curricula (Lim et al., 2015). It was modified with the author’s permission to be inclusive of all health professions. This survey consisted of open- and close-ended questions that included a 6-point Likert scale, which allowed respondents to provide their “opinion about [their] LGBT health knowledge, experience in teaching LGBT health topics, and readiness to integrate these topics into the curriculum” (Lim et al., 2015). This paper reports on the close-ended question data.

Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS)

The LGBT-DOCSS assessed clinical preparedness, attitudes, and basic knowledge regarding LGBT patients (Bidell, 2017). The self-assessment was designed for myriad health providers, including mental health and primary care providers. The 7-point Likert scale, from strongly disagree (1) to strongly agree (7), included questions addressing sexual orientation and gender identities. The self-assessment is a reliable and valid tool to assess interdisciplinary LGBT clinical skills, knowledge, and attitudinal awareness (Bidell, 2017). Clinical preparedness, attitudes, and basic knowledge were scored separately. The author provided permission to adapt the tool to allow health-related and non-health-related participants to respond to the questionnaire through their professional lens and be inclusive of their professional expertise.

Post-Program Evaluation Upon Completion of the Program

Participants completed the post-program evaluation immediately after SGMET for feedback and to collect potential changes related to their role. This evaluation included 7 open-ended questions and 3 Likert-style questions with 7 items scored on a 4-point scale with anchors of strongly disagree and strongly agree; 10 items scored on a 4-point scale with anchors of not at all likely and extremely likely; and 4 items scored on a 4-point scale with anchors of not at all satisfied and very satisfied. This paper shares the close-ended question data results.

Seven-Month Post-Program Evaluation

Participants completed a seven-month post-program evaluation consisting of open-ended questions so participants could describe the modifications within their teaching and/or clinical role and Likert-scale questions acknowledging targeted behaviors that were addressed in the program and if change had occurred.

Statistical Analyses

Data were collected using Qualtrics (Qualtrics, 2005). Microsoft Excel version 2019 and IBM SPSS Statistics for Windows, Version 27 (IBM Corp, 2020) were used for analysis. Only individuals who responded to both the pre- and post-surveys were included in the analysis. Any missing responses for questions were not used in calculations reported. We used descriptive statistics to analyze demographic information and inferential statistics to analyze quantitative data.

The LGBT-DOCCS was scored in a two-step process. First, each participant’s survey was scored as outlined by Bidell (2017); then, the averages were calculated for each question on both pre- and post-program surveys using Microsoft Excel version 2019. Responses were compared using a Wilcoxon Rank Sum Test in IBM SPSS Statistics for Windows, version 27 (IBM Corp, 2020).

One member of the research team created a codebook for the FKER to Teach Survey with an additional value for “no response” for questions left unanswered. The other team members reviewed the codebook and agreed to the addition. We assigned numeric values to represent each response; calculated descriptive statistics; and, when appropriate, used a Wilcoxon Rank Sum Test to compare pre- and post-responses.

The seven-month post-program data were also collected anonymously and analyzed using Microsoft Excel to calculate frequencies and percentages of the close-ended data. For open-ended questions, coding consisted of the researchers categorizing similar topic areas into thematic groups.

Results

The results for all data are shared in Table 2, 3, 4 and 5 and Fig. 1. Participant reflections are shared below.

Table 2 Results of National Survey of Faculty Knowledge Experience with Lesbian, Gay, Bisexual and Transgender (LGBT) Health and Readiness for Inclusion in Teaching (FKER to Teach Survey)
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Table 3 Strategies Selected by Respondents from A National Survey of Faculty Knowledge Experience with Lesbian, Gay, Bisexual and Transgender (LGBT) Health and Readiness for Inclusion in Teaching (FKER to Teach Survey)
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Table 4 Results from the The Lesbian, Gay, Bisexual, Transgender Development of Clinical Skills Scale (LGBT-DOCSS)
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Table 5 Reported changes in teaching and other roles after seven months after program completion (N=9)
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Fig. 1
figure 1

Results of Pre and Post Program Domain Scores from the LGBT-DOCSS. Each column represents the average score within the respective domain. When pre and post program domains were compared, ‘Attitudes’ was the only domain that did not reflect a statistically significant difference in average score (p = 0.19).

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FKER to Teach Survey

Nineteen participants (n = 19) completed the pre- and post- adapted FKER to Teach Survey. After SGMET, statistically significant differences were seen in self-rated professional knowledge of LGBTQ+ healthcare issues and how frequently respondents taught about exposure to HIV and other sexually transmitted infections, particularly among LGBTQ+ communities of color.

