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Where Comfort and Confidence Diverge: Missed Opportunities for Sexual and Gender Minority Competency in Osteopathic Education

Journal: Journal of Osteopathic Medicine Date: 2018/11, 118(11):Pages: e179-e180. doi: Subito , type of study: pretest posttest design

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2018.163/html)

Keywords:

curriculum [229]
gender [25]
osteopathic medicine [1540]
pretest posttest design [108]
USA [1086]

Abstract:

Research Question/Hypotheses: If research shows that medical students lack sexual health competency, can optional training improve their knowledge base, and if so, how would such training affect their understanding of patients who identify as sexual and gender minorities? Statement of Significance: To address growing health disparities among patients of sexual and gender minority (SGM) persons, the Association of American Medical Colleges (AAMC) recommends that medical schools incorporate sexual health competencies into their curriculum.1,2 The Commission on Osteopathic College Accreditation standards lack recommendations for the inclusion of SGM-related health care competency in osteopathic curriculum.3,4 Recent studies of medical student competency in SGM care further validate these concerns by showing a lack of knowledge and understanding in treating patients of SGM.5-10 At NSU-KPCOM, students care for patients in Florida's Miami-Dade and Broward Counties, which outrank entire states in incidences of new HIV infections among patients who identify as men who have sex with men (MSM).11 Safe Zone trainings (https://thesafezoneproject.com/) can improve both knowledge and understanding of SGM communities. This study investigated the efficacy such training to improve SGM health competence of medical students residing within Miami-Dade and Broward Counties. Methods: IRB exemption obtained after standard protocols set forth by NSU-KPCOM. Recruitment via email and social media obtained 236 participants who then completed anonymous online surveys administered through Google Forms. Competency was measured through responses on Likert scale measurements of thirteen questions related to SGM patient care before and after the training to identify overall changes in knowledge or understanding. Surveys remained open for submission 1 week before (n=115) and for 1 week after (n=121). Data Analysis: Preliminary analysis of the survey data sought to isolate participants who attended the training and were medical students. Of those students, 78 completed pretraining surveys and 73 completed posttraining surveys. This variation identified a need for additional exclusion criteria to remove those who did not attend both trainings from further analysis. This led to a net total of 42 participants who met all inclusion criteria, compared with a negative control group (n=70) to examine survey bias. Results: The key outcomes found subtle differences before and after the training in both domains of knowledge and understanding. Also, almost 10% reported in the comments section of both surveys that while they felt comfortable treating SGM patients, they did not feel confident in doing so, revealing a discrepancy between comfort and confidence that was later evaluated in the posttraining survey. Lastly, more than 90% of participants expressed that the training is relevant enough to be incorporated into their required curriculum, identifying a desire to learn more about the health disparities of SGM communities. Conclusion: This study reveals that incorporating SGM health care competency into osteopathic medical curriculum can improve NSU-KPCOM student's awareness of local resources, knowledge, and understanding of SGM communities. This curriculum must be regularly assessed to maintain efficacy for patient care. A 1-hour training session can affect both the knowledge and understandings of students who attend, compared with those who did not. Additionally, this study shows that most students feel neither confident nor comfortable enough to refer SGM patients to local resources. Perhaps this explains why over 90% of participants declared that the Safe Zone training is relevant enough to be incorporated into their required curriculum. Further studies may reveal factors influencing the differences in confidence and comfort in patient care.


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