U.S. Pediatric Residents' Preparedness, Attitudes, and Knowledge in LGBTQ+ Health Care.

INTRODUCTION: The objective of this study was to evaluate pediatric residents' lesbian, gay, bisexual, transgender, queer, and all sexual and gender diverse (LGBTQ+) care. METHOD: In June 2022, U.S. pediatric residents completed an anonymous online survey including the Lesbian, Gay, Bisexual, and Transgender-Development of Clinical Skills Scale (LGBT-DOCSS). RESULTS: Pediatric residents (n = 78) reported low-to-moderate annual amounts of LGBT curricular hours (3.32 ± 3.17) and LGBT patients (13.84 ± 15.11) as well as low-to-moderate clinical preparedness and knowledge and high positive attitudes. They were significantly less likely to report receiving adequate training and supervision, having experience, and feeling competent in transgender care compared with lesbian, gay, and bisexual care. In general, pediatric residents who reported more LGBT education and LGBT patients also reported higher LGBT-DOCSS scores. DISCUSSION: Pediatric residents in this study had substantial shortcomings in LGBTQ+ care. Pediatric programs must increase LGBTQ+ education and LGBTQ+ patient exposure.

It's a Start: An Online, On-Demand LGBTQ+ Mental Health Training Session for Providers Nationwide.

OBJECTIVE: The purpose of this study was to determine whether an online, on-demand, and publicly accessible mental health training session on care for lesbian, gay, bisexual, transgender, queer, and all sexual-diverse and gender-diverse (LGBTQ+) individuals could improve providers' preparedness, attitudes, and knowledge regarding care for LGBTQ+ patients. METHODS: Between January and June 2022, participating mental health providers completed the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS) before and after training. RESULTS: Participants (N=322) represented various mental health specialties and all U.S. regions. LGBT-DOCSS scores significantly increased after training: for overall LGBT-DOCSS, Cohen's d=0.77 (p<0.001); for clinical preparedness, Cohen's d=0.68 (p<0.001); for attitudinal awareness, Cohen's d=0.14 (p=0.014); and for basic knowledge, Cohen's d=0.62 (p<0.001). CONCLUSIONS: Although participating mental health providers had improvements in the parameters assessed, small but notable gaps in their LGBTQ+ health awareness and practice remained, suggesting that LGBTQ+ education requires motivated, longitudinal, ongoing, and lifelong learning approaches.

Evaluation of the Three National Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority (LGBTQ+)-Competent Provider Directories in the United States.

Provider directories may serve as a bridge solution until lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) education becomes a requisite within standard medical education. The three national LGBTQ+-competent provider directories in the United States were evaluated. Two directories served the LGBTQ+ community while one served the gender minority community. All enumerated thousands of providers. One allowed provider-specific feedback. All provided searchable criteria (e.g., provider name, location, specialty, population identity, service type, payment types, gender identity, and languages spoken). By implementing these key features, existing and future directories could better provide equitable healthcare access for the LGBTQ+ population.

Lesbian, gay, bisexual, and/or transgender (LGBT) cultural competency across the intersectionalities of gender identity, sexual orientation, and race among healthcare professionals.

BACKGROUND: There is some data regarding lesbian, gay, bisexual, and transgender (LGBT) cultural competency among healthcare professionals. While few studies have indicated differences in competency between heterosexual and sexual minority professionals, no known studies have assessed LGBT cultural competency among diverse groups with multiple minority identities. This study aimed to characterize healthcare professionals' LGBT cultural competency by comparing twelve different demographically diverse healthcare professional groups based on gender identity, sexual orientation, and race. METHODS: Deidentified data (N = 2254) was aggregated from three independent studies (i.e., healthcare professional students, psychiatry residents, and dementia care providers). A series of multivariate analyses of covariance were conducted with groups (based on gender identity, sexual orientation, and race), other demographic variables as independent variables, and LGBT-Development of Clinical Skills Scale scores (Overall LGBT-DOCSS, Clinical Preparedness, Attitudinal Awareness, and Basic Knowledge) as dependent variables. FINDINGS: Compared to men, women reported significantly higher LGBT-DOCSS scores, except significantly lower Clinical Preparedness. Compared to cisgender, heterosexual professionals, cisgender, sexual minority professionals and gender minority professionals reported significantly higher LGBT-DOCSS scores. There were several other differences among groups, such as heterosexual, cisgender, White/Caucasian men reporting low LGBT-DOCSS scores but high Clinical Preparedness; heterosexual, cisgender, White/Caucasian women with high LGBT-DOCSS scores except Clinical Preparedness; heterosexual, racial minority professionals with low LGBT-DOCSS scores; and gender, sexual, and racial minority professionals with the highest LGBT-DOCSS scores. CONCLUSIONS: There are subtle, yet important, differences in LGBT cultural competency among healthcare professionals. More diversity, intersectionality, and multiple minority identities appear to lead to higher competency. Appreciating these gender, sexual, and racial minority professionals' unique perspectives may promote the development of better, more culturally affirming LGBT health education.

