Strategies for inclusion of lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) education throughout pharmacy school curricula
Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and others (LGBTQIA+) patients face stigma and barriers to health care, including a lack of health care professionals’ knowledge and confidence in treating this patient population. Pharmacists are in prime position to decrease this health disparity. United States pharmacy schools have limited LGBTQIA+ content, continuing the concern of recent graduates without knowledge and confidence. This commentary discusses potential barriers to introducing LGBTQIA+ content into school of pharmacy curricula and presents five strategies currently in use by nursing, medical, and pharmacy schools. Schools of Pharmacy should consider proactive incorporation of this content to graduate practitioners able to provide quality care to LGBTQIA+ patients.
James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi, M. The Report of the 2015 U.S. Transgender Survey. Available at: https://www.transequality.org/sites/default/files/docs/USTS-Full-Report-FINAL.PDF (accessed Jan 6, 2020).
Office of Disease Prevention and Health Promotion. Healthy People 2020 - Lesbian, Gay, Bisexual, and Transgender Health. Available at: https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health (accessed Jul 30, 2019).
Redfern JS, Sinclair B. Improving health care encounters and communication with transgender patients. J Commun Healthc. 2014;7(1):25-40. https://doi.org/10.1179/1753807614Y.0000000045
Mandap M, Carrillo S, Youmans SL. An evaluation of lesbian, gay, bisexual, and transgender (LGBT) health education in pharmacy school curricula. Curr Pharm Teach Learn. 2014;6(6):752-758. https://doi.org/10.1016/j.cptl.2014.08.001
Eckstein MA, Newsome CC, Borrego ME, Burnett A, Wittstrom K, Conklin JR. A cross-sectional survey evaluating transgender-related care education in United States pharmacy school curricula. Curr Pharm Teach Learn. 2019;11(8):782-792. https://doi.org/10.1016/j.cptl.2019.04.005
Leach C, Layson-Wolf C. Survey of community pharmacy residents’ perceptions of transgender health management. J Am Pharm Assoc. 2016;56(4):441-445.e6. https://doi.org/10.1016/j.japh.2016.03.008
Schwinghammer TL, Vice AJC, Boyce EG, Bradley B, Christensen A, Dunnenberger HM, Fravel M, Gurgle H, Hammond DA, Kwon J, Slain DS, Wargo KA. ACCP Toolkit. Available at: https://www.accp.com/docs/positions/misc/Toolkit_final.pdf (accessed Aug 1, 2019).
Accreditation Council for Pharmacy Education. Accreditation standards and key elements for the professional program in pharmacy leading to the doctor of pharmacy degree. Available at: https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf (accessed Aug 1, 2019).
Bachman J, Frye A, Fuke D. Addressing the concerns and needs of transgender persons. iForumRx. Available at: https://iforumrx.org/commentary/addressing-concerns-and-needs-transgender-persons (accessed Sep 18, 2019).
Maxwell E, Salch S, Boliko M, Anakwe-Charles G. Discrepancies in lesbian, gay, bisexual, and transgender patient care and how pharmacists can support an evolved practice. Am J Pharm Educ. 2017;81(7):6181.. https://doi.org/10.5688/ajpe8176181
Redfern JS, Jann MW. The evolving role of pharmacists in transgender health care. Transgender Heal. 2019;4(1):118-130. https://doi.org/10.1089/trgh.2018.0038
Wilkening GL. The current status of transgender health education in doctor of pharmacy curricula in North America. Ment Heal Clin. 2017;7(4):168-171. https://doi.org/10.9740/mhc.2017.07.168
Council of the District of Columbia. LGBTQ Cultural Competency Continuing Education Amendment Act of 2016. Available at: https://code.dccouncil.us/dc/council/laws/21-95.html (accessed Jan 2, 2020).
