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  • Carey Roth Bayer, EdD, MEd, BSN, RN, CSE
  • Center of Excellence for Sexual Health
  • Morehouse School of Medicine
  • Jennifer Potter, MD
  • Harvard Medical School
  • Beth Israel Deaconess Medical Center
  • The Fenway Institute
  • Leading Change Applications of the AAMC LGBT, Gender Nonconforming, and DSD Health Resources in Academic Health Centers

Learning Objectives

  • Identify at least 3 demonstration projects that have arisen from the AAMC LGBT, GNC, DSD Competencies/Publication.*
  • Discuss 2 strategies that have worked to overcome barriers to implementing LGBT, GNC, DSD demonstration projects.
  • Brainstorm at least 2 strategies for implementing demonstration projects at webinar participants’ institutions.
  • *Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born with DSD: a Resource for Medical Educators.


  • Laura Potter, BA
  • Sherri-Ann Burnett-Bowie, MD
  • Ryan Shields, MD Candidate
  • John Encandela, PhD
  • Michael Schwartz, PhD
  • Nicole Sitkin, MD Candidate
  • Stacie Steinbock, MEd
  • Susan Sawning, MSSW
  • Chelsea Unruh, MD
  • Axis Founding Committee
  • Axis Current Steering Committee
  • Demonstration Project Contributors
  • Kristen L. Eckstrand, MD, PhD, Co-Chair
  • Jennifer E. Potter, MD, Co-Chair
  • Jonathan S. Appelbaum, MD, FACP
  • Carey Roth Bayer, EdD, MEd, BSN, RN, CSE
  • Lavjay Butani, MD
  • Cameron Crandall, MD, PhD
  • Kristine M. Diaz, PsyD
  • Michelle M. Forcier, MD, MPH
  • Sana Loue, JD, PhD, MPH, MSSA
  • Henry Ng, MD, MPH, FAAP, FACP
  • Tiffani St.Cloud, CPC
  • Contextual specifiers of existing competencies
  • Roadmap for curricular integration and assessment of physician competence
  • Case scenarios with multiple suggested uses
  • Resource lists & glossary
  • Publication Components

AAMC Publication Reach

  • Estimated reach of >500,000, including Facebook, reposts on social media, projected sharing of the publication via email, etc.
  • 2,979 tracked downloads (i.e., people who provided their contact information when they downloaded the publication).
  • 60% of tracked downloads affiliated with academic health centers.

Publication Utilization (Tracked Downloads, n=2,979)

  • *Question was ‘select all’; numbers do not sum to 100%
  • Reason for Use
  • Percent Responding*
  • Culture/Climate Assessment
  • 28.4%
  • Medical Education
  • 56.4%
  • Patient Advocacy
  • 30.4%
  • Patient Care
  • 33.2%
  • Personal Use
  • 27.1%
  • Professional Development
  • 47.6%
  • Quality Improvement
  • 19.1%
  • Research
  • 19.7%
  • Other
  • 10.0%

Featured Demonstration Projects

  • Institution
  • (Location)
  • Drivers
  • Learner Level
  • Scope
  • [Coverage of Competencies?]
  • Content
  • Assessment
  • Sustainability
  • Harvard
  • Boston
  • (urban)
  • Students
  • Faculty
  • UME, year 1
  • This session addressed 11/30
  • M1
  • Student and faculty surveys
  • Integral part of basic clinical skills course
  • Johns Hopkins
  • Maryland (urban)
  • Students
  • Faculty
  • UME, years 1-4
  • Integration across UME curriculum
  • M1-4
  • M4 survey
  • Capstone SP
  • M4-M1 pairing
  • Faculty development
  • Yale
  • Connecticut
  • (urban)
  • Students
  • Administration
  • Med Ed Office
  • Faculty
  • UME, years 1-4
  • Integration across UME curriculum
  • M1-3 so far
  • Student surveys and focus groups
  • Faculty development
  • Creation of an ‘LGBT thread’ in the curriculum
  • U of Louisville
  • Kentucky
  • (urban)
  • Administration
  • Med Ed Office
  • Faculty
  • UME, years 1-4
  • Integration across UME curriculum
  • M1 so far
  • Multilevel
  • Providence St. Peter Hospital
  • Oregon
  • (urban)
  • Resident
  • GME, IPE
  • Integration GME/CME/CEU
  • Residency program, hospital staff
  • Electronic participant survey
  • Working with residency program and hospital
  • Morehouse School of Medicine
  • Georgia
  • (urban HBCU)
  • Faculty
  • Curriculum Committee
  • Students
  • Administration
  • Combination of approaches
  • M1-4, Peds Residents, Safe Space/Climate
  • Exam questions, pen/paper/electronic survey
  • Grants, student government, as long as prioritized

Harvard Medical School Boston, Massachusetts Example Integrated Learning Session

  • Laura Potter, BA
  • Sherri-Ann Burnett-Bowie, MD
  • Jennifer Potter, MD

Teaching Medical Students How to Ask Questions about Identity, Intersectionality, and Resilience

  • Learning Objectives:
  • Define identity, stigmatized identity, intersectionality and resilience.
  • Describe the impact of various sociocultural identifications on patients’ lived experiences, health-seeking and risk behaviors, and health outcomes.
  • Explain the importance of creating a trusting relationship in which patients can safely disclose their identities and lived experiences.
  • Practice asking patients contextual questions in scripted peer role-plays.


