Health Disparities in Transgender and Gender Expansive Adolescents: A Topical Review From a Minority Stress Framework.

OBJECTIVE: To present a topical review of minority stressors contributing to psychosocial and physical health disparities in transgender and gender expansive (TGE) adolescents. METHODS: We conducted a topical review of original research studies focused on distal stressors (e.g., discrimination; victimization; rejection; nonaffirmation), proximal stressors (e.g., expected rejection; identity concealment; internalized transphobia), and resilience factors (e.g., community connectedness; pride; parental support) and mental and physical health outcomes. RESULTS: Extant literature suggests that TGE adolescents experience a host of gender minority stressors and are at heightened risk for negative health outcomes; however, limited research has directly applied the gender minority stress framework to the experiences of TGE adolescents. Most research to date has focused on distal minority stressors and single path models to negative health outcomes, which do not account for the complex interplay between chronic minority stress, individual resilience factors, and health outcomes. Research examining proximal stressors and resilience factors is particularly scarce. CONCLUSIONS: The gender minority stress model is a helpful framework for understanding how minority stressors contribute to health disparities and poor health outcomes among TGE adolescents. Future research should include multiple path models that examine relations between gender minority stressors, resilience factors, and health outcomes in large, nationally representative samples of TGE adolescents. Clinically, adaptations of evidence-based interventions to account for gender minority stressors may increase effectiveness of interventions for TGE adolescents and reduce health disparities in this population of vulnerable youth.

Improvements in medical school wellness and career counseling: A comparison of one-on-one advising to an Advisory College Program.

BACKGROUND: Medical students have unmet needs in the areas of career and wellness advising. AIMS: The goal of this study is to describe the development of an Advisory College Program (ACP) and assess its effectiveness compared to a traditional one-on-one faculty advisor system. METHODS: The ACP, consisting of four colleges co-led by Advisory College Directors and supported by key Faculty, was developed to provide structured career and wellness advising. The authors compared the ACP to the former Faculty Advisory Program (FAP) using two parallel questionnaires. RESULTS: Surveys were completed by 74% of first-year students, 60% of second-year students, and 88% of third-year students. Survey data demonstrated a significant increase in the number of students who could identify their advisor, the frequency of student-advisor contacts, and the perceived accessibility of advisors in the ACP compared to the FAP. While an ordinal logistic regression model did not demonstrate a significant effect of the new advising system on overall satisfaction, univariate analysis demonstrated a significant increase in student satisfaction with wellness and career counseling. CONCLUSIONS: The ACP was more effective in promoting student wellness and career counseling than the traditional one-on-one faculty advisor system. Similar college-based programs may be beneficial to students at other medical school programs.

Medical student involvement in website development.

BACKGROUND: The digital management of educational resources and information is becoming an important part of medical education. AIMS: At Vanderbilt University School of Medicine, two medical students sought to create a website for all medical students to act as each student's individual homepage. METHOD: Using widely available software and database technology, a highly customized Web portal, known as the VMS Portal, was created for medical students. Access to course material, evaluations, academic information, and community assets were customized for individual users. Modular features were added over the course of a year in response to student requests, monitoring of usage habits, and solicitation of direct student feedback. RESULTS: During the first 742 days of the VMS Portal's release, there were 209,460 student login sessions (282 average daily). Of 348 medical students surveyed (71% response rate), 84% agreed or strongly agreed that 'consolidated student resources made their lives easier' and 82% agreed or strongly agreed that their needs were represented by having medical students design and create the VMS Portal. CONCLUSION: In the VMS Portal project, medical students were uniquely positioned to help consolidate, integrate, and develop Web resources for peers. As other medical schools create and expand digital resources, the valuable input and perspective of medical students should be solicited.

Career guidance and the Web: bridging the gap between the AAMC careers in Medicine Web site and local career guidance programs.

BACKGROUND: Medical students face a difficult challenge choosing a specialty. The Web offers several advantages in guiding students in the decision-making process. DESCRIPTION: The Vanderbilt University School of Medicine created a school-specific Web site to complement the Association of American Medical College's Careers in Medicine program. The goals were: connecting students with institution-specific resources, providing students with information on specialty choices and residency preparation, and promoting an interactive Web-based tool. A student team developed the Web site over several months. The site incorporates tracking tools to assess usage. During the first 240 days of use, the Web site has had 3,782 sessions viewing 29,864 Web pages. Monthly usage has trended upward. CONCLUSIONS: Using the Web to provide school-specific career information can guide students in the difficult process of specialty selection. Future studies are required to assess the Web site's overall effectiveness and overall student satisfaction.

Transitional Age Lesbian, Gay, Bisexual, Transgender, and Questioning Youth: Issues of Diversity, Integrated Identities, and Mental Health.

