(This conversation between the Josiah Macy Jr. Foundation and Dr. Marc Nivet, Chief Diversity Officer of the Association of American Medical Colleges (AAMC), appeared on the Foundation’s blog on May 1, 2012 and is reprinted with permission.)
Lesbian, gay, bisexual, transgender and intersex (LGBTI) patients face documented healthcare disparities related to bias and social stigma, restricted access to health services, and other disparities. Including competencies for the treatment of LGBTI patients in medical school could help future physicians provide better care. In June 2011, AAMC was awarded a President’s Grant from the Josiah Macy Jr. Foundation to define these competencies and establish core elements of a curriculum to train medical students in them. With the foundation laid for the project, the Foundation spoke to Dr. Marc Nivet, Chief Diversity Officer, about the importance of culturally competent care for LGBTI patients, what he hopes will come from this project and how developing key competencies for the care of LGBTI patients fits into AAMC’s history of promoting diversity.
Macy: How has the topic of diversity in medicine evolved over time to encompass LGBTI issues?
Dr. Nivet: We are making progress toward increased diversity in medical education. In terms of gender, we are near parity for women and men entering medical schools and we’re doing better at promoting women among the ranks of faculty. We haven’t moved the dial meaningfully in terms of race and ethnicity though, and need to double down on engaging schools to create more paths to medical school for underrepresented minorities. The underlying rationale for diversity in medicine is the provision of culturally competent care, creating an environment and delivering the educational experiences that equip doctors to deliver care that meets the needs of their patients.
As a natural extension of this thinking, our definition of diversity has expanded to include LGBTI populations. As a physician, you naturally want to understand each and every patient, and this includes lesbian, gay, bisexual, transgender and intersex individuals.
Macy: Where are we in the development of LGBTI competencies in healthcare?
Dr. Nivet: There are organizations at many levels engaged in the development of tools and resources to guide educational interventions to improve care for LGBTI populations—from national advocacy groups to professional societies and educational institutions. Our aim with this project is to build on these existing efforts to distill a broad set of competencies for medical education that schools can reference as they integrate curricular changes in line with their specific missions. Once we’ve published these consensus-driven educational goals, the next step will be to link them with a set of peer reviewed teaching and assessment resources to be housed in MedEdPORTAL.
Macy: What are your hopes for the project as it develops?
Dr. Nivet: In 2007 the President and CEO of AAMC, Dr. Darrell Kirch, issued a call for active engagement to better address the needs of LGBT patients. More recently, as our knowledge in this domain has evolved, AAMC has advocated for the explicit inclusion of intersex individuals in ongoing efforts to measure and improve health disparities among gender and sexual minorities. An important source of momentum on these issues has been the federal government’s growing attention to data collection on health outcomes for discrete populations.
However, many of our member institutions don’t have the resources to commit to stand alone efforts at curricular reform. Moreover, most current faculty members haven’t been trained to be culturally competent on LGBTI issues, so who is going to teach the students? There are a few experts driving these efforts at AAMC member medical schools, and this project aims to connect their disparate work to amplify its impact.
Macy: What has the response to this project been?
Dr. Nivet: For the most part the response has been extremely positive. We’ve tapped into an unmet need and have created a platform to allow passionate advocates to formally address the lack of training and guidance on how best to care for LGBTI patients.
The AAMC and the Macy Foundation share a commitment to diversifying the medical workforce and preparing healthcare providers to treat our diverse population. This project is a clear indicator of our continued attention to these issues.
To learn more about the AAMC department of Diversity Policy and Programs, please click here.