All respondents felt that LGBTQ+ issues are moderately important, important, or very important to teach in a health profession curriculum. We found no significant change from pre to post. On average, respondents only felt moderately or adequately ready to include these issues in their roles. No respondents reported feeling not ready. Over 83% indicated the following strategies would successfully promote faculty readiness to integrate LGBTQ+ health topics into courses: reviewing the curriculum to identify gaps in LGBTQ+ health topics, implementing faculty development seminars on LGBTQ+ health issues, increasing the diversity of faculty rosters, and partnering with LGBTQ+ community organizations (Table 3).

LGBT-DOCSS

Data were collected from 17 participants who completed the adapted LGBT-DOCSS (n = 17). Results are in Table 4. Significant differences were found in mean scores pre-post for questions 1, 4, 8, 10, 11, and 14.

After the program, respondents were more aware of institutional barriers that may inhibit transgender individuals from using healthcare services. Respondents reported increased adequacy of clinical training and supervision to work with both LGB and transgender patients. The change in feeling competent to assess an LGB person in a therapeutic setting was statistically significant, but not to assess a transgender person. Feelings of unpreparedness towards speaking with LGBT clients about issues related to sexual orientation or identity also significantly changed.

Immediate Post-Program Evaluation

Fourteen participants completed the post-program evaluation. All respondents (n = 14) strongly agreed or agreed that SGMET enabled them to discuss new concepts and questions presented in the sessions; feel safe and supported in discussing biases or personal behavior goals and strategies for change with others; and brainstorm ways of applying new knowledge of terminology/language/theories to course development, advising students, and personal growth. Of the respondents, 57% (n = 8) strongly agreed, 36% (n = 5) agreed, and 7% (n = 1) disagreed that participation allowed for collaboration for curricular changes. One respondent commented that being online limited collaboration compared to being in-person.

All respondents (n = 14) reported that they were extremely likely or somewhat likely to make changes to their personal communication/approach and classroom or clinical environments. Some respondents (n = 12) were extremely likely or somewhat likely to advise learners using an intersectional inclusive lens. Some respondents (n = 9) with teaching responsibilities reported being extremely likely to change the course syllabi (n = 7); case studies (n = 5); and exam questions (n = 5). These respondents reported being either somewhat or extremely likely to make changes to their lecture content (n = 9) and audio-visual presentations (n = 9).

All respondents (n = 14) reported being either moderately or very satisfied with SGMET’s organization, structured learning session content, small group discussions, and frequency.

7-Month Post-Program Evaluation

Nine participants (n = 9) responded to the post-program evaluation, including eight full-time and one part-time employees. Respondents included assistant professors (n = 5); an associate professor (n = 1); a clinical assistant professor (n = 1); a clinical instructor (n = 1); and an instructor (n = 1). Not all respondents answered every question.

Table 5 exhibits the frequency and range of modifications respondents reported in and outside of the classroom.

All respondents (n = 9), including academic and clinical faculty, completed all open-ended questions. Three themes were derived: 1.) increasing sense of awareness, 2.) implementing inclusive strategies in clinical practice or instructional methods, and 3.) utilizing intentional inclusive communication strategies.

Theme 1: Increasing Sense of Awareness

Respondents shared how the program increased their awareness of issues and impact on education and health. Some reported seeking additional training and service opportunities specific to inclusivity after the program. One respondent, a full-time faculty member from the medical college, shared:

I have a greater awareness of the issues that can occur in SGMET community both amongst patients as well as students…. I am working on building some research in this arena.

Other respondents, all faculty from health and non-health professions, reported changing curricular content to ensure lectures and case studies address LGBTQ+ issues and care.

Theme 2: Implementation of Inclusive Strategies (Symbols and Assignments) in Clinical Practice or Education

One faculty member from the medical college mentioned, “...I have a rainbow pin,” and another faculty member from the health professions reported, “My office has a combination of posters, stickers, and figurines promoting diversity and inclusion, some specific to LGBTQ+.” One non-health educator intentionally “encourages research into gender-neutral market studies for end-use product development.”

