THROUGH my role as chair of the 2022 Australian Medical Students Association (AMSA) queer group, I have had the privilege of hearing from medical students across the country about their experiences with LGBTQIA+SB. bisexual, transgender, queer, intersex, asexual, Sistergirl and Brotherboy)* teaching. What I have been told has been nothing short of disappointing, frustrating and hurtful.
Medical education is failing LGBTQIA+SB people.
For a profession built on the values of beneficence, nonmaleficence, autonomy, and justice, it is concerning that our education about LGBTQIA+SB people, or lack thereof, does not uphold these same principles.
LGBTQIA+SB people are a diverse community with a rich and proud history, many of whom live healthy and happy lives. However, despite representing a significant proportion of Australia’s population, representation of LGBTQIA+SB teaching is poor within medical curricula nationwide, with most medical schools reporting 0-5 hours spent teaching LGBTQIA+SB content “during the required preclinical phase.” This curricular erasure then leads to a hidden medical curriculum that positions cisgender, heterosexual, endosexual, and alosexual people as the healthy “norm” and LGBTQIA+SB people as a pathological “other” (here Y here).
Equally worrying is that much of the limited content taught in Australian medical schools is done in ways that, in the experience of many LGBTQIA+SB medical students who identify stereotypes, pathologize and sometimes even actively discriminate against women. LGBTQIA+SB people, in turn teaching our future medical workforce to do the same.
At the public health level, the further consequences of poor LGBTQIA+SB teaching within medical education are clear. Health outcomes for LGBTQIA+SB people are significantly worse than non-LGBTQIA+SB people, and this health inequity is only magnified for underrepresented groups, particularly those with marginal intersecting identities (here Y here).
It is well established that these physical and mental health outcomes are not a direct consequence of being LGBTQIA+SB, but rather a consequence of the interpersonal, institutional, and sociocultural discrimination that comes with navigating the world as an LGBTQIA+SB person. Importantly, experiences of stigma and discrimination in health care, including the inability to access health professionals who have the knowledge and skills to provide LGBTQIA+ SB-inclusive health care, are an important factor in these health outcomes.
To date, the Australian Medical Council Standards for Assessment and Accreditation do not describe the need for specific LGBTQIA+ SB teaching within Australian medical curricula, despite AMSA calls and the Australian Medical Association (AMA) to do so. As a result, teaching about LGBTQIA+SB content is neither mandated nor standardized, with significant variation in the quantity, content, and quality of LGBTQIA+SB health topics taught.
This year, AMSA Queer reached out to students at 14 medical schools in Australia, revealing that not only is LGBTQIA+ SB health largely excluded from the curriculum, but most of the content that is included it is outdated, reductionist, inaccurate and harmful.
Student feedback indicated that LGBTQIA+SB health education is commonly limited to decontextualized mental health statistics, or stigmatizing and stereotypical tropes of gay men diagnosed with human immunodeficiency virus (HIV) infection. Other times, LGBTQIA+SB health and human rights may be represented in the context of ethical debate, such as framing access to gender-affirming care as an ethical dilemma rather than an evidence-based, gender-focused health care issue. the patient. Intersex people are frequently erased or pathologized, and students are inculcated with harmful language and ways of understanding innate variations in sex characteristics.
This poor LGBTQIA+SB education not only produces medical students and physicians who feel ill-equipped to navigate clinical encounters with LGBTQIA+SB patients, it also directly harms patients. Patients are denied competent healthcare professionals, often having to educate doctors about their health needs and advocate for themselves to access appropriate care.
During years, Medical students across Australia have called for a unified top-down commitment to the inclusion of LGBTQIA+SB teaching in the medical curriculum.. However, the responsibility for LGBTQIA+SB teaching still often falls on the shoulders of LGBTQIA+SB students. This means that in addition to being exposed to harmful and potentially triggering content in classrooms and halls, these students have a responsibility to educate their peers and staff, provide lectures and learning resources, and meet with faculty to advocate for a Curriculum. change. This work not only comes at a cost to students’ time and learning, but also to their mental health and well-being.
Generally speaking, medical schools are open to feedback on the curriculum and can often recognize the deficit of LGBTQIA+SB content within the curriculum once alerted to this issue. However, a major barrier often lies in the subsequent enactment of curriculum changes.
