AEM Early Access

AEM Education and Training 12: Attitudes, Behavior, and Comfort of Emergency Medicine Residents in Caring for LGBT Patients: What do we know?

Welcome to the twelfth episode of AEM Education and Training, a podcast collaboration between the Academic Emergency Medicine E&T Journal and Brown Emergency Medicine. Each quarter, we'll give you digital open access to AEM E&T Articles or Articles in Press, with an author interview podcast and links to curated supportive educational materials for EM learners and medical educators.

Find this podcast series on iTunes here.

DISCUSSING (CLICK ON TITLE TO ACCESS):

Attitudes, Behavior, and Comfort of Emergency Medicine Residents in Caring for LGBT Patients: What Do We Know? Joel Moll MD, Paul Krieger MD, Sheryl L. Heron MD MPH, Cara Joyce PhD, Lisa Moreno‐Walton MD

LISTEN NOW: INTERVIEW WITH FIRST AUTHOR Joel Moll, MD, FACEP

Joel Moll, MD, FACEP

Residency Program Director

Associate Professor

Department of Emergency Medicine

Virginia Commonwealth University School of Medicine

Abstract

Background

Although lesbian, gay, bisexual, and transgender (LGBT) patients are ubiquitous in emergency medicine (EM), little education is provided to EM physicians on LGBT health care needs and disparities. There is also limited information on EM physician behavior, comfort, and attitudes toward LGBT patients. The objective of this study was to assess EM residents behavior, comfort, and attitudes in LGBT health.

Methods

An anonymous survey link was sent to EM programs via the Council of Residency Director listserv. The primary outcome of the 24‐item descriptive survey was the self‐reported comfort levels and self‐reported practice in LGBT health care. Secondary outcomes included individual comfort toward LGBT colleagues and patients who are LGBT, and the frequency of colleagues making discriminatory statements toward LGBT patients and staff in the emergency department setting. Associations between personal and program demographics and survey responses were also examined.

Results

There were 319 responses The majority of respondents were male (63.4%), Caucasian (69.1%), and heterosexual (92.4%). A sizeable minority of respondents felt histories and physical examinations were more challenging for lesbian, gay, or bisexual patients (24.6%) and more so for transgender patients (42.6%). Most residents do not ask patients to identify sexual orientation when presenting with abdominal or genital complaints (63%). Discriminatory LGBT comments were reported from both fellow residents (16.6%) and faculty (10%). A total of 2.5% of respondents were uncomfortable with other LGBT physicians, and 6% did not agree that LGBT patients deserve the same quality care as others.

Conclusion

A number of residents find caring for LGBT patients more challenging than heterosexual patients. Even with professed comfort with LGBT health care, most residents report taking incomplete sexual histories that may affect patient care. Attitudes toward LGBT patients are mainly, but not completely, positive in this cohort.

AEM Education and Training 10: Turning Your Educational Work Into Scholarship

Welcome to the tenth episode of AEM Education and Training, a podcast collaboration between the Academic Emergency Medicine E&T Journal and Brown Emergency Medicine. Each quarter, we'll give you digital open access to AEM E&T Articles or Articles in Press, with an author interview podcast and links to curated supportive educational materials for EM learners and medical educators.

Find this podcast series on iTunes here.

AEM E and T Podcasts logo[1].png

DISCUSSING (CLICK ON TITLE TO ACCESS):

Educational Download: Turning Your Educational Work Into Scholarship. Sally A. Santen MD, PhD ; William Peterson MD; Margaret Wolff MD, MHPE.

LISTEN NOW: INTERVIEW WITH FIRST AUTHOR SALLY SANTEN, MD PHD

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Sally Santen, MD, PhD

Professor, Department of Emergency Medicine

Senior Associate Dean of Evaluation, Assessment and Scholarship

Virginia Commonwealth University School of Medicine

SUMMARY:

Education research and scholarship are essential for promotion of faculty as well as dissemination of new educational practices. Educational faculty frequently spend the majority of their time on administrative and educational commitments and, as a result, educators often fall behind on scholarship and research. This quick educational download focuses on five tips to increase and improve your scholarship.

Dr. Merritt and Dr. Santen engage in a conversation about how to best achieve these points in their conversation. Hear valuable advice on how to ask the right questions in developing your research, how best to work in teams to help promote educational work, how to manage work flow to ensure completion, and other valuable tips.

AEM Education and Training 09: Looking Through the Prism - Caring for LGBTQI Patients in the ED

Welcome to the ninth episode of AEM Education and Training, a podcast collaboration between the Academic Emergency Medicine E&T Journal and Brown Emergency Medicine. Each quarter, we'll give you digital open access to AEM E&T Articles or Articles in Press, with an author interview podcast and links to curated supportive educational materials for EM learners and medical educators.

Find this podcast series on iTunes here.

AEM E and T Podcasts logo[1].png

DISCUSSING (CLICK ON TITLE TO ACCESS):

Looking Through the Prism: Comprehensive Care of Sexual Minority and Gender‐nonconforming Patients in the Acute Care Setting. Angela F. Jarman MD, MPH; Alyson J. McGregor MD, MA; Joel L. Moll MD ; Tracy E. Madsen MD, ScM; Elizabeth A. Samuels MD, MPH; Mollie Chesis; Bruce M. Becker MD.

