Evaluating Effectiveness of an Online LGBTQIA+ Health Course for Medical Students.

BACKGROUND AND OBJECTIVES: Despite the increasing number of sexual and gender minority (SGM) patients in the United States and designation by the National Institutes of Health as a population with health disparities, available tools are lacking to train medical students on appropriate care for this population. Therefore, we developed and implemented a novel, self-directed, 2-week online elective for undergraduate medical students. The objective of our study was to evaluate the effectiveness of this course in increasing medical students' competency and confidence in caring for SGM patients. METHODS: We developed the curriculum using Kern's six-step model for curriculum development. We created anonymous pre- and postcourse surveys using the standardized Lesbian, Gay, Bisexual, Transgender Development of Clinical Skills Survey (LGBT-DOCSS) questionnaire to assess cultural competence, as well as a 5-point Likert-scored survey to assess self-perceived confidence in the care of SGM patients. We tested the statistical significance in pre- and postsurvey scores via paired sample t tests in R (R Project for Statistical Computing). RESULTS: We found statistically significant increases in the LGBT-DOCSS categories of clinical preparedness (P<.001), basic knowledge (P<.001), overall competency (P<.001), and self-perceived confidence in caring for SGM patients (P<.001, N=33). CONCLUSIONS: The course represents an effective solution for increasing medical students' self-perceived competence and confidence in caring for SGM patients. The flexibility and ease of the online format may be appealing to both students and institutions, and ultimately can serve to increase access to crucial content that is largely absent from current undergraduate medical education. Future evaluation efforts will be required to determine whether the course impacts long-term behavioral changes and outcomes.

Assessment of neophallus length following metoidioplasty.

Background: An increasing number of gender diverse individuals are presenting for gender affirming care. An option for genital gender affirming surgery (gGAS) in transmasculine individuals is metoidioplasty, creating a small neophallus from enlarged clitoral tissue following prolonged testosterone exposure. The goal of this study is to understand factors which contribute to greater exposed neophallus length following metoidioplasty. Methods: We performed a retrospective chart review on patients presenting to a single academic institution who underwent a metoidioplasty. All operations were performed using the Belgrade technique with or without urethral lengthening depending on patient preference. Results: Twenty-seven patients underwent metoidioplasty from 2017-2022. Sixteen had recorded stretched clitoral length (pre-operatively) and exposed neophallus length (post-operatively). The median length of time on testosterone therapy was 4.6 years. The median stretched clitoral length was 5.8 cm, and exposed neophallus length was 6 cm. There was a strong correlation between pre-operative length and post-operative length (ρ=0.9; P<0.0001). There were no correlations between pre-operative length or exposed neophallus length and BMI (ρ=-0.02, P=0.93; ρ=0.05, P=0.83, respectively). Time on testosterone does not correlate with stretched clitoral length nor exposed neophallus length (ρ=-0.28, P=0.15; ρ=-0.35, P=0.18, respectively). Conclusions: Patients considering metoidioplasty often wonder how large their neophallus will be. We found that patients can expect exposed neophallus length to be about 0.6 cm longer than their pre-operative stretched clitoral length. No evidence of association of time on testosterone nor BMI with exposed neophallus length was found. This information is crucial for gender diverse patients to make informed decisions about gGAS.