Sexual and Gender Minority Curricula Within US Dermatology Residency Programs

Abstract

This survey study assesses what health topics specific to sexual and gender minority patients are covered in dermatology residency programs to identify possible gaps and guide improvements.

Sexual and gender minority (SGM) patients face many health challenges, including higher burdens of skin cancer, sexually transmitted diseases, and complications associated with hormone therapy or gender-affirming surgery.¹ Improving clinician knowledge of SGM patients’ health needs may improve quality of care for this population.² The goal of this study was to assess what SGM-specific health topics are covered in dermatology residency programs to identify possible gaps and guide improvements.

Methods

In August 2018, a web-based survey (eAppendix in the Supplement) was sent to the 123 US dermatology residency programs represented by the Association of Professors of Dermatology listserv (electronic mailing list), requesting 1 response per program. The survey was adapted from surveys used to assess SGM residency curricula in other medical specialties^3,4 and included questions about residency demographic characteristics, integration of SGM content, importance of SGM-specific training, barriers to integration, and opinions on best ways to incorporate SGM-specific topics. This study was deemed exempt by the Stanford University Institutional Review Board as the study incurred no more than minimal risk and involved research on established or commonly accepted educational settings. Written informed consent was obtained by each participant prior to completing the survey instrument.

Descriptive statistics were used to report program demographic and curricular information. Missing survey question responses were excluded from analyses.

Results

Of 123 residency programs contacted, 90 surveys were returned (73% response rate). Four respondents did not complete the survey, and missing question responses from these surveys were excluded from the analysis. Most program directors acknowledged the importance for residents to receive training on the care of SGM patients (72 of 89 [81%]) (Table). Most programs reported training on dermatologic concerns secondary to HIV/AIDS (66 of 90 [73%]). More than one-fourth of programs (25 of 90 [28%]) had curricular content on gender minority or transitioning care. Eighteen of 90 programs (20%) reported there were no topics relevant to SGM patients in their curricula. Approximately half (45 of 89 [51%]) of programs reported considering adding SGM content in the next 5 years. The most common perceived barriers to curricular integration of SGM content were insufficient time in the curriculum schedule (59 of 86 [69%]) and lack of experienced faculty (53 of 86 [62%]).

Table. SGM Needs Assessment Survey Results.

Participant responses	Participants who responded, No. (%) (N = 90)
Demographic characteristic
Geographic location
Northeast	27 (30)
Southeast (including Texas)	17 (19)
Southwest	8 (9)
Pacific Northwest (including California, Idaho, Montana, Hawaii, and Alaska)	19 (21)
Midwest	19 (21)
Program size (residents)
1-3	6 (7)
4-8	28 (31)
9-15	34 (38)
≥16	22 (24)
Curricular integration
Importance of trainees to receive training in SGM carea
Very important	53 (59)
Somewhat important	19 (21)
Neutral	15 (17)
Not important	2 (2)
Don’t know	0
Integrated curricular topics
Dermatologic concerns secondary to HIV/AIDS	66 (73)
Pronoun use	23 (26)
SGM skin cancer risk	22 (24)
Effect of hormone therapy on transitioning patients	16 (18)
Injectable neurotoxin and filler for transitioning patients	15 (17)
SGM-oriented history taking and physical examination	11 (12)
Dermatologic concerns regarding gender-confirming surgeries	3 (3)
Dermatologic concerns associated with puberty blockers for pediatric patients	2 (2)
Current No. of hours dedicated to SGM content
0	41 (46)
1-2	33 (37)
≥3	16 (18)
Desired No. of hours dedicated to SGM content
0	6 (7)
1-2	32 (36)
3-5	31 (34)
6-10	8 (9)
≥10	1 (1)
Unsure	12 (13)
Barriers to SGM-content integration (“lack of…”)b
Time in curriculum schedule	59 (69)
Experienced faculty	53 (62)
Funding	18 (21)
Interested faculty	17 (20)
Need	17 (20)
Culture to support inclusion
Department	14 (16)
Institutional	3 (3)
Other	5 (6)
None	11 (13)
Best ways to incorporate SGM dermatology contentc
SGM integration in all relevant lecture topics	63 (73)
Online training or modules	51 (59)
Didactic lectures from visiting faculty or topic experts	44 (51)
Small group discussions	36 (42)
Didactic lectures from core program faculty	25 (29)
Optional elective	12 (14)
Mandatory rotation	3 (3)
Other	2 (2)
Program considering adding SGM content in the next 5 ya
Yes	45 (51)
No	14 (16)
Unsure	30 (34)

Abbreviation: SGM, sexual and gender minority.

^aEighty-nine responses to these questions.

^bEighty-six responses to this question.

^cEighty-seven responses to this question.

Discussion

Although most dermatology residency programs reported that training in the care of SGM patients was important, curricular integration was inconsistent. Most programs included training on dermatologic conditions secondary to HIV/AIDS, with less frequent curricular integration of other SGM-related topics. Dermatology residency programs faced barriers in integrating content about the care of SGM patients. Programs may benefit from centralized resources from organizations such as the American Academy of Dermatology, with expert speaker lists and opportunities for virtual lectures to promote more accessible training on dermatologic topics relevant to the care of SGM patients. Dermatologists who are interested in improving SGM curricula and training may also consider joining the American Academy of Dermatology Expert Resource Group on LGBTQ (lesbian, gay, bisexual, transgender, and queer) and SGM health, where members actively share institutional best practices and educational resources. In addition, academic conferences such as the American Academy of Dermatology’s annual and summer meetings often include SGM and LGBTQ sessions, which program directors, faculty, and residents could attend. Finally, continuing to encourage SGM-related questions on the American Academy of Dermatology board preparatory question bank and on the American Board of Dermatology basic, core, and applied examinations is an important step to encourage trainees to become familiar with relevant material.

The limitations to this study include the cross-sectional design without longitudinal data. Some programs may not have been reached through the Association of Professors of Dermatology listserv, and we cannot ensure that programs did not complete the survey multiple times, although we requested only 1 response per program. There also may be limited recall of curriculum content by participants. Despite its limitations, this study is a valuable snapshot of the present curricular integration of SGM-related topics within US dermatology residency programs.

The American Academy of Dermatology’s recent position statement on SGM patient health in dermatology highlights the importance of including SGM content in curricula at all stages of training.⁵ Dermatology residency program leaders agree that SGM content in residency training is important, and significant gaps in curriculum content currently exist. Creating available resources to address these gaps is essential to providing high-quality, culturally competent care for SGM patients.

Supplement.

eAppendix. Sexual and Gender Minority Curricula and Diversity Survey