Prevalence and curriculum of sexual and gender minority education in Japanese medical school and future direction

Linguistic equity: Anatomy educators and inclusive language

Incorporating inclusive language in healthcare education allows learners to develop holistic communication skills. Adhering to principles of linguistic equity in healthcare, specific to sex- and gender-inclusive language (SGIL), creates a safe environment for all participants. Anatomy education introduces students to a standard, consistent language used in healthcare. This report presents data from the 2022 Experimental Biology conference roundtable discussion regarding the use of SGIL in anatomy education. Most of the respondents had defined sex (i.e. male/female; 83%) and gender (i.e. man/woman; 66.7%) for their learners since 2018 (67.4%). Most often, sex- and gender-diverse (SGD) topics are discussed during the pelvis, perineum, and reproduction content (50%). While teaching teams and departments have made attempts, most believe the current use of SGIL is inconsistent (66.7%). Although there is no consensus on best practice, a few recommendations emerged, including (1) early integration of linguistic equity, (2) patient-centered educational interventions, and (3) multi-level discussions. These data and recommendations should be treated as a pilot for future research. Future studies should investigate anatomy educators' use of SGIL, including modality, context, bias, time, duration, and integration of SGD topics, students' response, perspective, and implementation in clinical practice.

Heteronormativity and cisgenderism in medical training: A scoping review of lesbian, gay, bisexual, transgender, queer and plus (LGBTQ+) issues in medical training in Asia

Lesbian, gay, bisexual, transgender, queer and plus (LGBTQ+) related health concerns in medical training have historically been underrepresented or largely omitted. This review goes beyond the Global North and is one of the first scoping reviews to take a regional approach to understanding LGBTQ+ issues in medical training in Asia, a region that millions of LGBTQ+ people call home. A scoping review of peer-reviewed articles published from 2000 to 2024 on LGBTQ+ issues in medical training (including medical, nursing and dentistry) in Asia was conducted. A diversity of attitudes towards LGBTQ+ issues were found among medical, dental, and nursing students. Negative attitudes, especially pathologization of LGBTQ+ people, were still evident. Despite receiving inadequate training from their medical curriculum, students generally showed a strong eagerness to learn more about LGBTQ+ healthcare to know how to act professionally. Although LGBTQ+ students perceived a supportive environment among their peers, there were constant worries about how they were perceived as doctors by attending physicians and patients. Medical, dental, and nursing educators in the identified studies had minimal knowledge of LGBTQ+ issues and limited experience working with LGBTQ+ patients. Articles found that LGBTQ+ issues were lacking in the formal medical curriculum, with very little consideration beyond strictly biomedical concerns. Importantly, this paper debunks the idea that Asia is uniformly negative and conservative on LGBTQ+ issues, highlights the importance of regionally and culturally specific factors in understanding the medical training environment, and provides suggestions for practice and further research. Altogether, this paper argues that there is an urgent need and a substantial opportunity to make medical training in Asia more LGBTQ+ inclusive.

Characterization of content associated with lesbian, gay, bisexual, transgender, intersex, and queer individuals in Chilean medical schools: a cross-sectional survey

BACKGROUND

Lesbian, gay, bisexual, transgender, intersex, queer, and other sexual and gender identities (LGBTIQ+) individuals face health inequities. Additionally, medical students report a lack of confidence in providing specific health care to LGBTIQ + individuals, and medical schools do not offer the breadth and depth of coverage needed to fully prepare and make them comfortable in caring for these individuals. This study aims to characterize the teaching of curricular content related to LGBTIQ + health issues in medical schools in Chile.

METHODS

This was a cross-sectional descriptive mixed-methods study based on a 15-question survey sent to school directors of the 24 medical schools in Chile, conducted between October 2020 and July 2021. The questions included in the study were mostly based on two pre-existing questionnaires covering content, assessment methods, and identification of barriers to teaching this content.

