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Questions - Please use the Q&A panel located on the right side of your screen to submit your questions. Send to “All Panelists”.
- 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.
Acknowledgements - 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 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
- http://www.aamc.org/lgbtdsd
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%
| | | - Culture/Climate Assessment
| | | | | | | | | | | | | | | | | | | | | | | | | | Featured Demonstration Projects | | | | - Scope
- [Coverage of Competencies?]
| | | | | | | | - This session addressed 11/30
| | - Student and faculty surveys
| - Integral part of basic clinical skills course
| - Johns Hopkins
- Maryland (urban)
| | | - Integration across UME curriculum
| | | - M4-M1 pairing
- Faculty development
| | | - Students
- Administration
- Med Ed Office
- Faculty
| | - Integration across UME curriculum
| | - 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
| | - Integration across UME curriculum
| | | | - Providence St. Peter Hospital
- Oregon
- (urban)
| | | | - 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.
Methods - 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.
- 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
Presentation - 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.
Outcomes - 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
Assessment - 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?
Discussion - 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?
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