LGBTQ+ Worker Protections: Implications for Academic Medicine Today and in the Future.

The Supreme Court's 2020 ruling prohibiting workplace discrimination based on sexual orientation or gender identity ( Bostock v Clayton County ) offers new legal protections for LGBTQ+ employees and allies and new opportunities for academic medicine to advance LGBTQ+ inclusion at their institutions. In this perspective piece, the authors examine the history of LGBTQ+ community recognition, tolerance, protections, and ongoing inclusion and the advocacy efforts led by LGBTQ+ patients, community activists, and medical colleagues. They also examine the current limitations of the court's ruling and recommend future actions to advance workplace and health equity. While recent advancements in equality have not erased chronic barriers to inclusion and advancement, they can pave the way for leaders in research, education, and clinical care to shape national health guidelines and policies that impact the health of all Americans.

HIV Pre-exposure Prophylaxis Education for Clinicians Caring for Spanish-Speaking Men Who Have Sex With Men (MSM).

Introduction: A growing number of Liaison Committee on Medical Education-accredited allopathic medical schools offer formal bilingual (English and Spanish) medical education, and numerous other schools offer medical Spanish through elective workshops as part of their curricula. One significant health disparity in the Hispanic community is the incidence of HIV among Spanish-speaking men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) has emerged as an effective strategy to reduce the risk of HIV transmission. Methods: We developed an education module to train clinicians to discuss PrEP with Spanish-speaking MSM. Our module is adapted from an English module on PrEP education. It includes a Spanish-language PowerPoint slide deck with information about PrEP as well as a Spanish-language videotaped scripted clinical encounter. Results: The module was implemented on three occasions with 18 participants, and learners reported increased comfort in discussing and confidence in prescribing PrEP with Spanish-speaking patients. Discussion: This workshop can be incorporated within medical Spanish curriculums offered at health professional schools and community-based organizations dedicated to reducing the HIV burden in the Spanish-speaking Hispanic community.

Video tool to promote knowledge of syphilis among black and Hispanic men recruited from clinical and non-clinical settings.

UNLABELLED: Recent syphilis outbreaks in metropolitan cities are attributed to men who have sex with men (MSM) with a significant proportion of Black or Hispanic identity. However, there are few syphilis interventions that are tailored to minority MSM. METHODS: We conducted a randomized controlled trial to assess whether Black and Hispanic MSM recruited from various venues who viewed the "Syphilis and Men" video showed an increase in syphilis knowledge, regardless of self-reported characteristics associated with increased risk for syphilis infection. RESULTS: Of the 168 participants, 91.1% were Black or Hispanic and 64.9% had a male partner in the past 6 months. The video intervention group had a significant increase of 19.5-20.9 percentage points on the post-test survey, depending on the venue. This difference was present irrespective of participant socio-demographic and health-related characteristics. DISCUSSION: The "Syphilis and Men" video is a brief, cost-limited intervention to promote syphilis knowledge among Black and Hispanic MSM that can potentially be implemented in various venues.

Health care utilization, barriers to care, and hormone usage among male-to-female transgender persons in New York City.

OBJECTIVES: We investigated health care utilization, barriers to care, and hormone use among male-to-female transgender persons residing in New York City to determine whether current care is in accord with the World Professional Association for Transgender Health and the goals of Healthy People 2010. METHODS: We conducted interviews with 101 male-to-female transgender persons from 3 community health centers in 2007. RESULTS: Most participants reported having health insurance (77%; n = 78) and seeing a general practitioner in the past year (81%; n = 82). Over 25% of participants perceived the cost of medical care, access to specialists, and a paucity of transgender-friendly and transgender-knowledgeable providers as barriers to care. Being under a physician's care was associated with high-risk behavior reduction, including smoking cessation (P = .004) and obtaining needles from a licensed physician (P = .002). Male-to-female transgender persons under a physician's care were more likely to obtain hormone therapies from a licensed physician (P < .001). CONCLUSIONS: Utilization of health care providers by male-to-female transgender persons is associated with their reduction of some high-risk behaviors, but it does not result in adherence to standard of care recommendations for transgender individuals.

