Riley Darby-McClure, a medical student at University of Oklahoma College of Medicine, understands what it's like to experience the healthcare system as a transgender individual. When LGBTQ care was only briefly discussed during the first two years of medical school, they were concerned.
"It was important to me going to medical school to make sure that my peers and I were getting educated" on the LGBTQ community, Darby-McClure said.
There is evidence that shows LGBTQ individuals face discrimination when seeking healthcare. Some providers deny transgender individuals care and physicians and nurses have a history of asking inappropriate questions or making wrong assumptions about healthcare needs for LGBTQ persons.
That's likely in part because medical education overall doesn't significantly address healthcare specific to the LGBTQ community. A 2011 study found on average 132 U.S. and Canadian medical schools spent 6.5 hours overall on LGBTQ content. There was also wide variability in the topics the schools addressed.
Although more schools have incorporated LGBTQ education in recent years, it's still not a topic schools spend much time on, said Dr. Shauna Lawlis, an assistant professor at the University of Oklahoma College of Medicine who treats transgender adolescents in her practice.
Darby-McClure said they approached Lawlis last spring to implement a program for students focused on appropriately interacting with LGBTQ patients in a clinic setting.
Lawlis, Darby-McClure and another faculty member put together the program, which involves a one-hour didactic session, a few hours in a clinic interacting with LGBTQ patients and discussion afterward. In total, the program is about four to five hours long. Lawlis said while that's still not much time, more lectures on LBGTQ care have been added as well to the curriculum.
The didactic involves discussing the health disparities the LGBTQ population experiences, the historic lack of knowledge from providers on LGBTQ care, the difference between sex and gender and how to tactfully ask questions about sexual behavior, sexual orientation and hormone therapy. The didactic employs cultural humility, which is reflecting on personal biases towards a culture and a heightened awareness of the culture's unique sensitivities.
The clinical portion involves volunteers from the LGBTQ community scripting different scenarios that may come up in a visit such as getting a prescription for pre-exposure prophylaxis for HIV or a transgender individual asking about fertility.
"That helps us challenge the assumption trans people aren't interested in reproducing," Darby-McClure said.
The student sits down in a simulated clinical environment with the volunteer to ask and answer questions pertinent to the scenario. Afterward, the students discuss the experience as a class such as what they learned and what was challenging.
The course design was inspired by other medical school programs as well as Lawlis' and Darby-McClure's own experiences with the LGBTQ community, Lawlis said.
The pilot, which occurred last April, was well-received by the roughly 30 students who participated, Darby-McClure said.
"It better empowered me to take care of patients within the LGBTQ+ community, and even beyond that, using cultural humility to approach patient care," said Danial Gebreili, an Oklahoma College of Medicine student who participated in the pilot.
The volunteers also enjoyed the experience because they were asked for their input on the questions and scenarios presented.
"They felt they were listened to and they were having an effect on medical education," Darby-McClure said.
This year, the program received a grant to continue the program for all second-year medical students. The $5,000 grant also allowed the school to pay the volunteers.
The students completed the course in January before COVID-19 forced schools to transition to virtual classes.
Lawlis said it's unclear if another grant will be offered to continue the program next year, but she's interested in studying its impact on the more than 150 students who have now experienced it.
Darby-McClure said it would be wonderful if the school expanded the program to other underrepresented populations too.
"That will contribute to more realistic educational experiences for students that really need to be exposed to different cultures," they said.