By Will Boggs MD
NEW YORK (Reuters Health) - Lesbian, gay, bisexual and transgender (LGBT) persons make up as much as 4% of the population but are barely mentioned in the basic dermatology curriculum, researchers report.
"A lack of healthcare providers who have the medical and cultural competency to care for LGBT patients contributes to LGBT health disparities and to negative experiences in healthcare settings that surveys show many LGBT persons have had," said Dr Kenneth A. Katz from Kaiser Permanente in San Francisco.
"Improving LGBT health is increasingly a national public health and clinical priority. The paucity of LGBT health-related content in the online Basic Dermatology Curriculum shows that opportunities exist to expand LGBT-health-related education for dermatologists and dermatologists in training," he told Reuters Health by email.
Guidelines from the Association of American Medical Colleges (AAMC) recommend integration of LGBT health-related competencies throughout medical school curricula, especially through the use of clinical scenarios that incorporate discussion points specific to this population.
Dr Katz and Andrew J. Park investigated the extent to which LGBT health-related content was incorporated into the American Academy of Dermatology's online Basic Dermatology Curriculum, which consists of 293 patients, including 121 pediatric patients, in 40 modules and 36 quizzes.
Only one of the cases (0.3%) mentioned an LGBT patient, a woman with basal cell carcinoma in a same-sex marriage, the two researchers report in JAMA Dermatology, online March 28.
There were no cases involving a transgender patient, and none mentioned same-sex sexual behavior or specified sexual orientation.
"Including more LGBT-health related content in the online Basic Dermatology Curriculum - as well as other educational materials aimed at dermatologists and dermatologists in training - will help dermatologists achieve the medical and cultural competency to best take care of their LGBT patients," Dr Katz said.
"It's clear that the American Academy of Dermatology and the Society for Pediatric Dermatology, which are the organizations that produced the online Basic Dermatology Curriculum, are committed to excellence in patient care and value inclusiveness and diversity," he said. "Colleagues and I look forward to working with those organizations to incorporate more LGBT health-related material into the curriculum. Doing so would help improve dermatologists' ability to provide the best possible care for LGBT patients."
American Academy of Dermatology President Dr Suzanne N. Olbricht told Reuters Health by email that the society "recognizes that lesbian, gay, bisexual, and transgender (LGBT) patients need the same kinds of culturally competent and sensitive care that other patients do. There are exciting changes happening at the Academy and with other health care organizations and providers to address the health care disparities that exist and benefit the health of the LGBT patients we serve."
She noted that the Basic Dermatology Curriculum is currently being revised to include LGBT-related content, among other updates.
"In addition to the Basic Dermatology Curriculum, the Academy educates dermatologists through its Annual and Summer Scientific Meetings, its Board Certification Prep courses, and its Core Curriculum in Dermatology, which is also being updated to include sessions on cultural competence, sensitivity to diverse populations, and transgender health. All of these educational opportunities have components aimed at enhancing the health care provided to LGBT patients," she said.
Nicole DiVito, public relations specialist at the society, added that it offers the following LGBT-related sessions at its Annual and Summer Scientific Meetings:
-LGBT Health: Providing Culturally Competent Care to Patients Who Are Sexual and Gender Minorities.
-Gender Dermatology: Diagnosis and Treatment of Genital Skin Disorders.
-Taking Care of Gay Men and Other Men Who Have Sex with Men: What the Dermatologist Needs to Know.
Dermatologist Dr Carrie Kovarik from the University of Pennsylvania, in Philadelphia, said she was not surprised by the lack of LGBT content in the current curriculum.
"Although there are a large number of social factors that have emerged as influencers of health outcomes, modern medicine continues to be focused on the biologic basis of disease, with desocialization of the medical work-up, leading to missed opportunities for proper diagnosis, treatment, and complete care of the patient," she told Reuters Health by email.
"As mentioned in the article, we know that there are specific LGBT issues that play a pivotal role in the prevalence of certain skin diseases, and this could easily be incorporated into the learning modules," said Dr Kovarik, who was not involved with the new work.
"As physicians, it is our duty to take care of the entire patient the best way we can, which includes considering all past medical, family, and social history, taking a thorough history of the current problem, and doing a physical examination," she said. "We must communicate with our patients in a respectful way, allowing us to develop a rapport that will build trust. This interaction will ultimately allow us to make a diagnosis and build the best treatment plan for the patient, taking into account all of the factors that are specific to each patient. We need to teach this to our medical students and residents - helping them to realize it's more than making a diagnosis and giving a medication."
Dr Brian A. Ginsberg from Icahn School of Medicine at Mount Sinai, New York, who has reviewed dermatologic care of the transgender patient, echoed Dr Kovarik's reaction to the new findings.
"Unfortunately, I did not find the results surprising, as I remember experiencing this paucity of content during my training. It's disheartening to know that this remains the case," he told Reuters Health by email.
"The more exposure a provider has to LGBT patients and issues, the better they will be able to care for their patients," said Dr Ginsberg, who was not involved in the new work. "This includes better medical care as well as more culturally competent care. Medical schools and residency programs should actively add content to their own curricula so that such issues are reinforced throughout training. Journals should seek and publish LGBT-related content. The issues should then be tested on major exams to emphasize their importance to trainees."
JAMA Dermatol 2018.
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