How to Find an Academic Position After Residency: Who, What, When, Where, Why, and How.

Introduction: Transitioning from trainee to practicing physician is a process that is not frequently discussed during postgraduate training, but such a discussion is necessary if the number of academic physicians is to increase and physicians from underrepresented communities are to gain insight about the varied opportunities to join academe. This workshop combines a case-based format in its didactic portion with a step-by-step guide and time line to introduce the process for securing an academic position postresidency. Methods: Kern's six-step model was used as the framework for the workshop's design, delivery, and assessment. The workshop was presented to medical students and residents at a series of programs fostering the development of the next generation of academic physicians that were offered at host medical schools across the US between July 2016 and May 2017. Results: Evaluation data were collected from 64 participants from nine academic medicine conferences across the nation. In comparing pre- and postworkshop responses, there was a statistically significant increase in confidence to find an academic position after residency (1.95 vs. 3.18, paired-sample t test, p < .001). More than 90% of respondents agreed or strongly agreed that the workshop's three objectives were met. Participants commented that they appreciated discussions on contracts and the steps they should take following residency in order to successfully obtain an academic position. Discussion: This workshop may assist trainees in making better-informed decisions about considerations that are important for finding and retaining an academic position long-term.

Providing Trainees With an Introduction and Decision-Making Framework for Pursuing an Academic Residency Position.

Introduction: Medical students are a significant source of the future academic medicine workforce, but surprisingly little is typically done to promote academic medicine career awareness during the early stages of medical education. To raise awareness among medical students of the critical role an academic residency plays in pursuing a future academic career, we developed a workshop that describes what an academic residency entails and what to consider when selecting such a program. Methods: The six-step Kern model was applied to develop a multimodal workshop to help trainees understand characteristics of and explore their interest in an academic residency program. The 60-minute workshop consists of a PowerPoint presentation, reflection exercise, and case scenarios to help trainees learn and apply new skills in selecting a residency program. The workshop was offered to diverse medical students at nine different medical schools across the country between July 2016 and May 2017. Results: Of the 115 workshop participants who completed the evaluation form, over 95% agreed or strongly agreed that each of the learning objectives was met. A paired t test of learner responses pre- and postworkshop demonstrated significantly increased confidence in finding an academic residency position. Discussion: This workshop fills an important gap in raising medical students' awareness of how to pursue an academic medicine career by highlighting the critical role of an academic residency program. Participants liked the use of vignettes and small-group discussion to better prepare them in exploring and benefiting from an academic residency position.

Leadership and Academic Medicine: Preparing Medical Students and Residents to Be Effective Leaders for the 21st Century.

Introduction: Physician leadership positions have evolved from autonomous roles in clinical medicine to those of leaders in interdisciplinary teams managing population-based care in a value-based care-delivery system, to C-suite administrative roles in hospitals and other health care systems. Unfortunately, many practicing physicians are ill prepared to take on these new roles. Methods: In response to the evolution of the role of the physician leader in the 21st century, an educational workshop consisting of didactics and interactive case discussion was developed to introduce medical students and residents to the concepts and practices of physician leadership. During the workshop, trainees were: (1) introduced to leadership terms and theories, (2) provided examples of leadership opportunities during medical training and upon entering medical practice, and (3) given instruction and resources on how to become more effective leaders. Results: Results of a paired-sample t test of learner responses (pre- and postworkshop) showed a statistically significant increase in participants' perception that a career in academic medicine would allow them to serve in a leadership role at their medical school or community of interest. Over 90% of participants agreed that the workshop gave them a greater appreciation of leadership terms and theories, leadership opportunities, and ways to become a more effective leader. Discussion: Participants gained specific knowledge regarding leadership styles and the scope of leadership roles available to physicians. They also recognized their lack of knowledge regarding physician leadership roles and opportunities, and expressed their interest in pursuing leadership opportunities in their current educational programs.