Understandably, the breadth of the topic is overwhelming for faculties, especially considering the inadequate training of LGBTQIA+ SB health staff themselves. Responses to student feedback often cite a lack of space within the curriculum, the time and effort involved in updating the curriculum, or simply a lack of clear solutions regarding what LGBTQIA+SB curriculum best practices look like. .
However, these challenges facing faculties should not come at the cost of trying to implement an LGBTQIA+SB curriculum, but rather warrant a new conception of what inclusion in medical education looks like. Importantly, this includes dealing with the historical and current role of medicine in perpetuating structural violence against LGBTQIA+ SB people, and a broader questioning of the normative biases in which medical pedagogy currently operates.
Where do we go from here?
AMSA Queer is working in this space through two key mechanisms: Wavelength and AMSA’s LGBTQIA+SB health and gender equity in the medical curriculum guide.
Wavelength is a free and open access educational resource on LGBTQIA+SB health for medical students and health professionals, designed to help fill current gaps in the medical curriculum.
Wavelength was founded by a group of medical students, with expert input from community representatives and LGBTQIA+SB health leaders, and is now managed by AMSA Queer. Wavelength modules serve as an accessible and interactive learning tool, providing lectures, clinical scenarios, and quizzes on LGBTQIA+SB health.
In addition to developing learning resources, AMSA Queer also advocates for nationwide medical curriculum reform to ensure all medical students receive structured LGBTQIA+ SB health instruction. AMSA is developing its LGBTQIA+SB Health and Gender Equity Guide in Medical Curricula, a collaboration between AMSA’s Queer and Gender Equity groups, and seeks to answer the question of what best practice curriculum looks like. This document will serve as an up-to-date, evidence-based, community-reviewed tool for medical school faculty, medical student societies, and individual student advocates to use as a starting point for mainstreaming LGBTQIA+ education. SB in their respective study plans.
The guideline recommendations will focus on scaffolding LGBTQIA+SB health into the medical curriculum through an integrated, skills-based framework that is explicitly intersectional, community-led, and transdisciplinary in nature.
Key recommendations explored in the guide will include:
- development of postgraduate outcomes specific to LGBTQIA+SB health;
- integrating a long-term iterative LGBTQIA+SB curriculum into existing medical curricula, including language-specific learning objectives, clinical and professional knowledge and skills relevant to working with LGBTQIA+SB individuals;
- adoption of an intersectional approach to all LGBTQIA+SB teaching;
- use of transdisciplinary and multimodal teaching methods, including formal and informal assessment;
- community-led teaching that prioritizes lived experience and co-design of the curriculum;
- training and improvement of all teaching staff in health and LGBTQIA+SB terminology;
- considerations for safeguarding the safety and well-being of LGBTQIA+SB students; Y
- implementation of accessible and anonymous student feedback mechanisms.
It is important to note that a broader reconstruction of the curriculum must also be accompanied by simpler changes that can be carried out as soon as possible. Examples of such changes include removing directly harmful content, adopting inclusive language, adding diverse patients to clinical vignettes, and being responsive to student comments and concerns.
The time has come for medical schools across the country to look to the future of the LGBTQIA+SB medical curriculum. LGBTQIA+SB people deserve access to health care providers who have the knowledge and skills to deliver inclusive, patient-centered care. Medical education is uniquely positioned to bring this knowledge and skill to an entire generation of new health professionals, thereby transforming the health care experiences of LGBTQIA+SB people across the country.
What are we waiting for?
* LGBTQIA+SB stands for Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, Sistergirl, and Brotherboy, and the “+” indicates the expansive and non-exhaustive nature of the acronym to represent all people of diverse gender identities and sexualities . and sexual characteristics.
Flynn Halliwell is the AMSA Queer President 2022 and a Doctor of Medicine (MD) student at the University of Melbourne.
AMSA is the main representative body for Australia’s 17,000 medical students. AMSA Queer is the representative body for queer medical students and works to improve health outcomes for all LGBTQIA+SB people through education and advocacy.
Statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent official WADA policy, SERVER either Vision+ unless otherwise indicated.
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