The current state of lesbian, gay, bisexual, and transgender cultural competency among U.S. dermatology residents.

Lesbian, gay, bisexual, and transgender (LGBT) people interface with dermatology providers for many reasons. Implementing culturally competent LGBT dermatologic care necessitates evaluating provider competency to identify where gaps remain. Objectives: To assess the LGBT cultural competency among U.S. dermatology residents. Methods: A self-reporting, cross-sectional survey was emailed to U.S. dermatology program coordinators (N = 143). LGBT patient exposure, LGBT educational hours, and LGBT cultural competency via the LGBT-Development of Clinical Skills Scale (with the subscales Clinical Preparedness, Attitudinal Awareness, and Basic Knowledge) were measured. Results: Dermatology residents (N = 119) across the United States completed the survey. They reported caring for less than 20 LGBT patients per year and receiving less than 75 minutes of LGBT education per year. They reported significantly higher Attitudinal Awareness than both Clinical Preparedness and Basic Knowledge; they reported significantly higher Basic Knowledge than Clinical Preparedness. They reported significantly less adequate clinical training and supervision, experience, and competence to assess transgender patients compared to lesbian, gay, and bisexual patients. In general, dermatology residents who reported more LGBT patients and LGBT education also reported higher LGBT cultural competency. Limitations: A larger national sample of U.S. dermatology residents is necessary for generalizability. Conclusions: Currently, there is a lack of LGBT education in U.S. dermatology residency curricula, which may delay addressing the health disparities that exist in this patient population. Due to such dearth of standardized LGBT education, dermatology residents likely do not feel adequately knowledgeable or prepared to address LGBT needs. Both LGBT education and LGBT patient experiences may help alleviate these shortcomings and help LGBT patients feel affirmed in their dermatologic care.

The impact of COVID-19 on the LGBTQ+ community: Comparisons between cisgender, heterosexual people, cisgender sexual minority people, and gender minority people.

There is a dearth of public health data and research focusing on lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) populations during the coronavirus ("COVID") pandemic. This study evaluated how COVID has impacted health, social, and occupational areas of functioning of the LGBTQ+ community. A community survey was distributed via email by local LGBTQ+ community organizations between September and December 2020. Participants (cisgender, heterosexual people, n = 63; cisgender sexual minority people, n = 184; and gender minority people, n = 74) were asked how COVID has impacted their life circumstances (i.e., physical health, mental health, financial stability, meeting basic needs, and social connectedness). A multivariate analysis of covariance was tested with these groups, demographic and HIV serostatus variables as independent variables and covariates, and outcomes as dependent variables. Compared to cisgender, heterosexual people, significantly more cisgender sexual minority people reported worsening physical health, and significantly more gender minority people reported worsening of all outcomes. Significantly more gender minority people reported worsening financial stability than cisgender sexual minority people. COVID has contributed to a worsening of life circumstances among the LGBTQ+ community, especially for gender minority people. More research is needed to create proactive, equitable, culturally-focused responses and interventions to pandemics.

A Qualitative Investigation Into Faith and LGBTQ Identities in a Nonclinical Sample of Readers of the Dear Abby Column: The Dear Abby Project.

ABSTRACT: To better understand the relationship between faith and LGBTQ+ identity, we conducted a qualitative analysis of 86 respondents to a general question posed through the Dear Abby column. Responses were anonymized and analyzed using a grounded theory approach. Analysis revealed six themes, reflecting a diversity of lived experience from community rejection to acceptance, and self-rejection to feelings of acceptance by God. Despite frequent media portrayals of conflict between faith and LGBTQ+ identity, the reality is more complex, and faith and LGBTQ+ identity development can be complementary.

Development, Implementation, and Effectiveness of a Self-sustaining, Web-Based LGBTQ+ National Platform: A Framework for Centralizing Local Health Care Resources and Culturally Competent Providers.