An Introduction to Research Work, Scholarship, and Paving a Way to a Career in Academic Medicine.

Introduction: Despite high faculty attrition and challenges to expanding the number of clinician-researchers, career development to heighten trainees' pursuit of an academic research career remains a relatively understudied topic. Completing peer-reviewed publications during medical school increases a trainee's likelihood of becoming a future faculty member. There is a lack of educational content to guide trainees in selecting research activities, publishing, and gaining self-efficacy to pave a path towards a clinician-researcher track. Methods: The Kern model was applied to create a multimodal workshop that would heighten trainee awareness of various research opportunities, skills for conducting research, best practices in publishing, and also help them develop a personal plan to pursue research. The workshop included a presentation, reflection exercises, and a case scenario. The workshop was implemented among trainees attending professional development conferences at nine medical schools. A questionnaire assessed participants' change in self-efficacy in completing research scholarship and pursuing an academic research career. Results: Sixty medical students and seven residents participated in the workshops. Paired-sample t tests indicated a statistically significant increase in participants' perception that academic medicine would allow them to engage in research work, and in their self-efficacy to publish and succeed along a clinician-researcher track. Discussion: The workshop not only exposed participants to a variety of research activities but also provided a sense that all research types are valid, aiding some participants to identify new research opportunities. In addition, participants gained clarity on how to publish and develop a research path, which may help maintain interest in a clinician-researcher track.

Diversity and Inclusion in the Academic Medicine Workforce: Encouraging Medical Students and Residents to Consider Academic Careers.

Introduction: The expansion of medical schools and increased faculty attrition call for heightened efforts to encourage medical students and residents to consider academic careers. As diversity serves as a driver of institutional excellence, special attention to the ongoing underrepresentation of certain groups in academia, such as racial and ethnic minorities, women, and lesbian, gay, bisexual, and transgender individuals, is warranted. Methods: We developed a 90-minute workshop to raise medical student and resident awareness of academic medicine careers, and the benefits and challenges of having a diverse faculty. The workshop consists of a didactic PowerPoint presentation and a reflection exercise, shared in small- and large-group format, discussing facilitators and barriers to pursuing academia. The workshop was implemented at nine regional conferences. Results: There were 165 diverse participants. In comparing pre- and postworkshop responses of learners using the sample t test, there was a statistically significant increase in confidence to succeed in academic medicine given learners' gender (2.69 vs. 3.34, p < .001), race and ethnicity (2.53 vs. 3.24, p < .001), or sexual orientation (3.04 vs. 3.42, p < .001). Approximately 95% of learners felt that each of the workshop's learning objectives had been achieved. Participants considered the workshop to be enlightening, motivational, realistic, and validating. Discussion: This workshop was effective in providing an interactive format for medical students and residents to gain awareness of the state, benefits, and challenges of diversity and inclusion in academic medicine, and can affect their perception of being a future faculty member.

Preparing for an Academic Career: The Significance of Mentoring.

Introduction: Mentorship is essential for students considering a future in academic medicine. Mentoring is recognized as one of the most important factors in determining career success through enhancing trainees' goals and productivity. An effective mentoring relationship can drive trainees' goals to fruition by providing support so that opportunistic risk can be taken and failures can be reevaluated into learning experiences. Mentorship has such importance that it was deemed mandatory in education by the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education. Moreover, mentoring can play a significant role in helping to diversify the academic medicine workforce. Methods: This 60-minute workshop utilizes a didactic PowerPoint presentation and small-group role-play exercise to introduce participants to the importance of mentoring in the development of academic medicine careers and to provide instruction on establishing effective meetings with prospective mentors. Faculty facilitated the workshop at nine regional academic medicine conferences held across the country. Results: Eighty-seven diverse participants completed an evaluation form. In comparing pre- and postworkshop responses, there was a statistically significant increase in confidence to "Find a mentor for a career in academic medicine" (2.29 vs. 3.26, p < .001) and "Have a successful relationship with an academic medicine mentor" (2.52 vs. 3.38, p < .001). Moreover, more than 85% agreed or strongly agreed that the workshop's learning objectives were met. Discussion: Trainees from diverse backgrounds gained crucial insight into the importance of mentorship and techniques on how to establish and maintain mentors while pursuing an academic medicine career.

