Clinical Learning and LGBTQ+ Health: Summary of a LGBTQ+ Health Clinical Rotation.

INTRODUCTION: People who identify as lesbian, gay, bisexual, transgender, queer, and people who identify as something else (LGBTQ+) experience barriers to health care including a lack of health care providers adequately prepared to care for them. The literature describing LGBTQ+-focused didactic learning activities has increased in recent years, however remains limited with respect to clinical learning experiences. This publication describes the development and implementation of a clinical rotation for Physician Assistant (PA) students focused on caring for LGBTQ+ patients. METHODS: A 4-week LGBTQ+ Health clinical rotation was developed for PA students through collaboration with multiple clinical sites. Students (n = 6) were surveyed before and after completion of the clinical rotation on their knowledge, comfort, and confidence in caring for LGBTQ+ patients and to identify learning priorities. Paired t tests were used to compare quantitative pre and post data. Two reviewers independently reviewed qualitative data. RESULTS: Improvement in students' knowledge, comfort, and confidence were statistically significant from prerotation to postrotation surveys. Student ratings on standard course evaluations showed positive ratings for all course elements. Qualitative analysis showed that all students identified learning more about trans-related health care as a learning priority. DISCUSSION: Clinical rotations focused on the care of LGBTQ+ patients are valuable learning experiences which can support increased student knowledge, comfort, and confidence. Clinically based educational interventions may be one strategy in addressing the health disparities experienced by LGBTQ+ people.

An Analysis of Lesbian, Gay, Bisexual, Transgender, and Queer Curricula Inclusion: A National Study of Physician Assistant Programs.

INTRODUCTION: The health professions education literature shows an increased focus on inclusion of lesbian, gay, bisexual, transgender, and queer (LGBTQ) content in curricula; however, it does not address hours of content or methods for content delivery. The purpose of this study was to describe the delivery of LGBTQ content in physician assistant (PA) education through a national survey of PA programs. METHODS: In 2021, a national program survey was sent to all US-accredited PA Programs (n = 284) and had a completion rate of 71.8% (n = 204). Descriptive statistics were conducted to describe trends and make comparisons in the delivery of LGBTQ content. RESULTS: Most PA programs are incorporating LGBTQ content into preclinical phases of PA education (81%) and describe that LGBTQ curricula align with institutional values (82%). Most report 1 to 3 hours of preclinical education for all LGBTQ population groups and cite medical interviewing courses as the most frequently used course to address LGTBQ care. Many programs (43%) do not provide instructional hours on LGBTQ content in the clinical phase, and the majority do not offer clinical rotations focused on this care. The results show variability in the level of preparedness that programs report on their students caring for LGBTQ populations. DISCUSSION: Physician assistant programs are generally integrating the content throughout their didactic curricula; however, few offer clinical experiences focused on caring for patients who are LGBTQ. Offering clinical experiences and assessing student competencies are areas of growth in health professions education as related to LGBTQ health.

COVID Collaborations: A Physician Assistant Program and Health Department Partnership.

ABSTRACT: The onset of the COVID-19 pandemic resulted in the displacement of clinical-phase medical learners across the country. Physician assistant (PA) and other health professions programs were challenged to innovate and offer alternate learning experiences that would meet students' needs as future health care professionals. At the same time, local and state health departments were faced with quickly increasing their capacity for contact tracing and case investigation in response to the growing number of COVID-19 infections. Through a collaborative partnership based on the needs of the local health department and clinical-phase PA students, the Duke PA program developed an elective in which students served as contact tracers and case investigators. PA students provided over 1500 hours of contact tracing and case investigation support to the local health department. Qualitative review showed students gained a greater appreciation of the impact of social determinants of health, saw first-hand how the pandemic disproportionately affected communities of color, and increased their knowledge about the role of public health. The partnership between the PA program and the health department was mutually beneficial and established a foundation for future collaborative experiences that support both the community and the needs of health professions' learners.

Implementing standardized substance use disorder screening in primary care.

OBJECTIVES: This quality improvement initiative aimed to develop and implement a protocol for an alcohol and substance use disorder screening for primary care. METHODS: The Two Item Conjoint Screen was selected and a process was piloted by care teams. Quality improvement tools were used to improve the protocol. Primary care providers (PCPs) were surveyed about their use of the screening protocol in the primary care setting. Data on total number of screenings were collected through the electronic health record. RESULTS: Implementation resulted in more than 30,000 screenings completed in 2016. PCP survey results indicated that PCPs felt screening was helpful in identifying potential substance use problems (100%) and that most providers (76%) felt that overall patient care improved after screening was initiated. CONCLUSIONS: Brief alcohol and substance use disorder screenings can be easily implemented and well integrated into primary care settings. PCPs found screenings to be valuable in caring for patients.