the medical curriculum at the students ’ respective institutions , as well as studentreported levels of feeling prepared and comfortable as a result of medical school curricular content . The four primary outcomes which were tracked included the following : level of preparedness ( rated on a 5-point scale ) with the 16 LGBT-related health topics , level of comfort ( rated on a 5-point scale ) with LGBT health-related issues , perceived change in level of preparedness ( rated on a 3-point scale ) due to exposure to the information included in the medical school curriculum , and perceived change in level of comfort ( rated on a 3-point scale ) due to exposure to the information included in the medical school curriculum . The 16 topics covered barriers to care , safer sex practices , substance use , sexually transmitted infections , mental health and gender identity among others . Preparedness was defined as “ having the knowledge and training to effectively identify and address LGBT-specific health issues ” and comfort as “ being personally at ease having a sustained health-care-related interaction with LGBT-identified patients .”
Data Analysis
Completed questionnaires or those including a response to all four questions related to the primary outcome measures were included in analysis . Respondents who did not answer all questions related to the primary outcome measures were excluded . Respondents were stratified into Preclinical and Clinical groups for a comparative analysis . Students were asked to report which year of medical school they were enrolled , those who answered year 1st or 2nd fell into the Preclinical group ( n = 46 ), while those who answered 3rd , 4th , or recently graduated fell into the Clinical group ( n = 45 ). The decision to make this split was designed to most effectively elucidate the impact of clinical training on student attitudes .
Students ’ level of preparedness with 16 LGBT-related health areas was selfassessed . Students were classified as “ not prepared ” if they rated themselves as “ insufficiently prepared ” or “ not at all prepared .” Participants were classified as “ prepared ” if they rated themselves as “ well prepared ” or “ extremely well prepared .” Participants were considered neither “ prepared ” nor “ not prepared ” if they responded “ don ’ t know ” or had no answer . Student comfort level was selfassessed on a 5-point scale with the ratings of “ uncomfortable ,” “ somewhat uncomfortable ,” “ neutral ,” “ somewhat comfortable ,” or “ comfortable .”
RESULTS
The questionnaire was emailed to approximately 750 students and a total of 95 questionnaires were submitted ( 12.7 % response rate ). Results of fully completed questionnaires related to our main outcome measures were included ( Questionnaire 16 – 19 ; n = 91 ). The responses of participants who did not complete all questions related to the primary outcome were considered incomplete ( n = 4 ) and excluded . Of the 91 included responses , the majority identified as White ( 69 ; 75.8 %), heterosexual / straight ( 69 ; 75.8 %), cis female ( 46 ; 50.5 %), and were enrolled at WVU SoM ( 73 ; 82 %).
On average , preclinical students felt prepared for four of the 16 LGBT-specific subject areas , while clinical students reported feeling prepared to address 10 out of 16 topics on average . The majority of all students felt prepared to discuss sexual orientation ( 64 / 91 ; 70.3 %). Students felt least prepared to discuss sex reassignment surgery ( 17 / 91 ; 18.7 %) and transitioning ( 21 / 91 ; 23.1 %). Table 1 displays the number and percent of students who reported feeling prepared for each of the 16 subject areas .
Overall , 82.4 % of respondents reported feeling “ comfortable ” or “ somewhat comfortable ” with LGBT health issues . Additionally , medical school education helped 59.3 % of respondents feel “ more comfortable ” and 65.9 % of respondents feel “ more prepared ” to provide medical care for LGBT patients .
Students were asked to select sources of LGBT-related information that they encountered during medical school whether required in the curriculum or not ; the top responses were as follows : required pre-clinical instruction ( 68 %), interaction with LGBT-identified professors or physicians ( 50 %), interaction with LGBT- identified patients ( 48 %), interaction with LGBT student group ( 44 %), other students , not part of LGBT student group activities ( 44 %), required clinical training ( 42 %), panel discussions ( 42 %), and personal reading ( 37 %).
Greater than half of questionnaire respondents reported having “ too little coverage ” for the following topics : transitioning ( 62.64 %), body image in LGBT people ( 62.64 %), sex reassignment surgery ( 61.54 %), unhealthy relationships among LGBT people ( 61.54 %), LGBT adolescent health ( 59.34 %), mental health in LGBT people ( 56.04 %), coming out ( 54.95 %), safer sex for LGBT people ( 52.75 %), and chronic disease risk for LGBT populations ( 52.75 %)
When asked about additional LGBT-related topics that students wished they would had received as part of their medical training in free response format , most frequent responses included : hormonal treatment and gender-affirming surgery for transitioning patients , ways to improve communication skills , mental health , chronic disease risks , adolescent care , and pre-exposure prophylaxis for human immunodeficiency virus . When asked about strategies students would find most successful for increasing LGBT-specific content , the top four responses were as follows : clinical experiences with LGBT patients ( 77 %), faculty willing / able to teach about LGBT-related topics ( 69 %), case-based discussion of LGBT-related health / health disparities ( 57 %), and lectures about LGBTrelated health / health disparities ( 51 %).
DISCUSSION
The percent of Americans who identify as LGBT has increased to 4.5 % of adults in the US and 4.0 % of adults in WV . 10 , 11 The term LGBT encompasses communities and individuals of varying sexual orientations , gender identities and expressions that exist on a continuum . Health needs specific to patients who identify as LGBT have been elucidated . Barriers to care and prejudice within the medical community may contribute to poor delivery of care and worse overall outcomes for sexual and gender minority patients . For these reasons , attitudes and perceptions of medical professionals towards the LGBT community need to be analyzed and amended in an effort to improve quality of life for this vulnerable population .
Our study evaluates allopathic medical students ’ perception of caring for LGBT
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