BACKGROUND: The lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) population has long faced substantial marginalization, discrimination, and health care disparities compared to the cisgender, heterosexual population. As the etiology of such disparities is multifaceted, finding concrete solutions for LGBTQ+ health care equity is challenging. However, the internet may offer the space to initiate an effective model. OBJECTIVE: In an effort to make LGBTQ+ public resources and culturally competent providers transparent, modernize medical education, and promote cultural competency, OutCare Health-a nonprofit 501(c)(3) multidisciplinary, multicenter web-based platform-was created. METHODS: The organization employs a cyclic, multidimensional framework to conduct needs assessments, identify resources and providers, promote these efforts on the website, and educate the next generation of providers. LGBTQ+ public health services are identified via the internet, email, and word of mouth and added to the Public Resource Database; culturally competent providers are recruited to the OutList directory via listservs, medical institutions, local organizations, and word of mouth; and mentors are invited to the Mentorship Program by emailing OutList providers. These efforts are replicated across nearly 30 states in the United States. RESULTS: The organization has identified over 500 public health organizations across all states, recognized more than 2000 OutList providers across all states and 50 specialties, distributed hundreds of thousands of educational materials, received over 10,000 monthly website visits (with 83% unique viewership), and formed nearly 30 state-specific teams. The total number of OutList providers and monthly website views has doubled every 12-18 months. The majority of OutList providers are trained in primary, first point-of-care specialties such as family medicine, infectious disease, internal medicine, mental health, obstetrics and gynecology, and pediatrics. CONCLUSIONS: A web-based LGBTQ+ platform is a feasible, effective model to identify public health resources, culturally competent providers, and mentors as well as provide cultural competency educational materials and education across the country. Such a platform also has the opportunity to reach self-perpetuating sustainability. The cyclic, multidisciplinary, multidimensional, multicenter framework presented here appears to be pivotal in achieving such growth and stability. Other organizations and medical institutions should heavily consider using this framework to reach their own communities with high-quality, culturally competent care for the LGBTQ+ population.

Eating disorder symptomatology in transgender patients: Differences across gender identity and gender affirmation.

OBJECTIVE: Past studies have reported high rates of eating disorder (ED) symptomatology among transgender people, yet without consideration of gender affirmation. The primary objective of this study was to evaluate the relationship between gender identity, gender affirming interventions such as gender affirming hormones (GAH) and gender affirming surgeries (GAS), and ED symptomatology. METHOD: Transgender patients at a primary care outpatient gender health program in the United States completed a survey consisting of demographics, medical history, and clinical variables, including the Eating Disorder Examination Questionnaire (EDE-Q). Multivariate analyses of covariance were conducted to compare EDE-Q scores across gender identity and gender affirmation. RESULTS: Compared to transgender men (n = 79), transgender women (n = 87) reported higher EDE-Q scores and significantly higher Eating Concern. Compared to hormone/surgery-naïve and hormone-experienced/surgery-naïve patients, hormone/surgery-experienced patients had lower EDE-Q scores. Hormone/surgery-experienced patients reported significantly lower Shape Concern and marginally lower Global Score and Weight Concern than hormone-experienced/surgery-naïve patients. There were no differences in EDE-Q scores between hormone/surgery-naïve and hormone-experienced/surgery-naïve patients. DISCUSSION: Transgender patients report high levels of ED symptomatology. There are subtle, yet important, differences in ED between gender identities and gender affirmations. High ED prevalence may result from the dual pathways of sociocultural pressures as well as gender dysphoria. Both GAH and GAS may be effective interventions to support gender affirmation and thereby alleviate ED symptomatology. While the potential positive benefits of GAS on ED are more apparent, the effects of GAH are less clear.

LGBT cultural competency, patient exposure, and curricular education among student pharmacists.