Gaines J. APhA adopts actionable policy once again: Leading the profession into the future. J Am Pharm Assoc (2003). 2018;58(4):333-334. https://doi.org/10.1016/j.japh.2018.06.008
Leach C, Seung H, Layson-Wolf C. Student pharmacists’ perceptions of transgender health management. Curr Pharm Teach Learn. 2019;11(12):1254-1258. https://doi.org/10.1016/j.cptl.2019.09.015
Higgins A, Downes C, Sheaf G, Bus E, Connell S, Hafford-Letchfield T, Jurček A, Pezzella A, Rabelink I, Robotham G, Urek M, van der Vaart N, Keogh B.Pedagogical principles and methods underpinning education of health and social care practitioners on experiences and needs of older LGBT+ people: Findings from a systematic review. Nurse Educ Pract. 2019;40:102625. https://doi.org/10.1016/j.nepr.2019.102625
Schwinn S, Dinkel S. Changing the culture of long-term care: combating heterosexism. Online J Issues Nurs. 2015;20(2). http://doi.org/10.3912/OJIN.Vol20No02PPT03
Carabez R, Pellegrini M, Mankovitz A, Eliason MJ, Dariotis WM. Nursing students’ perceptions of their knowledge of lesbian, gay, bisexual, andtransgender issues: Effectiveness of a multi purpose assignment in a public health nursing class. J Nurs Educ. 2015;54(1):50-53. https://doi.org/10.3928/01484834-20141228-03doi:10.3928/01484834-20141228-03
Osler W. Association of American Medical Colleges. J Am Med Assoc. 1896;26(17):827. https://doi.org/10.1001/jama.1896.02430690029002f
Hardacker CT, Rubinstein B, Hotton A, Houlberg M. Adding silver to the rainbow: The development of the nurses’ health education about LGBT elders (HEALE) cultural competency curriculum. J Nurs Manag. 2014;22(2):257-266. https://doi.org/10.1111/jonm.12125
Krupa A, Wertheimer AI. Impact of pharmacists’ religious and personal beliefs in dispensing contraceptives. Inov Pharm. 2016;7(4). https://doi.org/10.24926/iip.v7i4.467
McDowell A, Bower KM. Transgender health care for nurses: An innovative approach to diversifying nursing curricula to address health inequities. J Nurs Educ. 2016;55(8):476-479. https://doi.org/10.3928/01484834-20160715-11
Jann MW, Penzak S, White A. An elective course in lesbian, gay, bisexual, and transgender health and practice issues. Am J Pharm Educ. 2019;83(8):6967. https://doi.org/10.5688/ajpe6967
Braun HM, Ramirez D, Zahner GJ, Gillis-Buck EM, Sheriff H, Ferrone M. The LGBTQI health forum: An innovative interprofessional initiative to support curriculum reform. Med Educ Online. 2017;22(1). https://doi.org/10.1080/10872981.2017.1306419
Leslie K, Steinbock S, Simpson R, Jones VF, Sawning S. Interprofessional LGBT Health Equity Education for Early Learners. MedEdPORTAL Publ. 2017;13:1-7. https://doi.org/10.15766/mep_2374-8265.10551
Pratt-Chapman ML, Phillips S. Health professional student preparedness to care for sexual and gender minorities: efficacy of an elective interprofessional educational intervention. J Interprof Care. 2019 [Ahead of print] https://doi.org/10.1080/13561820.2019.1665502
Newsome C, Chen L-W, Conklin J. Addition of care for transgender-related patient care into doctorate of pharmacy curriculum: implementation and preliminary evaluation. Pharmacy. 2018;6(4):107. https://doi.org/10.3390/pharmacy6040107
Parkhill AL, Mathews JL, Fearing S, Gainsburg J. A transgender health care panel discussion in a required Diversity course. Am J Pharm Educ. 2014;78(4). https://doi.org/10.5688/ajpe78481
Kelley L, Chou CL, Dibble SL, Robertson PA. A critical intervention in lesbian, gay, bisexual, and transgender health: Knowledge and attitude outcomes among second-year medical students. Teach Learn Med. 2008;20(3):248-253. https://doi.org/10.1080/10401330802199567
Rogers A, Rebbe R, Gardella C, Worlein M, Chamberlin M. Older LGBT adult training panels: an opportunity to educate about issues faced by the older LGBT community. J Gerontol Soc Work. 2013;56(7):580-595. https://doi.org/10.1080/01634372.2013.811710
Ostroff JL, Ostroff ML, Billings S, Nemec EC. Integration of transgender care into a pharmacy therapeutics curriculum. Curr Pharm Teach Learn. 2018;10(4):463-468. https://doi.org/10.1016/j.cptl.2017.12.016
Knockel LE, Ray ME, Miller ML. Incorporating LGBTQ health into the curriculum: Assessment of student pharmacists’ knowledge and comfort level in caring for transgender patients. Curr Pharm Teach Learn. 2019;11(9):928-935. https://doi.org/10.1016/j.cptl.2019.07.001