Although most LGBTQ youth become healthy young adults, they often face considerable stress over the course of their lives because of bullying, victimization, and overt/covert discrimination. Families, educational and religious institutions, health care professionals, and communities help shape the experience of LGBTQ transitional age youth. LGBTQ youth have higher rates of depression, suicide, anxiety, posttraumatic stress disorder, alcohol and drug use, and preventable sexually transmitted diseases. When best practice guidelines are followed and key stakeholders take action to support LGBTQ youth, health disparities begin to disappear. Much can be done to change the trajectory for LGBTQ youth through advocacy, education, culturally competent health care, and policy-making.

Building learning communities: evolution of the colleges at Vanderbilt University School of Medicine.

Learning communities, which are an emerging trend in medical education, create a foundation for professional and academic development through the establishment of longitudinal relationships between students and faculty. In this article, the authors describe the robust learning community system at Vanderbilt University School of Medicine, which encompasses wellness, career planning, professional development, and academics.The Vanderbilt Advisory Colleges Program introduced in 2006 initially focused on two goals: promoting wellness and providing career advising. In the 2011-2012 academic year, the focus of the colleges expanded to incorporate an enhanced level of personal career advising and an academic component. In the four-year College Colloquium course, faculty selected as college mentors teach the medical humanities and lead sessions dedicated to student professional development in the areas of leadership, research, and service-learning. This academic and professional development program builds on the existing strengths of the colleges and has transformed the colleges into learning communities.The authors reflect on lessons learned and discuss future plans. They report that internal data and data from the Association of American Medical Colleges Medical School Graduation Questionnaire support consistently high and increasing satisfaction among Vanderbilt medical students, across the metrics of personal counseling, faculty mentoring, and career planning.

Careers in medicine at Vanderbilt University School of Medicine: an innovative approach to specialty exploration and selection.

Research on resident attrition rates suggests that medical students would benefit from more comprehensive career advising programs during medical school. Responding to this need, students and administrators at the Vanderbilt University School of Medicine (Vanderbilt) introduced a broad Careers in Medicine (CiM) program in 2005 to complement the CiM resources offered by the Association of American Medical Colleges (AAMC). In this article, the authors detail the Vanderbilt CiM program's four core components: career-related events, an elective course, specialty interest groups, and career advising. The authors discuss the program's implementation and its student-led organizational structure, and they provide a critical assessment of important lessons learned. Using data from internal satisfaction surveys and the AAMC's Medical School Graduation Questionnaire (GQ), they demonstrate the success of Vanderbilt's career counseling efforts. According to recent GQ data, Vanderbilt ranks above the U.S. medical school average on graduating students' ratings of overall satisfaction with career services and of the usefulness of key programming. The authors present this description of the Vanderbilt CiM model as a framework for other medical schools to consider adopting or adapting as they explore options for expanding their own career counseling services.

Assessing student mental health at the Vanderbilt University School of Medicine.

PURPOSE: To determine the prevalence rates of four major categories of mental illness among medical students and to examine associations between these illnesses and a range of demographic variables. METHOD: The authors invited all 330 first-, second-, and third-year medical students at Vanderbilt University School of Medicine to participate in a survey during winter 2008-2009. Students completed an anonymous written questionnaire assessing the prevalence of depression, anxiety, eating disorders, and alcohol and drug use disorders. Additionally, the authors obtained student demographic information to investigate variations in rates of illness based on interindividual differences. RESULTS: Most students (301; response rate: 91.2%) completed the survey. The authors found that depression and anxiety were more prevalent in the Vanderbilt medical student population than in their nonmedical peer group. The authors found that 37 (12%) of the students were borderline for possible alcohol abuse and 3 (1%) were problem drinkers, 1 (0.3%) had a possible drug abuse disorder, and 3 (1%) had possible eating disorders. Whereas exercising one to three times per week was associated with lower rates of both depression and anxiety, having a family history of mental illness was associated with higher eating disorder scores and anxiety. There was an association between gender and all disorders. CONCLUSIONS: Insight into the prevalence of mental health disorders in the medical student population and the variables that may influence them provides important information for medical schools as they develop more robust and effective wellness programs to help students in these very stressful learning environments.

A comprehensive medical student wellness program--design and implementation at Vanderbilt School of Medicine.

Research suggests that student burnout and mental illness are increasing in U.S. medical schools. In response, students and administrators developed the Vanderbilt Medical Student (VMS) Wellness Program to promote student health and well-being through coordination of many new and existing resources. This program consists of three core components: The Advisory College Program, The Student Wellness Committee, and VMS LIVE. Each of the core components includes separate and unique individual programs, but each of these three components collaborates with the other two to accomplish the broad wellness goal of maximizing student health, happiness, and potential. The VMS Wellness Program has had early success with substantial growth and outstanding student buy-in since its inception in 2005. Preliminary data indicate that nearly every student has participated in at least two components of the VMS Wellness Program. In addition to participation, student response has been highly satisfactory, as evidenced by their positive feedback. The VMS Wellness Program is the first published model of a comprehensive medical student wellness initiative. The development and design of the program described in this article may serve as a framework for other institutions.