Improving LGBT Patient Cultural Competency of Internal Medicine Residents

Background: A survey of 176 allopathic medical schools in North America revealed that only 5 hours were dedicated to teaching LGBT-related content over 4 years. The LGBT community faces healthcare challenges and barriers to accessing care, further exacerbated by healthcare practitioners’ discomfort with asking difficult questions. Taking a comprehensive sexual history helps build initial rapport with LGBT patients; thus, we set out to assess internal medicine residents’ comfort level in obtaining a sexual history from LGBT patients.

Methods: We administered a survey to 47 residents and 2 staff physicians from the internal medicine residency program to measure their baseline level of comfort taking an LGBT sexual history. Respondents selected from the following options: very comfortable, comfortable, neutral, uncomfortable, and very uncomfortable. Additional questions asked about previous sexual history taking training and exposure to training specifically tailored to LGBT patient care. We implemented training modules and lectures in an effort to improve both comfort and overall competency in caring for our LGBT patients. The same survey was administered to residents following workshops and lectures to quantify any improvement in comfort level following the educational initiative.

Results: A Fisher exact test demonstrated a statistically significant difference in the level of comfort in taking a sexual history from LGBT patients compared to heterosexual patients (P < 0.0001). Additionally, 30% percent of those surveyed described their level of training in LGBT sexual history taking as “some, but inadequate,” and 1 in 5 (20%) responded they had received “no training.” Based on this information, we incorporated several workshops and lectures into the internal medicine resident curriculum, including a sexual history taking workshop, a lecture on HIV preexposure prophylaxis, and topics commonly encountered in the LGBT primary care setting.

Conclusion: Disparities in healthcare continue to affect the LGBT patient population. We demonstrated a statistically significant difference in internal medicine residents’ comfort level in obtaining a sexual history from LGBT patients. The goal of implementing LGBT-specific teaching into the internal medicine curriculum was to improve the comfort level in sexual history taking and reduce this healthcare disparity. After quantifying the effect that educational sessions have had on sexual history taking comfort, we will use this information to further design educational initiatives aimed at improving LGBT cultural competency and working toward eliminating disparities in LGBT patient care.