RESULTS

The validated questionnaire was answered by 14 of 24 Chilean medical schools, with 11 schools (78.9%) declaring that they included some training in their curriculum. The predominant range of time allocated to LGBTIQ + training in medical programs was between 1 and 5 h. The most addressed topics were HIV (92.85%), sexual orientation (78.57%), and chronic disease risk in LGBTIQ + populations (78.57%). Most schools, accounting for 71.5%, considered the content they delivered to be "moderately insufficient" or "insufficient". Regarding the teaching methodologies, the most used were lectures (92.8%), clinical cases (42.9%), and clinical simulation (28.6%).

CONCLUSION

Most surveyed medical schools reported curricular spaces dedicated to teaching health issues of LGBTIQ + individuals, primarily during the pre-internship training period. However, the time allocated is insufficient, and there is little approach to topics beyond the patient's sexual history or sexual orientation. Given the crucial role of medical schools, they must adopt both local and national strategies to enrich training focused on the care of LGBTIQ + patients.

Trans health training objectives: A scoping review

BACKGROUND

Transgender individuals are discriminated against in health care environments and consistently experience poorer health outcomes than their cisgender counterparts. Enhancing physician training in transgender-specific health is critical to closing the transgender health gap.

METHODS

We conducted a scoping review to identify transgender health training objectives in Internal Medicine and Internal Medicine Subspecialty residency programmes in Canada and the United States. A systematic search was conducted from 1946 to 15 February 2022. Studies were eligible for inclusion if they were written in English, included transgender training objectives, and were aimed at resident physicians in Internal Medicine or Internal Medicine Subspecialty training programmes in Canada or the United States.

FINDINGS

We found 4048 papers, of which 11 were included for analysis. Transgender health training objectives were synthesised into five themes, including (1) terminology, physiology, and gender presentation, (2) gender-affirming care and communication, (3) hormonal and surgical management, (4) routine health management and maintenance, and (5) equity, diversity, and inclusion in clinical care. The majority of objectives pertained to equity, diversity, and inclusion in clinical care, namely, respectful communication and non-judgemental care of transgender patients.

DISCUSSION

Our findings provide a comprehensive overview of published transgender health objectives in Canada and the United States and highlight existing gaps in postgraduate medical education for Internal Medicine and Subspecialty programmes.

CONCLUSIONS

We argue a need for standardisation of transgender-related residency training and suggest that postgraduate Internal Medicine programmes can utilise this review as a framework to begin enhancing transgender health education for their residents.

Medical students' perceptions of their preparedness to care for LGBT patients in Taiwan: Is medical education keeping up with social progress?

INTRODUCTION

Integrating training on health equity of sexual and gender minorities (SGM) in medical education has been challenging globally despite emphasis on the need for medical students to develop competence to provide adequate care for diverse patient groups. This study elicits Taiwanese medical students' perceptions of their values and preparedness to care for Lesbian, Gay, Bisexual, or Transgender (LGBT) patients using a qualitative approach that considers broader societal changes, and more focused topics such as the provision of relevant training in medical education.

METHODS

Eighty-nine medical students/trainees from two southern Taiwanese medical schools (one public and one private) participated in focus groups (n = 70) and individual interviews (n = 19). Qualitative analysis was conducted using inductive thematic analysis.

RESULTS

Participants (i) expressed wide social acceptance and openness toward LGBT individuals, but were unsure of ways to communicate with LGBT patients; (ii) confirmed that stigmatization and biases might be developed during their training; (iii) recognized gender stereotypes could have negative impacts on clinical reasoning; (iv) considered themselves prepared to care for LGBT patients, yet equated non-discriminatory attitudes to preparedness; (v) acknowledged a lack of relevant professional skills; (vi) implicated curriculum did not address LGBT issues systematically and explicitly.

CONCLUSION

This study has identified the insufficiencies of current medical training and inadequate preparedness of medical students/trainees to provide better care for LGBT patients. It provides insights for medical educators to design and implement effective medical curriculum and training, and faculty development programs to equip medical students/trainees with self-awareness and competencies to more readily provide holistic care for SGM, in keeping up with social progress, and promote health equity for a more diverse patient population.

Cross-sectional survey of education on LGBT content in medical schools in Japan

OBJECTIVES

We aimed to clarify current teaching on lesbian, gay, bisexual, transgender (LGBT) content in Japanese medical schools and compare it with data from the USA and Canada reported in 2011 and Australia and New Zealand reported in 2017.

