Affirming Education, Affirming Care: Best Practices for LGBTQ+ Training in Academic Medicine

LGBTQ+ inclusion in medical education is not a matter of representation; it’s a matter of patient safety and professional competency. Despite systemic challenges and recent policy shifts, equipping physicians with the tools to provide compassionate, affirming care remains critical.

At Germane Solutions, our LGBTQ+-focused Employee Resource Group has compiled best practices and insights aimed at strengthening LGBTQ+ competency across medical schools and GME programs. From identifying institutional gaps to implementing scalable solutions, this ERG underscores the urgent need for continued progress and accountability in preparing providers to serve all patients.

LGBTQ+-Related Challenges and Barriers to Care

There are several challenges related to LGBTQ+ competence throughout medical education, such as with patient communication, lack of knowledge, and a lack of LGBTQ+ educational activities. These challenges were often deep-rooted: physicians were not knowledgeable of how to ask about a patient’s gender, pronouns, or anatomy, primarily due to the lack of LGBTQ+-related training (Sileo). Additionally, physicians who are not comfortable with their ability to work with LGBTQ+ patients often do not complete full histories and have biases towards these patients (Cooper). 

Medical schools often have very little time allotted to LGBTQ+ care (Juarez). For academic medical centers, a survey of current GME trainees found that 1 in 5 trainees reported their institution did not provide an environment for LGBTQ+ research and community service (Danckers). These deficits impact the medical training experience and lead to inexperienced faculty and unwelcome LGBTQ+ patients. This lack of knowledge can make it harder for physicians to assess themselves and others as well, leaving challenges hidden.

LGBTQ+ patients, specifically, have cited a lack of knowledge from physicians as a major barrier to care, and these deficits can lead to bias and discrimination within the healthcare setting as well (Sawning). LGBTQ+ patients are more likely to delay medical care, in part due to the fear of discrimination (Khalili). More so, recent reports have revealed that 20% of transgender or gender diverse patients have been refused care due to their gender identity (Juarez). These barriers to care can be mitigated by improved LGBTQ+ education and curriculum throughout medical school and GME

LGBTQ+ Training in Medical School

Medical school training is often the first time medical students can be provided with LGBTQ+ healthcare training, and these experiences are often limited. The median time spent on LGBTQ+ healthcare in medical school was only five hours (Gibson); and of ~130 medical schools, only 83 taught half of the essential LGBTQ+ content, and 11 schools taught all topics (Sawning). With this in mind, several medical schools have implemented initiatives to enhance this aspect of their training. These are predominantly composed of lectures and pathway programs that have been shown to increase LGBTQ+ competency.

One institution implemented a single didactic lecture (particularly focused on health disparities) for 3rd-year medical students that proved successful following a survey. Additionally, improvements could have been made in developing educational materials on LGBTQ+ political history, which sheds light on the cultural environment for LGBTQ+ patients and doctors (Cooper).

Other institutions have developed pathway programs for medical school students. One program was meant for 1st and 2nd year students and was composed of online modules, didactics, community service and work, scholarly projects, and clinical clerkships (Gibson).

Lastly, the University of Louisville implemented a certificate program focused on 11 sessions. This program did improve competency and was an avenue for the LGBTQ+ Office to work with the GME Office; however, a need was identified to improve physician confidence when completing examinations and histories for LGBTQ+ patients (Sawning). Ultimately, LGBTQ+ initiatives within medical school do seem to be successful, whether individual lectures or a series of courses; additionally, these initiatives provide institutions with clearer guidance for solving their unique challenges.

LGBTQ+ Education in GME

LGBTQ+ medical education initiatives can develop ACGME competencies and benefit LGBTQ+ patient populations. Similar to their undergraduate and medical school training, LGBTQ+ residents and fellows face additional challenges in GME. While LGBTQ-related research in GME is limited, research has suggested that these challenges are more prominent during residency. More so, GME is disadvantageous for educating LGBTQ+ residents and fellows, as the vast majority report microaggressions (Danckers). 

In primary care, residents in these settings need to be trained to care for LGBTQ+ patients, and care considerations should include respectful and culturally compassionate communications as well as conducting histories and examinations with preferred pronouns (Juarez). LGBTQ+ content in GME programs can successfully be implemented within programs wherein LGBTQ+ representation and perceived attitudes are low. One study cites a surgical program that developed said curriculum, and LGBTQ+ cultural competency and their value of work increased (Grova). The below information discusses general best practices, recommendations to provide comprehensive LGBTQ+ care, and LGBTQ+ competencies proposed by the American Academy of Family Physicians.

Best Practices for LGBTQ+ GME Training

GME programs have had success with implementing educational conferences, awareness of LGBTQ+ concerns, contact with LGBTQ+ patients, and mentorship. Didactic lectures, conferences, journal clubs, and workshops focused on evidence-based studies are prominent settings to discuss LGBTQ+ healthcare (Recommended Curriculum Guidelines); this could include education on the management of patients receiving hormones (Juarez). Institutions should also consider the time trainees spend with LGBTQ+ patients, as the more LGBTQ+ exposure physicians have, has been associated with reduced biases (Danckers). Other suggested initiatives include increasing the comfort and confidence of completing histories and evaluations with LGBTQ+ patients, greater awareness of LGBTQ+ anatomy, and familiarity with diagnosing gender dysphoria, hormone therapy, and LGBTQ+ health disparities (Juarez). Lastly, mentorship can improve confidence, professional success, and belonging (Danckers). The care needed and provided will differ by specialty; while many LGBTQ+ considerations will be met through primary care, it is vital that LGBTQ+ patients, trainees, and physicians are confident and comfortable with the care provided.