Russell S, More F. Addressing health disparities via coordination of care and interprofessional education: lesbian, gay, bisexual, and transgender health and oral health care. Dent Clin North Am. 2016;60(4):891-906. https://doi.org/10.1016/j.cden.2016.05.006
Preeti B, Ashish A, Shriram G. Teaching undergraduates through “problem based learning” a better approach. J Clin Diagnostic Res. 2013;7(12):2896-2897. https://doi.org/10.7860/JCDR/2013/7339.3787
Kong LN, Qin B, Zhou Y qing, Mou S yu, Gao HM. The effectiveness of problem-based learning on development of nursing students’ critical thinking: A systematic review and meta-analysis. Int J Nurs Stud. 2014;51(3):458-469. https://doi.org/10.1016/j.ijnurstu.2013.06.009
Hughes AK, Luz C, Hall D, Gardner P, Hennessey CW, Lammers L. Transformative theatre: a promising educational tool for improving health encounters with LGBT older adults. Gerontol Geriatr Educ. 2016;37(3):292-306. https://doi.org/10.1080/02701960.2015.1127812
Maley B, Gross R. A writing assignment to address gaps in the nursing curriculum regarding health issues of LGBT+ populations. Nurs Forum. 2019;54(2):198-204. https://doi.org/10.1111/nuf.12315
Cooper MB, Chacko M, Christner J. Incorporating LGBT health in an undergraduate medical education curriculum through the construct of social determinants of health. MedEdPORTAL J Teach Learn Resour. 2018;14:10781. https://doi.org/10.15766/mep_2374-8265.10781
Cannon SM, Shukla V, Vanderbilt AA. Addressing the healthcare needs of older lesbian, gay, bisexual, and transgender patients in medical school curricula: A call to action. Med Educ Online. 2017;22(1). https://doi.org/10.1080/10872981.2017.1320933
Greene RE, Hanley K, Cook TE, Gillespie C, Zabar S. Meeting the primary care needs of transgender patients through simulation setting and problem creating provider-level quality reports for residents to improve the clinical learning environment background. J Grad Med Educ. 2017;(June):380-381. https://doi.org/10.4300/JGME-D-16-00770.1
I AAMC Videos and Resources. Integrating LGBT and DSD Content into Medical School Curricula. Available at: https://www.aamc.org/initiatives/diversity/449506/integratingcontent.html (accessed Jul 27, 2019).
Deutsch M. University of California San Francisco Center of Excellence for Transgender Health. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People. 2nd ed. Available at: https://transcare.ucsf.edu/guidelines (accessed Jul 28, 2019).
LGBTQIA Resource Center Glossary. UC Davis. Available at: https://lgbtqia.ucdavis.edu/educated/glossary (accessed Feb 1, 2020).
Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T'Sjoen GG. Endocrine treatment of gender-dysphoric/ gender-incongruent persons: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017;102(11):3869-3903. https://doi.org/10.1210/jc.2017-01658
Coleman E, et al. World Professional Association for Transgender Health (WPATH). Standards of care for the health of transsexual, transgender, and gender-nonconforming people. 7th ed. Available at: https://www.wpath.org/media/cms/Documents/SOC%20v7/Standards%20of%20Care_V7%20Full%20Book_English.pdf (accessed Jul 28, 2019)
WordPress.com. Lavender Health - LGBTQ Resource Center. Available at: https://lavenderhealth.org/education/ (accessed Jan 22, 2020).
CitySoft Community Enterprise. GLMA health professionals advancing LGBTQ equality. Available at: http://www.glma.org/index.cfm?fuseaction=Page.viewPage&pageId=534 (accessed Jul 22, 2020).
Schneider J, Silenzio V, Erickson-Schroth L, eds. Praeger. The GLMA Handbook on LGBT Health. Washington, DC: GLMA;2019. ISBN-10: 0313395659
Snowdon S. Recommendations for Enhancing the Climate for LGBT Students and Employees in Health Professional Schools: A GLMA White Paper. Washington, DC: GLMA; 2013.
Makadon H, Mayer K, Potter J, Goldhammer H. The Fenway Institute. Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health. 2nd ed. Philadelphia: ACP;2015. ISBN-10: 1938921003
The Fenway Institute. The National LGBT Health Education Center. 2019. https://www.lgbthealtheducation.org/ (accessed Aug 1, 2019).
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