DESIGN

Cross-sectional study.

SETTING

Eighty-two medical schools in Japan.

PARTICIPANTS

The deans and/or relevant faculty members of the medical schools in Japan.

PRIMARY OUTCOME MEASURE

Hours dedicated to teaching LGBT content in each medical school.

RESULTS

In total, 60 schools (73.2%) returned a questionnaire. One was excluded because of missing values, leaving 59 responses (72.0%) for analysis. In total, LGBT content was included in preclinical training in 31 of 59 schools and in clinical training in 8 of 53 schools. The proportion of schools that taught no LGBT content in Japan was significantly higher than that in the USA and Canada, both in preclinical and clinical training (p<0.01). The median time dedicated to LGBT content was 1 hour (25th-75th percentile 0-2 hours) during preclinical training and 0 hour during clinical training (25th-75th percentile 0-0 hour). Only 13 schools (22%) taught students to ask about same-sex relations when obtaining a sexual history. Biomedical topics were more likely to be taught than social topics. In total, 45 of 57 schools (79%) evaluated their coverage of LGBT content as poor or very poor, and 23 schools (39%) had some students who had come out as LGBT. Schools with faculty members interested in education on LGBT content were more likely to cover it.

CONCLUSION

Education on LGBT content in Japanese medical schools is less established than in the USA and Canada.

Assessment of blood pressure measurement skills in second-year medical students after ongoing simulation-based education and practice

BACKGROUND

Simulation-Based Education (SBE) simulates specific physiological characteristics of a patient, allowing student practice in developing clinical skills and assessment of skill competency. Literature is limited regarding SBE's effectiveness in curriculum enrichment. This study investigated Blood Pressure (BP) measuring proficiency of second-year medical students with first-year SBE training and a second-year review, by comparing data from Simulation-Based assessments in 2017 and 2019.

METHODS

Second-year medical students measured BP on three manikin arms, associated with distinct clinical contexts (healthy young male, young female experiencing hypotension, and older male suffering hypertension and diabetes). All manikins' BP settings were independent of clinical context. In January 2019, 108 second-year medical students who received traditional training, as well as SBE in 2017 and Simulation-Based practice in 2018, were divided into four groups (n = 32, 24, 24, and 28), with two groups each assessed on consecutive days. The proportions of correct BP values in each of three contexts were compared between experiments in 2017 and 2019. Additionally, systolic (SBP) and diastolic (DBP) blood pressure results were stratified into three groups: lower than setting value, correct, and higher than setting vgalue, with proportions for each group compared for the 2017 and 2019 studies using Fisher's Exact Tests.

RESULTS

In Case Two and Three, the proportion of correct BP values significantly increased from 2017 (Case Two: 51%; Case Three: 55%) to 2019 (Case Two: 73%; Case Three: 75%). Additionally, proportions of students who reported lower SBP values than setting values were significantly decreased in Case One and Two, with five failing all contexts.

CONCLUSIONS

Second-year student BP measurement skills were improved, not only due to repeated Simulation-Based practice but advancing basic science knowledge and mastery experience in ongoing curriculum. Simulation-Based assessment provided an effective tool for evaluating skill retention and proficiency in medical training.

Transgender health in medical education

Transforming our world the 2030 agenda for sustainable development is working towards a world that reflects equity, with universal respect for human dignity, pledging to leave no one behind. However, transgender and gender-diverse individuals experience significant health inequities, including negative health outcomes and multiple barriers to accessing care. In this article, we first highlight the health inequities that transgender and gender-diverse people face globally. We describe important aspects of transgender and gender-diverse health care, including the design and provision of health services, epidemiological considerations, transition-related care, changes in transition-related goals, cultural considerations, and political and legal issues. We then review the existing global literature on incorporating transgender health into medical curricula. We make a case for prioritizing improved education in medical schools on the specific health needs of transgender and gender-diverse people as part of addressing global health inequities in care. Our recommendations for comprehensive education on transgender health include cultural humility and anti-oppression training; involvement of transgender and gender-diverse community members; integration of transgender and gender-diverse health into curricula; practice-focused and in situ training; staff development in medical schools; and improving access to careers in medicine for transgender and gender-diverse people.