Abstract
This cross-sectional study examines the extent to which an online dermatology curriculum for medical students incorporated lesbian, gay, bisexual, and transgender health-related content.
Lesbian, gay, bisexual, and transgender (LGBT) persons in the United States account for 2.2% to 4.0%1 of the population and face considerable health disparities, generally and specifically related to dermatology.2,3,4 According to Healthy People 2020, the federal government’s public health agenda, these disparities partially arise from a shortage of health care professionals who are knowledgeable and culturally competent in LGBT health.2 Mitigating LGBT health disparities is a focus of Healthy People 2020 and the Association of American Medical Colleges (AAMC).2,5 The AAMC guidelines recommend that medical schools integrate LGBT health-related competencies throughout their curricula, especially through use of clinical scenarios that incorporate discussion points specific to this population.5 We investigated the extent to which an online dermatology curriculum for medical students incorporated LGBT health-related content.
Methods
We conducted a cross-sectional study of the American Academy of Dermatology’s (AAD) online Basic Dermatology Curriculum, which consists of case-based modules. The curriculum was created by the AAD in collaboration with the Society for Pediatric Dermatology (SPD). Most modules have an associated learner quiz, allowing students to assess their knowledge after module completion.
All curriculum modules (in PDF format) and quizzes were downloaded from the American Academy of Dermatology Association Basic Dermatology Curriculum Website (http://www.aad.org/education/basic-derm-curriculum) on November 20, 2017. Patients’ gender or sex, dating or marriage status, sexual orientation, and sexual behavior were all recorded. For pediatric modules, patients’ parents were characterized by parental status (mother, father) and marriage status.
Results
The curriculum consisted of 293 patients, with 157 in 40 modules and 136 from 36 quizzes, including 121 pediatric patients. Characteristics of patients and, for pediatric cases, patients’ parents are shown in the Table. One of 293 (0.3%) cases mentioned an LGBT patient, a woman with basal cell carcinoma (BCC) in a same-sex marriage. No cases included a transgender patient, mentioned same-sex sexual behavior, or specified sexual orientation.
Table. Characteristics of Patients and Pediatric Patients’ Parents in the Basic Dermatology Curriculum.
| Characteristic | No. (%) |
|---|---|
| Patients | 293 (100) |
| Gender or sex | |
| Male, man, boy, or he | 141 (48.1) |
| Female, woman, girl, or she | 121 (41.3) |
| Cisgender specifieda | 0 |
| Transgender specifiedb | 0 |
| Not noted | 31 (10.6) |
| Adult patients | 172 (58.7) |
| Marriage or dating status | |
| Opposite-sex marriage | 23 (13.4) |
| Marriage between persons of unspecified gender(s) | 6 (3.5) |
| Same-sex marriage | 1 (0.6) |
| Opposite-gender dating relationship | 1 (0.6) |
| Not noted | 141 (82.0) |
| Sexual orientation | |
| Not noted | 172 (100) |
| Sexual behavior | |
| Opposite-sex sexual partner | 1 (0.6) |
| Sexually active, not further specified | 1 (0.6) |
| Not noted | 170 (98.8) |
| Pediatric patients | 121 (41.3) |
| Parent(s) | |
| Mother | 35 (28.9) |
| Father | 6 (5.0) |
| 2 Parents (gender[s] unspecified) | 5 (4.1) |
| Not noted | 75 (62.0) |
| Parental marriage status | |
| Marriage between persons of unspecified gender(s) | 59 (48.8) |
| Opposite-sex marriage | 9 (7.4) |
| Same-sex marriage | 0 |
| Not noted | 53 (43.8) |
The term cisgender refers to persons whose gender identity aligns with their sex assigned at birth.
The term transgender refers to persons whose gender identity does not align with their sex assigned at birth.
Discussion
This study shows a near-absence of LGBT-related content in the AAD and SPD’s Basic Dermatology Curriculum. This paucity of content represents a missed opportunity to educate medical students in providing medically appropriate and culturally competent care to LGBT persons in dermatology settings, even as the importance of these competencies to dermatologists is increasingly noted in the medical literature.3,4,6 This absence might also signal to medical students potentially interested in pursuing dermatology, and to residents, dermatology faculty, and other educators who use this curriculum, that LGBT health is not important in dermatology.
It is possible that other dermatology-related educational materials besides the Basic Dermatology Curriculum not assessed in this study incorporate more LGBT health-related content. However, considering this study’s findings and recommendations from Healthy People 2020 and AAMC, AAD, and SPD should include more cases involving LGBT persons in the curriculum. Some cases should highlight dermatologic issues of specific importance to LGBT health.3 For example, some evidence suggests that lifetime prevalence of nonmelanoma skin cancer in sexual-minority women is lower, and in sexual-minority men is higher, than in heterosexuals.6 As in the case of the woman with BCC in a same-sex marriage, other cases should feature patients without LGBT-specific dermatologic concerns (or parents of children with dermatologic concerns); in line with AAMC recommendations, those cases can sensitize students to general issues of LGBT-related cultural competency (for example, appropriate use of pronouns and other terminology).5 Per AAMC recommendations, to ensure that medical students are achieving relevant competencies through the online curriculum and other sources, medical student evaluations should include LGBT-related content in examination questions, evaluation scenarios, and patient scenarios.5 Graduate and continuing medical education in dermatology should also include LGBT health-related content to help dermatologists provide appropriate care to LGBT persons.
References
- 1.Gates GJ. LGBT Demographics: Comparisons among population-based surveys. The Williams Institute, UCLA School of Law; 2017. http://williamsinstitute.law.ucla.edu/wp-content/uploads/lgbt-demogs-sep-2014.pdf. Accessed December 21, 2017.
- 2.Office of Disease Prevention and Health Promotion Lesbian, Gay, Bisexual, and Transgender Health. Healthy People 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health. Accessed November 20, 2017.
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