BACKGROUND: Pharmacists are positioned in unique and important roles in health care in their ability to care for the lesbian, gay, bisexual, and transgender (LGBT) population. For example, pharmacists are a highly prevalent, accessible provider type, and informal surveys have shown that LGBT patients may be more comfortable asking their pharmacists sensitive medication questions rather than their primary provider. OBJECTIVES: To demonstrate gaps in LGBT cultural competency among student pharmacists and propose specific recommendations on the number of LGBT patient exposures and educational hours that can significantly improve LGBT cultural competency. METHODS: Student pharmacists (N = 275) at 3 universities in the United States completed a survey comprising demographics, experiential variables (i.e., number of LGBT patients and LGBT hours), and the 7-point Likert LGBT-Development of Clinical Skills Scale (LGBT-DOCSS). LGBT-DOCSS scores were stratified by 1-point increments, and experiential variable means were computed per each stratification to characterize the mean LGBT patients and hours of student pharmacists with higher scores and those with lower scores. RESULTS: Student pharmacists reported low numbers of annual LGBT patients (Mean = 3.82, SD = 9.54), annual LGBT curricular hours (Mean = 0.55, SD = 0.95), and annual LGBT extracurricular hours (Mean = 2.50, SD = 15.42). They reported very high attitudinal awareness (Mean = 6.19, SD = 1.02), moderate knowledge (Mean = 5.00, SD = 1.25), and low clinical preparedness (Mean = 3.26, SD = 1.33). Student pharmacists who cared for 25 or more LGBT patients and received 10 or more LGBT total hours reported significantly higher preparedness, knowledge, and overall cultural competency. CONCLUSION: Student pharmacists have shortcomings in LGBT cultural competency and limited LGBT patient exposure and education. To improve LGBT cultural competency, pharmacy schools and accrediting bodies should consider ensuring that student pharmacists receive at least a total of 25 LGBT patient contacts and 10 LGBT formal education hours across their pharmacy education.

Assessing the LGBT cultural competency of dementia care providers.

INTRODUCTION: Although dementia risk factors are elevated in lesbian, gay, bisexual, and transgender (LGBT) older adults and are perpetuated by a lack of cultural competency, no known studies have quantified LGBT cultural competency among dementia care providers. METHODS: Dementia care providers (N = 105) across the United States completed a survey consisting of the 7-point Likert LGBT-Development of Clinical Skills Scale. RESULTS: Dementia care providers reported very high affirming attitudes (M = 6.67, standard deviation [SD] = 0.71), moderate knowledge (M = 5.32, SD = 1.25), and moderate clinical preparedness (M = 4.93, SD = 1.23). Compared to previously published data, they reported significantly lower knowledge than medical students. There were no differences compared to psychiatry residents. DISCUSSION: The current state of dementia care providers' LGBT cultural competency has significant, yet modifiable, gaps. Better education, including more LGBT patient exposure, is necessary to improve the care being provided to members of the LGBT community impacted by dementia illness.

How much is needed? Patient exposure and curricular education on medical students' LGBT cultural competency.

BACKGROUND: For medical students, providing exposure to and education about the lesbian, gay, bisexual, and transgender (LGBT) patient population are effective methods to increase comfort, knowledge, and confidence in caring for LGBT people. However, specific recommendations on the number of patient exposures and educational hours that relate to high LGBT cultural competency are lacking. METHODS: Medical students (N = 940) at three universities across the United States completed a survey consisting of demographics, experiential variables (i.e., number of LGBT patients and LGBT hours), and the 7-point Likert LGBT-Development of Clinical Skills Scale (LGBT-DOCSS). LGBT-DOCSS scores were stratified by 1-point increments, and experiential variable means were computed per each stratification to characterize the mean LGBT patients and hours of medical students with higher scores and those with lower scores. RESULTS: Medical students reported caring for some LGBT patients annually (M = 6.02, SD = 20.33) and receiving a low number of annual LGBT curricular hours (M = 2.22, SD = 2.85) and moderate number of annual LGBT extracurricular hours (M = 6.93, SD = 24.97). They also reported very high attitudinal awareness (M = 6.54, SD = 0.86), moderate knowledge (M = 5.73, SD = 1.01), and low clinical preparedness (M = 3.82, SD = 1.25). Medical students who cared for 35 or more LGBT patients and received 35 or more LGBT total hours reported significantly higher preparedness and knowledge. CONCLUSIONS: Medical students have shortcomings in LGBT cultural competency and limited LGBT patient exposure and education. To improve LGBT cultural competency, medical schools and accrediting bodies should consider providing medical students with at least a total of 35 LGBT patient contacts and 35 LGBT education hours (10 h of required curricular education and 25 h of supplemental education).

A multicenter, multidisciplinary evaluation of 1701 healthcare professional students' LGBT cultural competency: Comparisons between dental, medical, occupational therapy, pharmacy, physical therapy, physician assistant, and social work students.