LISTEN NOW: AUTHOR INTERVIEW WITH angela jarman, MD, Mph

Jarman Headshot.jpg

Angela Jarman, MD, MPH

Assistant Professor, Department of Emergency Medicine

University of California, Davis

This interview discusses a commentary in AEM E&T which synthesizes a didactic session co‐led by the SAEM Sex and Gender in Emergency Medicine Interest Group and the Academy for Diversity and Inclusion, which was presented by the authors at the SAEM 2018 annual meeting in Indianapolis, Indiana.

The National Institutes of Health have recently recognized LGBTQ (lesbian, gay, bisexual, transgender, queer) as an official health disparity and designated the Sexual and Gender Minority Research Office in an effort to support evidence‐based medical care for this underserved patient population. As the front line of medical care for the underserved, emergency medicine (EM) physicians need to be equipped with the tools to care for these patients in a culturally competent and clinically appropriate manner. EM providers must develop an understanding of their patients’ social and medical context to provide both sensitive and effective care and to teach residents and other learners. A significant number of patients who seek treatment in the emergency department define themselves as LGBTQI—lesbian, gay, bisexual, transgender, queer, or intersex. This commentary combines both affective and objective information on the importance of semantics and language, appropriate communication, and confronting our own implicit biases in caring for this vulnerable population, creating a unique perspective and paradigm for the practice of EM and a blueprint for education. 

The authors have provided this handout for further information:

https://drive.google.com/file/d/1WDyk0HcCCP3DKmgGRdom53s8LKZB5Znz/view?usp=sharing

Excerpt:

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ADDITIONAL REFERENCES:

“Don’t be a jerk” EM Pulse Podcast, Episode 9. https://ucdavisem.com/2018/07/17/dont-be-a-jerk/

http://www.transstudent.org/gender/

NIH ORWH sex/gender. Available at https://orwh.od.nih.gov/research/sex-gender.

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Clayton JA, Tannenbaum C. Reporting Sex, Gender, or Both in Clinical Research? JAMA 2016; 316(18):1863-1864

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Soc Sci Med. 2014 Feb;103:33-41. doi: 10.1016/j.socscimed.2013.06.005. Epub 2013 Jun 18.

Structural stigma and all-cause mortality in sexual minority populations. Soc Sci Med. 2014 Feb;103:33-41. doi: 10.1016/j.socscimed.2013.06.005. Epub 2013 Jun 18.

The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Editors: Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities.

Bauer GR, Scheim AI, Deutsch MB, et al. Reported Emergency Department Avoidance, Use, and Experiences of Transgender Persons in Ontario, Canada: Results From a Respondent-Driven Sampling Survey. Annals of Emergency Medicine. 2014;63(6):713-720.

Brown JF, Fu J. Emergency department avoidance by transgender persons: another broken thread in the "safety net" of emergency medicine care. Annals of Emergency Medicine. 2014;63(6):721-722.

Center of Excellence for Transgender Health, Department of Family and Community Medicine, University of California San Francisco. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People; 2nd edition. Deutsch MB, ed. June 2016. Available at www.transhealth.ucsf.edu/guidelines .

Chisolm-Straker M, Jardine L, Bennouna C, Morency-Brassard N, Coy L, Egemba MO, Shearer PL (2017) Transgender and gender nonconforming in emergency departments: a qualitative report of patient experiences, Transgender Health 2:1, 8-16, DOI: 10.1089/trgh.2016.0026.

Deutsch MB, Jamison Green, Keatley J, Mayer G, Hastings J, Hall AM. Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health. J Am Med Inform Assoc. 2013;20:700-703

IOM. Collecting sexual orientation and gender identity data in electronic health records: Workshop summary. Washington, DC: Institute of Medicine;2013.

James SE, Herman JL, Rankin S, et al. The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality;2016.

Jalali S, Sauer LM. Improving Care for Lesbian, Gay, Bisexual, and Transgender Patients in the Emergency Department. Annals of Emergency Medicine. 2015;66(4):417-423.

Lambda legal. Creating equal access to quality health care for transgender patients: transgender-affirming hospital policies. May 2016. Http://assets.Hrc.Org//files/assets/resources/transaffirming-hospitalpolicies-2016.Pdf?_Ga=2.179968679.225917522.1494296888-1373396650.1480810731

Samuels EA, Tape C, Garber N, Bowman S, Choo EK. “Sometimes you feel like the freak show”: A Qualitative Assessment of Emergency Care Experiences Among Trans and Gender Non-Conforming Patients. Ann Emerg Med 2017: doi:10.1016/j.annemergmed.2017.05.002.

World Professional Association for Transgender Health, Standards of Care for the Health of Transexual, Transgender, and Gender Nonconforming People 5 (7th ed.), http://www.wpath.org/uploaded_ les/140/ les/Stan- dards%20of%20Care,%20V7%20Full%20Book.pdf