Theme 3: Implementation of Intentional Inclusive Communication Strategies

Respondents described how the program encouraged them to deliberately use their pronouns in the classroom, during student events like orientation, and within the clinical environment. They reported being open during one-on-one interactions and inviting students to share their pronouns during introductions. One faculty member from the health professions expressed:

I have made a conscious effort to use appropriate language when communicating with all individuals and groups. At this point, I would say 60% of it occurs naturally (i.e., addressing students in class as "everybody," "folks," etc.), while the remaining 40% continue to require a moment of reflection before speaking to ensure I am thoughtful and inclusive.

This quote speaks to the conscious effort required for this behavioral change.

Discussion

Institutions must provide PD opportunities for faculty, administrators, and staff to learn how to be welcoming and inclusive across disciplines (Zamani-Gallaher et al., 2019). Inclusivity allows LGBTQ+ students to be authentic and feel part of the community (Raja et al., 2023; Zamani-Gallaher et al., 2019). Policies include using the person’s chosen name and pronouns and establishing all-gender bathrooms to reduce stress and fear of violence. SGMET was developed to address the health and educational disparities that impact LGBTQ+ students and patients. Program results indicate that non-health and health professional faculty, staff, and clinicians can learn and implement LGBTQ+ inclusive strategies into their roles after a long-term pilot PD program. The participants became more aware of LGBTQ+ historical experiences and the need to capture their experiences in research. Evidence-based resources served as a foundation for the structure (i.e., long-term format), curricular topics, and learning activities with opportunities for practice, feedback, and reflection; and intentional community building (Darling-Hammond et al., 2017; Ramani et al., 2019; Steinert et al., 2016).

Change was reported in participant knowledge and awareness. The assessments captured these shifts, with some areas indicating statistically significant levels of change such as: 1.) feeling more prepared in talking with an LGBTQ+ patient about issues related to their sexual orientation or identity and 2.) becoming more aware of the physical and mental health needs of transgender individuals. Participants acknowledged the value of inclusivity and the need to create a welcoming student-centered or patient-centered environment. Some participants shared the conscious changes they made to their personal behaviors, professional role-related processes, coursework, or environment. SGMET increased awareness of social and institutional barriers to health and societal equity; the program also deepened the preparedness to discuss LGBTQ+ issues. These results demonstrate that participants became more inclusive in their roles (Raja et al., 2023; Zamani-Gallaher et al., 2019). The integrated small group mentoring sessions were highlighted by many participants as a key way of processing new information and applying it to various challenges they have faced in trying to be more inclusive in their roles.

Even after SGMET, respondents continued to express lower levels of competence despite all scores related to knowledge and skills increasing. This phenomenon could be multi-factorial and may be due in part to SGMET providing a broader overview of the communities and not necessarily addressing specific professional competencies. This is an area to explore in the future. The results suggest that awareness and knowledge can be developed through participation in a long-term program and changes specific to inclusivity of the LBGTQ+ communities can be made in clinical and educational environments (Harrison-Bernard et al., 2020; Raja et al., 2023; Zamani-Gallaher et al., 2019).

Limitations

Our study had two primary limitations: 1.) small convenience sample size (used as pilot data) and 2.) the inclusion of only one university with an adjacent health system. Using a convenience sample may have impacted the data because participants volunteered, had an awareness of the communities, and were open to learning more. These factors also reduce the generalizability of the results and the interpretation of the analysis. Further, this program was not profession- or context-specific and broadly addressed knowledge, awareness, and skills. Another limitation was the relationship between the research team (authors) and participants, some of whom are colleagues; however, this was addressed through the IRB by using a specified de-identification process with the data during the consent process and creating small group meeting protocols that established ground rules when differing perspectives were shared. Lastly, the assessment tools were used in their original format; thus, both the non-health and health professional faculty, clinicians, and staff were instructed to respond to the questions in a general sense as it pertained to their roles. The participants’ responses to close-ended questions may have been different and open-ended responses may have been more detailed if the questions were tailored to their profession.

Conclusions

This PD program provided participants a space to explore their attitudes, beliefs, biases, and knowledge related to LGBTQ+ communities while examining current academic and/or clinical roles and responsibilities related to these populations. The results suggest that programs like SGMET can influence the academic or clinical work setting to be more inclusive and welcoming. Future studies should explore using this program at other institutions to address perceptions and readiness to implement inclusive practices and should explore student preparedness to work with and alongside LGBTQ+ patients and colleagues of varying age ranges, including measuring attitudes, values, and skills training in medical and non-medical settings. Future directions of SGMET at our institution will include aggregate data over several years for a more robust sample and data analysis.