A publication from 2023, discusses policy recommendations for medical education to provide comprehensive and affirming transgender gender minority patients, recommending the following: 1) standardize and fund inclusive care assessments; 2) involve LGBTQ+ voices and interdisciplinary feedback; 3) monitor LGBTQ+ health outcomes; 4) support mentorship by experienced physicians; 5) ensure a safe, respectful environment; 6) evaluate physician attitudes and competencies (Juarez).

Additionally, prioritizing mentorship, cultural humility, and patient privacy will enhance clinical practice, while ongoing monitoring of patient outcomes and longitudinal research can ensure sustained progress. Academic medical centers should also invest in scalable, evidence-based models, particularly in underserved areas, to build a more equitable and affirming healthcare system for all. The American Academy of Family Physicians recommends that Family Medicine residents must have before graduation from GME, which are related to the ACGME competencies: 1) communicate respectfully and confidentially with LGBTQ+ patients and their families; 2) understand considerations for histories and physical exams; 3) be aware of key psychological, sexual, and behavioral issues; 4) recommend screenings, reduce risks, and support mental health; 5) develop treatment plans using community and system resources; 6) discuss hormone replacement therapy confidently (Recommended Curriculum Guidelines).

The path to equitable, affirming healthcare begins with education. Medical schools and GME programs have both the opportunity and the responsibility to lead this change by embedding LGBTQ+ competencies into the fabric of physician training. When institutions invest in mentorship, evidence-based curricula, and safe learning environments, they not only improve care for LGBTQ+ patients but also strengthen the confidence, empathy, and cultural humility of tomorrow’s healthcare workforce.

By embracing a comprehensive, outcomes-driven approach to LGBTQ+ training, academic medical centers can ensure their learners are not only clinically prepared but ethically and emotionally equipped to serve every patient with dignity and respect.

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Works Cited

Cooper, Brett, MD, Mariam Chacko, MD, and Jennifer Christner, MD. “Incorporating LGBT Health in an Undergraduate Medical Education Curriculum Through the Construct of Social Determinants of Health.” The Journal of Teaching and Learning Resources, 2018, Incorporating LGBT Health in an Undergraduate Medical Education Curriculum Through the Construct of Social Determinants of Health | MedEdPORTAL.

Grova, Monica M., MD, MST, Sean J. Donohue, BA, Matthew Bahnson, MA, Michael O. Meyers, MD, Edward M. Bahnson, PhD. “Allyship in Surgical Residents: Evidence for LGBTQ Competency Training in Surgical Education.” Education and Career Development, vol. 260, 2021, Allyship in Surgical Residents: Evidence for LGBTQ Competency Training in Surgical Education - Journal of Surgical Research.

Gibson, Alec, Theodore Gobillot, Kevin Wang, Elizabeth Conley, Wendy Coard, Kim Matsumoto, Holly Letourneau, Shilpen Patel, Susan Merel, Tomoko Sairenji, Mark Whipple, Michael Ryan, Leo Morales, and Corinne Heinen. “A Novel Curriculum for Medical Student Training in LGBTQ Healthcare: A Regional Pathway Experience.” Journal of Medical Education and Curricular Development, 2020, https://doi.org/10.1177/2382120520965254.

Juarez, Paul D., Aramandla Ramesh, Jayne S. Reuben, Asa E. Radix, Cheryl L. Holder, Katherine Y. Brown, Mohammad Tabatabai, Patricia Matthews-Juarez. “Transforming Medical Education to Provide Gender-Affirming Care for Transgender and Gender-Diverse Patients: A Policy Brief.” The Annals of Family Medicine, vol. 21, suppl.2, 2023, Transforming Medical Education to Provide Gender-Affirming Care for Transgender and Gender-Diverse Patients: A Policy Brief | Annals of Family Medicine.

Marr, Mollie, Samuel Bnting, Bradley Blansky, Lexi Dickson, Aayush Gabrani, and Nelson Sanchez. “Graduate medical education curriculum regarding the health and healthcare of older lesbian, gay, bisexual, transgender, and queer (LGBTQ+) adults.” Journal of Gay and Lesbian Social Services, 2023, Graduate medical education curriculum regarding the health and healthcare of older lesbian, gay, bisexual, transgender, and queer (LGBTQ+) adults: Sexual and Gender Diversity in Social Services: Vol 35 , No 4 - Get Access.

“Recommended Curriculum Guidelines for Family Medicine Residents: Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, and Asexual Health.” American Academy of Family Physicians, Revised 2019, AAFP Reprint No 289D Recommended Curriculum Guidelines for Family Medicine Residents LGBTQA Health.

Sawning, Susan, Stacie Steinbock, Rachel Croley, Ryan Combs, Ann Shaw, Toni Ganzel. “A First Step in Addressing Medical Education Curriculum Gaps in Lesbian-, Gay-, Bisexual-, and Transgender-Related Content: The University of Louisville Lesbian, Gay, Bisexual, and Transgender Health Certificate Program.” Education for Health, 2017, vol. 30, no. 2, Education for Health.