Trainees in this study wanted to learn more about the care of LGBTQ + patients, yet faculty members are unprepared to train them [2, 3]. Teaching queer health requires faculty development for even introductory content, as many clinician-educators have little knowledge of LGBTQ + health or how to teach it. We must uniformly train all faculty and students in the basics: LGBTQ + vocabulary, social and behavioral determinants of queer health, creation of welcoming and inclusive health care spaces, legal issues for unmarried partners, medical prevention of HIV, care of transgender patients, and pelvic health in patients assigned female at birth.
We believe that all physicians, regardless of specialty, should be trained in these fundamentals of LGBTQ + health. Such training would ensure more comfortable, respectful, and productive encounters for patients and providers. In emergency medicine, LGBTQ + health is similar to many other low-frequency, high-stakes conditions that require targeted provider education. Therefore, all emergency physicians should be adequately trained in the basics of LGBTQ + health. Such knowledge will empower emergency physicians to confidentially and respectfully assess queer patients, manage their presenting conditions, and refer them to appropriate specialists for aftercare. We meet our training requirements for other unique patient populations, LGBTQ + health should be no different.
Some skeptics suggest that education alone cannot drive practice change. For education to work, there often needs to be corresponding pressure on the learner, such as regulatory mandates, normative influences, or financial incentives. With respect to LGBTQ + health content, all we have right now is education, as there are no practice mandates. But that could change. We could structurally incentivize and mandate training in many different ways. Regulators, colleges, medical schools, and hospitals could include LGBTQ + health training as a requirement for certification, licensure, and employment. And importantly, we could create engaging learning resources for busy physicians asked to meet additional training requirements. One example is Teaching LGBTQ + Health, a free online CME course offered by Stanford University . The course is comprehensive, covers the core principles of queer health, and is self-paced.
Beyond provider training, we could address gaps in patient care by designating some emergency departments as centres of excellence in LGBTQ + health, not unlike the way stroke, trauma, and sexual assault centres are designated. This would conveniently mirror the specialization of LGBTQ + clinics, health centers, and community services. Such designations would require emergency physicians to be knowledgeable and competent in queer health.
Decades of physicians poorly trained in LGBTQ + health represent a persistent failure of the medical education system. Change begins with improved education… yours. Choose an appropriate resource and learn about your queer patients. Share the resource with members of your practice and colleagues outside your institution. Then teach a few trainees. End the cycle of inadequate training on LGBTQ + health. This is how the House of Medicine can catch up. It would be nice to see these changes happen soon… and a survey study with better results thereafter.