BOSTON, April 14, 2022—A paper published in Academic Medicine documents lessons learned from a pilot sexual and gender minority (SGM) health curriculum offered to clinicians working at NYC Health + Hospitals from 2017-2020. The program is believed to be the largest and most comprehensive single-institution sexual and gender minority health education program to engage professionally diverse employees across multiple practice facilities. It contributed important new knowledge to efforts to provide professional development and training to clinicians in how to meet the healthcare needs of LGBTQIA+ people.
“LGBTQIA+ people experience disparities in health outcomes, including mental health, substance use, preventive care, and HIV and sexually transmitted infections,” said study co-author Hilary Goldhammer, SM. “A contributing factor to these disparities is a lack of comprehensive education about LGBTQIA+ people during formative clinician training. Consequently, there is a dearth of clinicians with expertise in the healthcare needs of LGBTQIA+ people.”
“The Joint Commission recommends that practicing clinicians and other staff receive sexual and gender minority health education,” added study senior author Dr. Alex S. Keuroghlian, who directs the National LGBTQIA+ Health Education Center at The Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program. “Optional training of some clinicians may be helpful for reducing health disparities, but this may be insufficient to ensure adequate knowledge and skill among all clinicians. System-wide training may be what is needed to make significant progress.”
NYC Health + Hospitals is the largest public health care system in the United States, employing approximately 6,000 clinicians at 11 acute care hospitals, over 70 neighborhood clinics, and other health care facilities that serve more than 1 million people in New York City. In this pilot study, NYC Health + Hospitals engaged the National LGBTQIA+ Health Education Center at The Fenway Institute at Fenway Health to design and implement a SGM health care curriculum for clinicians. The pilot program featured a 90-minute live introductory session, a pre-test, a post-test, and six 45-minute online learning modules focusing on a range of topics in SGM health care. Modules include video of LGBTQIA+ patients sharing their experiences in clinical settings.
NYC Health + Hospitals encouraged participation by clinicians in the pilot program by promoting it in emails, posters, and screen saver messages. Clinicians who completed the curriculum earned the Certificate of Advanced Training in LGBTQ Healthcare for promotion to patients as SGM-affirming providers.
Of the 6,000 clinicians eligible to participate at NYC Health + Hospitals, 792 enrolled in the program, with a majority of participants employed at acute care hospitals. Of the 792 participants, 372 (47%) completed all of the training modules. With a mean pre-program test score of 60.9 and a mean post-program test score of 81.9, those who completed the program demonstrated significantly higher knowledge of SMG health care.
The study’s authors recommend that future system-wide programs of SGM health care education invest in more rigorous program evaluations. In addition to a post-program test, evaluators could solicit feedback from participants about how likely they believe that the training will alter their practice. But the most rigorous evaluation would involve measuring changes in process and clinical outcomes.
“SGM health outcomes can be measured by examining data in electronic health records,” said lead author Dr. Kevin Ard, Medical Director of the National LGBTQIA+ Health Education Center at The Fenway Institute and Director of the Sexual Health Clinic at Massachusetts General Hospital. “As an example, it would be meaningful to examine the proportion of LGBTQIA+ patients in the electronic health record and the proportion receiving appropriate preventive health screenings. Measuring these outcomes prior to launching a training program would set a baseline for evaluation while also providing information about areas of need that the training program should focus on.”
Study authors also recommend that institutions investing in SGM health education training for clinicians allocate resources to encouraging clinicians to participate and assessing the reasons for non-participation.
“Reasons for lack of participation could have ranged from lack of awareness that the program was available, a self-perception of pre-existing expertise, limited interest in SGM health, time constraints or other factors,” added Ard. “Without a good understanding of why clinicians opted not to participate, it’s hard to develop meaningful recruitment strategies going forward.”
“A Pilot Sexual and Gender Minority Health Curriculum for the Largest Public Health Care System in the United States,” is available online here.