  • Instructional content:
    • Prework (60 min)
      • To Treat Me You Have to Know Who I Am (video)
      • Three award-winning medical student essays*
    • Didactic presentation (45 min)
    • Role-play scenarios / Small group discussion (75 min)
    • Faculty development workshop (90 min)
  • MS1 students (n=175) had already mastered the social history and faculty (n=19) had small group leadership experience.
  • Electronic student ed rep (n=10) and faculty (n=19) surveys provided post hoc qualitative assessment.

Role-Play Scenarios (6)

Qualitative Assessment

  • 5/10 (50%) of students and 14/19 (74%) of faculty responded to the post hoc survey.
  • According to the majority, the session…
    • Increased awareness of 1) the health impact of identity and intersectionality, and 2) the clinician’s role in establishing rapport.
    • Provided a unique opportunity for 1) students to examine their unconscious biases, and 2) practice challenging yet crucial interviewing skills in a supportive environment.
  • Suggested refinements:
    • Prework video defining diversity terminology
    • Patient panel describing diverse identities and experiences


  • Strengths
  • Addressed 4/4 evidence-based curricular interventions recommended to mitigate harms related to unconscious bias.
  • Incorporated 11/30 of the AAMC’s 30 Professional Competencies.
  • Modeled integration of content pertinent to SGM populations into the mainstream medical school curriculum.
  • Examined SGM health through the lenses of identity/resilience (rather than sexuality/maladjustment).
  • Considered SGM identities alongside other intersecting identities.
  • Used a flipped classroom technique and experiential role-play exercise to actively engage students.
  • Limitations
  • Quantitative assessment needed to address session impact on acquisition of learner KAS.
  • Interviewing an actor posing as a person with multiple intersecting identities can never replace the experience of interviewing an actual patient.
  • Ground rules reviewed to establish safety; did not actually measure participants’ level of comfort.

Johns Hopkins School of Medicine Baltimore, Maryland Student-Led Initiative Cross-Curricular Integration

  • Courtesy of Ryan Shields, MD Candidate
  • Student-Driven Grassroots Change to Integrate SGM Health at JHUSOM
  • Informal needs assessment sent to all classes
  • Used AAMC Report and MedEdPORTAL to develop curricular framework
  • Approached responsive faculty with ability to make real-time changes to the curriculum

JHUSOM Curriculum Map

Challenges and Solutions

  • Grassroots approach to course and clerkship directors
  • Partnered with faculty to provide trainings
  • Paired fourth-year and first-year students together for individual projects

Next Steps

  • Survey of Fourth-Year Students
  • Recruiting New Cohort of First-Year Students
  • Further Integration into Curriculum
  • Establishing Formal Integration

Yale University School of Medicine New Haven, Connecticut Student-Led Initiative Cross-Curricular Integration

  • Courtesy of:
  • John Encandela, PhD
  • Michael Schwartz, PhD
  • Nicole Sitkin, MD Candidate

Overview of Curricular Development Yale School of Medicine

Curricular Pitches : Key Components

Curricular Pitches : Key Components

Curricular Pitches : Key Components

Curricular Pitches : Key Components

Curricular Pitches : Key Components

Assessment & Sustainability

    • Current focus on implementation of the new Yale curriculum
    • Student/faculty surveys  constructive feedback re: usefulness and adequacy of LGBTQ curricular content
    • Overall curriculum evaluation will include tracking an ‘LGBTQ Thread’ alongside representation of other diversity inclusion/health equity topics

Core Strategies for Effective Communication

University of Louisville Louisville, Kentucky Multilevel Curricular Integration

  • Courtesy of:
  • Stacie Steinbock, M.Ed.
  • Susan Sawning, MSSW
  • Leading medical education to train future physicians to deliver equitable Quality care for all people, regardless of identity, development, or expression of gender/sex/sexuality.
  • UofL Steering Committee
  • UME Office, LGBT Center, HSC Office of Diversity and Inclusion
  • National Partners
  • Dr. Jenny Potter (Harvard), Dr. John Davis (The Ohio State), Dr. Kristen Eckstrand (University of Pittsburgh Medical Center)
  • at University of Louisville

Seeds grow in fertile ground!