Introducing Trainees to Medical Education Activities and Opportunities for Educational Scholarship.

INTRODUCTION: The growth of medical schools, faculty attrition, and reports of student disinterest in academia all stress the need to cultivate the next generation of academic physicians. Because medical educators serve as the largest segment of faculty, heightening diverse students' awareness of opportunities to engage in various educational roles and scholarship may help them consider future academic positions. METHODS: We implemented a workshop utilizing didactics and a small-group case discussion to help students learn how to (1) define educational scholarship and portfolios, (2) recognize the value of educational scholarship, and (3) identify how to get started with educational scholarship. RESULTS: One hundred and fifty-six learners participated in the workshop at 11 regional conferences. Of learners from conferences 1-6, 100% (69/69) responded to the statement "The workshop INCREASED my confidence in achieving the following - Performing educational scholarship." Among these learners, 39 (56.5%) strongly agreed and 20 (29.0%) agreed with this statement. Of learners from conferences 7-11, 98.9% (86/87) responded to the question "How much confidence do you have in your ability to succeed along a clinician-educator track and publish your education-related work?" Using a paired-samples t test, a statistically significant increase in learner confidence was noted (p < .01) before and after the workshop. DISCUSSION: Diverse learners appreciated a heightened awareness of educational roles and scholarship, which may help them gain confidence, interest, and experience in becoming future medical educators.

Introducing Trainees to Academic Medicine Career Roles and Responsibilities.

Introduction: The future of academic medicine depends on attracting motivated trainees to the academic career path, but challenges to recruitment include unfamiliarity with academic career options. Methods: This workshop comprises a didactic session with small-group case discussion to enable trainees to learn how to: (1) define academic medical center roles and responsibilities, (2) assess the alignment of academic medical center roles with personal goals and interests, and (3) identify factors that support an academic medicine career trajectory. Workshop evaluations were collected at five academic medicine conferences for medical students and residents held across the U.S. Results: Among the 139 conference participants who completed an evaluation form, the majority had a statistically significant increase in confidence regarding their building a foundation for a career in academic medicine, and in identifying an academic medicine career role aligning with their own personal and professional interests. The majority strongly agreed or agreed that the workshop objectives were met. Trainees reported that the workshop was "illuminating," "informative," and "educational." Discussion: Improved understanding of academic medicine career roles and responsibilities can increase trainees' awareness of the opportunities in academic medicine and may support development of the next generation of academic physicians.

Helping Trainees Develop Scholarship in Academic Medicine From Community Service.

Introduction: Service in the community and academic medicine are often seen by trainees as unrelated. This may be one reason for the lack of faculty diversity and the declining interest in academic medicine among new trainees. Methods: We developed an educational workshop through the application of the Kern model to help medical students and residents understand the relationship between community service work and scholarship as it pertains to a career in academic medicine. Specifically, the workshop helped trainees (1) understand the terms service and scholarship, (2) understand the benefits of achieving community service scholarship, and (3) identify steps to achieve community service scholarship through mock cases and personal stories. Results: The workshop was implemented at five conferences with a total of 139 trainees. Results of a paired-samples t test of learners' responses pre- and postworkshop showed statistically significant growth in their confidence to publish service-related work, as well as more positive agreement with the notion that community service work aligns with an academic medicine career. Discussion: This effective module can help trainees understand how community service and academic medicine are aligned, and raise their confidence in building a foundation for an academic medicine career through conducting community service scholarship.

