Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Others (LGBTQI+): Providing Comprehensive Care Across the Spectrum

Background

It is imperative for faculty and staff involved in health professions education to be culturally sensitive in serving an increasingly diverse student population. Cultural humility and sensitivity create a sense of belonging and inclusion for learners while simultaneously modeling behaviors that encourage them to inculcate the same approaches in their professional careers. It is therefore critically important that healthcare professional school personnel acquire the skills necessary to effectively cultivate an inclusive learning environment and train students to appropriately and effectively practice culturally competent health care. Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and other (LGBTQI+) population individuals are an example of such diverse groups that experience disparate outcomes in health care and while there is growing evidence that increasing the representation of gender and sexual minorities in the healthcare workforce could improve the health care experience and outcomes for LGBTQI+ individuals (Phelan et al., 2017; Rowe et al., 2017), health professions students that are a part of this demographic often face many challenges along their educational paths. Health professions students that identify as gender and sexual minorities often face anti-LGBTQI+ discrimination and heterosexism which contributes to a non-inclusive and hence suboptimal learning environment (Lapinski and Sexton, 2014). Gender diverse students are reluctant to disclose their gender in the classroom because of fear of bias, discrimination and marginalization (Dimant et al., 2019). The encounters met by gender diverse students often correlates to increased stress and reduced academic success of LGBTQI+ students (Nama et al., 2017; Ryus et al., 2022).

The challenges faced by LGBTQI+ students may be driven, in part, by explicit and implicit biases of colleagues, faculty, and staff. Explicit biases are attitudes and beliefs that individuals are aware of and can consciously control while implicit biases are attitudes and beliefs that are outside of the conscious awareness of the individual (Phelan et al., 2017). Biases among health professions students toward LGBTQI+ individuals are common and in one large study of heterosexual, first-year medical students greater than 50% exhibited both implicit and biases toward LGBTQI+ individuals (Burke et al., 2015). Similarly attitudes among educators toward LGBTQI+ students are likely a contributor to negative experiences and challenges faced by these individuals.

Several strategies are presented to enhance LGBTQI+ cultural competencies and to create a safe and affirming learning environment. Proficiency training for health care school personnel and students has been shown to mitigate biases, discrimination and microaggressions in learning environments by increasing the knowledge and cultural awareness of the faculty, staff, and students. Such exercises improve cultural awareness and proficiency and translate to improved healthcare outcomes for the LGBTQI+ population.