BACKGROUND: Efforts to characterize healthcare professional students' lesbian, gay, bisexual, and transgender (LGBT) cultural competency are necessary to recommend educational initiatives. Very few studies have evaluated LGBT cultural competency across multiple healthcare disciplines, and no known studies have included students of other healthcare disciplines such as occupational therapy, pharmacy, physical therapy, and physician assistant. METHODS: Healthcare professional students (N = 1701) at three universities across the United States completed a survey consisting of demographics, experiential variables (i.e., LGBT patients and LGBT curricular hours), and the 7-point Likert LGBT-Development of Clinical Skills Scale (LGBT-DOCSS). LGBT-DOCSS scores, annual LGBT patients, and annual LGBT curricular hours were compared across healthcare disciplines. RESULTS: While students reported very high Attitudinal Awareness (M = 6.48, SD = 0.92), they endorsed moderate Basic Knowledge (M = 5.54, SD = 1.16) and low Clinical Preparedness (M = 3.78, SD = 1.28). After controlling for several demographic and experiential variables, there were significant differences among healthcare disciplines on LGBT-DOCSS scores, with social work students reporting the highest on all scores, and dental students reporting the lowest on all scores except Clinical Preparedness. There were also significant differences among healthcare disciplines on annual LGBT patients [mean range: 0.57 (dental) to 7.59 (physician assistant)] and annual LGBT curricular hours [mean range: 0.51 (occupational therapy) to 5.64 (social work)]. Experiential variables were significant predictors for Overall LGBT-DOCSS, Clinical Preparedness, and Basic Knowledge (all p < 0.001); LGBT patients was also a significant predictor for Attitudinal Awareness (p < 0.05). CONCLUSIONS: Taken together, significant differences in LGBT cultural competency exist across healthcare disciplines, which may result from inadequate experiences with LGBT patients and LGBT curricular education. Future efforts should consider increasing LGBT patient contact hours and LGBT formal education hours to enhance healthcare students' LGBT cultural competency.

Impact on patient satisfaction and importance of medical intake and office staff in a multidisciplinary, one-stop shop transgender program in Indianapolis, Indiana.

BACKGROUND: Historically, the transgender population has postponed seeking primary care due to discrimination within social and medical settings. Very few studies have considered patient satisfaction with transgender care and whether there are differences in staff satisfaction. This cross-sectional study focuses on the satisfaction of transgender patients who receive primary care at a comprehensive, "one-stop shop" program in Indianapolis, IN, USA. METHODS: Sixty-two patients completed a patient satisfaction survey. Items consisted of 5-point Likert scales with anchors of satisfaction, caring, competence, and doctor recommendation. RESULTS: Overall, there were positive responses to all items, ranging from moderately high to very high. There was high overall satisfaction in the program's trans-friendliness, office visits, and "one-stop shop" model. Lower scoring items concerned medical intake with appointment making and timing. There were no statistical differences across age, gender, education, duration at the program, and number of visits in the past 12 months. There were clear differences between how respondents viewed the care and competence of the program's staff. In particular, the doctor was viewed most positively and office staff least positively with medical staff rated in-between. CONCLUSION: There is high patient satisfaction with this comprehensive, "one-stop shop" care model among the transgender population. We recommend that transgender programs routinely conduct quality improvement measures, maintain sufficient workforce coverage, and provide cultural competency training which should include appropriate care standards and patient-centered concerns regarding appointment making and burdens associated with timing, traveling, and cost.

Primary Care Providers' Attitudes, Practices, and Knowledge in Treating LGBTQ Communities.

Cultural competency in lesbian, gay, bisexual, transgender, and queer (LGBTQ) health care has been found to be lacking within various medical specialties, but no studies have compared competency among primary care providers. The authors compared 127 primary care providers' cultural competency regarding LGBTQ health using a survey that assessed providers' attitudes, practices, and knowledge. Overall, 78.0% of respondents agreed that they were comfortable treating LGBTQ patients. Yet many providers did not feel well informed on specific LGBTQ health needs (70.1%), on clinical management of LGBTQ care (74.8%), nor on referring patients with LGBTQ issues (78.7%). Overall accuracy on LGBTQ knowledge questions was 51.0%. This study revealed a lack of cultural competency and much need for improvement as primary care providers endorsed negative attitudes, biases, inconsistencies in clinical practice, and deficiencies in medical knowledge in specialty-specific ways. There is a need for greater LGBTQ-specific education to increase providers' comfortability and competency in the needs, management, and referrals within LGBTQ health care.