Providing Diverse Trainees an Early and Transparent Introduction to Academic Appointment and Promotion Processes.

Introduction: The growth in number of medical schools and increased numbers of faculty tracks have combined with evolving criteria for promotion to trigger a call for greater transparency of academic appointment and promotion processes. Most vulnerable to confusion about these changes are first-generation and diverse medical students and residents, the upstream pipeline of the academic medicine workforce. Diverse medical students have expressed diminished interest in academia because of perceived obstacles in appointment and promotion processes. Methods: This workshop was designed to utilize didactics and career reflection exercises to help trainees learn: (1) how to define core terms related to academic appointment and promotion processes, (2) how to compare data elements for different CVs and portfolios, (3) common steps in submitting a promotion package, and (4) that they can immediately begin to document content for academic CVs, portfolios, and promotion packages. Results: One hundred forty-five diverse participants completed an evaluation at eight conferences across the U.S. More than 90% strongly agreed or agreed that the aforementioned objectives were met. Participants commented that the workshop was "illuminating," was "very informative," and "provided an inside look of how faculty are evaluated." Results showed an immediate impact on participants' self-reported confidence to negotiate appointment and promotion processes. Discussion: Increases in self-rated confidence to negotiate appointment and promotion processes may help sustain trainees' interest in becoming future faculty. Further monitoring will be needed to determine if early exposure to these concepts improves probability of seeking, obtaining, and maintaining appointments.

Medical students' ability to care for lesbian, gay, bisexual, and transgendered patients.

BACKGROUND AND OBJECTIVES: Our objective was to assess medical students' ability to care for lesbian, gay, bisexual, and transgender (LGBT) patients and to identify potential deficiencies in medical school curricula pertaining to this care. METHODS: Between March 1 and April 15, 2004, third- and fourth-year medical students at a metropolitan medical school were sent an e-mail requesting participation in a confidential on-line survey of 64 quantitative questions designed to assess their ability to care for LGBT patients. RESULTS: A total of 248 of 320 (77.5%) students responded. Medical students with greater clinical exposure to LGBT patients reported more frequent sexual history taking with LGBT patients, had more positive attitude scores, and possessed higher knowledge scores than students with little or no clinical exposure. Overall, on the 13-item attitude survey, the mean was 4.15 (5 = most positive, SD = .55, range 1.86-5.00), indicating a desire and willingness to provide health care to LGBT patients. The mean score on the 14-item knowledge test was 60% (SD = .12) correct. CONCLUSIONS: Medical students with increased clinical exposure to LGBT patients tended to perform more comprehensive histories, hold more positive attitudes toward LGBT patients, and possess greater knowledge of LGBT health care concerns than students with little or no clinical exposure.

Cigarette smoking and lesbian and bisexual women in the Bronx.

This study investigated the prevalence of cigarette smoking, smoking patterns, and smoking cessation efforts of Black and Hispanic lesbian and bisexual women from a poor, urban community. One-on-one interviews were conducted with a convenience sample of 130 self-identified Black and Hispanic lesbian and bisexual women from the Bronx, NY. Bivariate statistics were used to determine differences between Black and Hispanic respondents in smoking prevalence, frequency, desire to quit, and impact on family unit. Fifty-five percent of Black respondents and sixty-two percent of Hispanic respondents were current smokers. Hispanics were more likely than Blacks to have a partner (p < 0.04), 2 or more children (p < 0.05), and an asthmatic in their household (p < 0.02). Hispanics were less likely than Blacks to have ever attempted to quit (p < 0.04) and to have made a serious attempt to quit in the past year (p < 0.02). Culturally sensitive interventions are needed to help Hispanic lesbian and bisexual women move from the pre-contemplative to action stage of quitting. The large proportion of current smokers requires greater access to effective smoking cessation tools.