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Training The Next Generation Of Doctors To Get LGBT Health Right

If you're gay or lesbian or bisexual or transgender, odds are that you've had a doctor flinch or flounder through an appointment. The next generation of physicians needs to do better, the Association of American Medical Colleges announced Tuesday.

The organization published a 306-page manifesto intended to change medical school curricula so that future doctors are competent in helping patients who are LGBT, gender nonconforming or born with sex differences in development.

How's that going to work? We asked Dr. Scott Leibowitz, an assistant professor of child psychiatry at Northwestern University's Feinberg School of Medicine. Leibowitz studies gender identity in children and teenagers, and was part of the committee who wrote the manifesto. This is an edited version of our conversation.

How did this decision come about?

There are surveys that clearly show that doctors aren't comfortable around this issue. And the many health disparities that continue to exist for these patients are clear-cut and well documented.

Many people don't trust their health care providers; I think there's good reason behind that. We all have blind spots; even well-meaning providers do. But we want everyone to feel welcome, and to feel that their unique needs are being met.

How have med schools been teaching about LGBT health?

Some medical schools are already doing a good job; usually there are a lot of student-led initiatives and also faculty champions. But even in the best of medical schools a significant barrier is faculty; not all the teachers are up to speed on this.

So how do you want to go about changing that?

We've moved away from trying to add extra content. It's not adding a lecture on gay or lesbian people, it's not adding a lecture on transsexual people, because that continues to reinforce the idea that they are other.

Instead, we translated the issues into the language of what we call competency-based medical education in pre-existing courses. We're not saying add an endocrinology course on what it means to be transgender. We're saying when you're already teaching on the hormonal axis, say, "For transgender people this is how it would be."

We give them very useful examples: here's where you could potentially insert this in your preclinical years; here's how you could potentially insert this in your clinical years.

I can't say more strongly how revolutionary this document is. We've set the bar really high by defining 30 competencies that all medical students need to have. But there's a lot of work that needs to take place.

One huge issue is how people are treated when they're in the doctor's office or ER. A lot of people feel that they're treated with disrespect. How did you address that?

Being able to develop rapport with all individuals is one of the competencies that we address, regardless of gender identity, gender orientation or body type. Nonverbal facial reactions can sometimes make a patient feel judged, or feel like they're not going to be able to disclose what they're truly ashamed about. And that may mean they're not going to get care that they need. Even if it's something positive, like positive healthy sexual development for someone who engages in male-to-male sex. Doctors need to be able to promote positive images of sexual health to individuals who may be having a different type of sexual behavior than they are. Everyone's entitled to positive sexual health.

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