  • Environment favoring growth:
    • LGBT climate change: “top down” and “ground up”
    • 2007-present: LGBT center growth
    • 2013 LGBT Health Certificate spurs student interest
    • Louisville’s LGBT community involvement
  • Seed is planted:
    • 2014 AAMC competencies published
    • Lunch meeting at 2014 AAMC annual meeting
  • Goal is created: use competencies to integrate relevant content and assessments throughout 4-year curriculum, using developmental approach

Planning and Implementation

  • Engage and secure buy-in from stakeholders
  • Identify and engage national experts
  • Establish steering committee
  • Identify, engage, develop key local faculty
  • Develop and deploy interventions, assessments, and educational research
  • Engage faculty, learners, and community in quality improvement cycle

2014-15 Pilot Year

  • 50 hours revised or developed in M1-2
    • Integrated naturally based on where topics taught in existing curriculum
    • No separate “LGBT and DSD section”
    • Revision for inclusiveness, affirmation
    • Addition of new content to existing sessions
    • Creation of new content/sessions
    • Included 3 LGBT Patient/Student interaction sessions

Role of Assessment

  • UME Research Office involved from day 1
  • Research Qs and Assessments planned
  • Outcomes:
    • M1-M4 Pre-post explicit attitudes/knowledge
    • M1-M2 Pre-post Implicit Attitude
    • Written exams (knowledge)
    • SP interactions (skills, attitudes)
    • Reflective papers (attitudes, knowledge)
    • Faculty baseline attitude/knowledge surveys
    • Institutional Climate survey focusing on LGBT

Lessons Learned

  • Steering committee initially heavily administrative; needed to include more faculty teaching leads  
  • Engage student and teaching leadership early as well as community in order to inform content
  • Seek grant funding early and grow program according to available resources
  • Plan for more faculty development and discussion than you think you need

Providence St. Peter Hospital, Olympia, Washington An Adaptation for Graduate Medical and Interprofessional Education

  • Courtesy of: Chelsea Unruh, MD


  • Primarily resourced chapter 2: “The Role of Medical Education and Health Care Professionals in Eliminating Health Disparities”
    • Objectives included:
    • Defining terms.
    • Acknowledging difference between identity, orientation, and behavior.
    • Recognizing specific LGBT health concerns.
    • Practicing safe and inclusive questioning.

Format and Audience

  • Format: 45 minute lunch lecture with 15 min Q & A.
  • Offered to all hospital and local outpatient providers for 1 hour CME credit.
  • Attended by MD, DO, PA, ARNP, RN, residents, faculty, and medical students.
  • Audience size approximately 70 people, with 38 evaluations completed.


  • Short term:
    • 97% of responders (n = 38) noted that the presentation had a “significant effect” on their ability to meet the stated objectives.
    • 92% of responders agreed that “I learned at least one item that, if implemented, would improve my practice and/or my patients' outcomes.”
  • Long term:
    • Raised awareness in the hospital and residency program about the needs of LGBT patients in the community.
    • Invited to repeat the presentation for diverse groups throughout the hospital.
    • Multidisciplinary transgender specialty clinic opened March 25th, 2016.

Multilevel Approach Using All AAMC AXIS Resources

  • Courtesy of:
  • Carey Roth Bayer, EdD, MEd, BSN, RN, CSE

MD1 – including LGBT identities in exam questions (sexuality throughout the lifespan)

  • MD1 – including LGBT identities in exam questions (sexuality throughout the lifespan)
  • MD2 – including AAMC Axis cases
  • MD3 – including AAMC Axis cases
  • MD4 – including AAMC Axis videos, vignettes, cases
  • Pediatric/Adolescent Residents – videos, vignettes as independent learning; experiential learning practicing answering LGBT health/development questions
  • Safe Space Training/MSM Alliance – including videos/cases


  • Exam questions (M1 yr)
  • Qualitative observations/discussion/feedback (M2, M3, M4 yrs, Pediatric Residents)
  • Pen/paper/electronic learning outcome & satisfaction surveys (Safe Space Training, MSM Alliance events)
  • Campus Climate Surveys

Creating Safe Spaces 102 Morehouse School of Medicine Alliance Training Session Evaluation March 31, 2015

  • Learning Objective
  • By the completion of the training, participants will be able to develop at least 1 strategy to help raise awareness and create an inclusive environment for lesbian, gay, bisexual, asexual, pansexual, transgender, queer, and questioning faculty, staff, and students at Morehouse School of Medicine
  • On a scale from 1 to 5 (with 1 being strongly disagree and 5 being strongly agree), how well were the learning objectives met for today’s session?
  • List at least one thing you learned as a result of today’s training:
  • List at least one strategy that you will work to implement to help create safe spaces at MSM:
  • What would you like to see included in future safe space trainings at MSM?
  • Who would you recommend attending future safe space trainings at MSM?


  • What are you doing?
  • What challenges have you encountered?
  • What strategies have worked to overcome obstacles?
  • What do you want to accomplish next?
  • How can we maximize the reach and still measure the outcomes and impact?
  • Questions

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