Why is this important?
If you are visiting this page, you already have a notion of the importance of LGBTQ education. But you may have doubts, particularly since many health care professional programs have a vast array of content that must be included. There has been a widespread belief that health care provider education should focus on universal technical skills that apply to all people, therefore, there is no need to learn about any sociocultural differences among people.
In recent years, however, with growing recognition of health disparities based on race/ethnicity, class, gender, and sexual identities, the health professions have increasingly acknowledged the need to address the role of culture on health and wellbeing. We are coming to understand that providing universal or generic care means that many of our patients/clients receive inadequate or culturally inappropriate care, and that failing to address health disparities means that some patients/clients do not enter health care institution doors until their illnesses are far advanced, because they fear poor treatment or because they do not have insurance because of discriminatory practices in society.
This program is designed to help educators in basic programs and in continuing education programs overcome the huge gap that exists between what providers are taught about the needs of LGBTQ people and their famlies, and what people in this community need from health care.
Who is qualified to deliver LGBTQ education?
Ideally, the person who delivers the curriculum has some knowledge of LGBTQ healthcare issues, and is comfortable talking openly about sexuality and gender. However, we know that not all schools can identify a person with both a healthcare background and LGBTQ expertise. It is acceptable to identify a facilitator with an open mind who is willing to study these materials and present them in a collaborative manner to students and colleagues for co-learning.
If no-one on the faculty is comfortable presenting the material alone, you could identify a co-facilitator from the local LGBTQ community as well (although not all people who are great liaisons for LGBTQ communities have healthcare experience). Finally, you could contact one of the co-authors of this educational program to do the training. At minimum, the requirements for delivering this content include:
- Accepting the premise that sexual orientation and gender identity are not risk factors for health problems: stigma is the risk factor.
- Willingness to learn more about LGBTQ health to become familiar with the content, and feel able to answer questions.
- High comfort level for talking about sexual and gender.
- Able to deal with potential conflict and disagreement among participants.
How long does it take to present this material?
The bare bones of the content, without elaborating on the discussion questions or using any of the supplemental activities or assignments, can be delivered in about a two hour frame in a class or continuing education venue. With activities and discussion questions, it can be extended to three to four hours, or more. The educational materials presented here could, and ideally, should be supplemented with films, guest speakers, facilitated discussions of case examples, and specific thought-provoking questions offered through-out the session. We recommend allotting at least three hours to this program.
What are some of the common barriers to introducing LGBTQ topics in the basic health care educational program, or as continuing education?
Time: The main barrier cited by faculty in healthcare education programs is time. Where in the overall curriculum can this material fit with the myriad of other information that students must learn to be safe and effective health care providers? This time barrier exists in all types of health care basic education. The primary argument for including this content is that if health care providers are not trained in cultural sensitivity, they will be less effective no matter what technical skills they have. Diversity training is a critical part of the health care curriculum. Sometimes the issue of time is used to detract attention from the real reasons for not addressing these issues, which are often related to lack of knowledge, negative attitudes about LGBTQ people, fear of offending others, or general fear of “controversial” topics.
No trained faculty to deliver the information. Many health care education programs report that they have no one on staff who is adequately trained to deliver LGBTQ content. This may be true for many programs, but often there are trained people who are afraid to present the content because of the overall climate of the program or department. If the administration expresses a willingness to support education about LGBTQ issues, someone will often step up to deliver the curriculum.
There are no readily available materials/curricula on LGBTQ health care. Actually this is no longer true since you are visiting our web site that is rich with materials! A variation on this barrier is the idea that there are no “evidence-based” materials about LGBTQ health. This, too, is false. As you will see from the reference list for this content, there is now a substantial research base about many aspects of LGBTQ health. We provide only a few specific references in the lecture materials, to make them more readable, but recommend that anyone delivering this content become familiar with the research in the field. We provide an extensive reading list for presenters at the end of this document.
Faculty who teach this curriculum will be perceived to be LGBTQ, whether they are or not, and may experience negative responses from coworkers. Many LGBTQ faculty, staff, students, and patients fear experiencing discrimination if they are open about their sexuality or gender, thus they stay quiet and invisible. If no one advocates for inclusion in the health care curriculum, why would the faculty change the curriculum? Some heterosexual faculty may be hesitant to endorse this educational program for fear of being labeled as LGBTQ, as if only LGBTQ people would support the inclusion of such content. This is a testament to the power of stigma. Why should heterosexual healthcare providers so fear being labeled as LGBTQ, unless stigma is powerful? White, European-American faculty have learned to teach about racial/ethnic minority patient/client issues without fearing being labeled—the same should be true of teaching about LGBTQ issues.
Health care professional training only needs to focus on universal technical skills. There is a widespread belief in most healthcare training programs that we teach knowledge and skills that apply to all humans, therefore, there is no need to address specific cultural groups (e.g. Eliason, 1996). Even if a program supports discussion on cultural diversity, some faculty may perceive that communities based on sexual and gender identities do not constitute a culture. However, there is ample evidence that LGBTQ people form communities with shared belief systems, have a unique language, art, and cultural productions, organize around political issues, have a shared experience of dealing with stereotypes, experiencing discrimination and hate crimes, and have social groups based on shared identities, much like other groups that are readily recognized as “cultures.” We know that a strict reliance on technical skills is often dehumanizing, and takes the personal touch out of health care. In reality, even technical skills are delivered in an interpersonal context.
Where in the health care education curriculum does this information belong?
There is no easy answer to this question. Students and practicing health care professionals will encounter LGBTQ patients/clients in every healthcare setting, so ideally material about sexuality and gender is integrated through-out the curriculum. The introductory material in this program could fit well within the first clinical course, a diversity course, a course about health care communication, or a course or unit on taking health histories or conducting health assessments.
Often if there is any discussion of LGBTQ issues in a program, it is in the unit on human sexuality. We believe that this is not the best place for LGBTQ health care issues to be placed because the health risks are primarily related to discrimination and stigma, not to sexual behavior or identity.
LGBTQ people are at higher risk for a range of physical and mental health problems because of societal stigma, and the oppression related to variations in sexuality and gender identities. Secondly, there are no sexual behaviors that are strictly associated with one’s sexual identity. Any person can potentially engage in any type of sexual behavior.
Finally, in terms of health care needs of LGBTQ people, the content fits better in units about diversity, taking health histories, or legal and structural barriers to quality care. Sex for LGBTQ people is one small part of life, just as it is for heterosexuals, so sexuality units should also include LGBTQ issues, but sexuality units should not be the only place where LGBTQ people are mentioned.
How do students or practicing healthcare providers usually receive this information?
In our accumulated experiences over many years of healthcare education in a wide variety of settings and geographical regions, we have found that students overwhelmingly are receptive, even eager, to learn about LGBTQ healthcare issues. They want to be good providers and they want to provide quality, culturally appropriate services to all patients/clients.
On rare occasions, we have encountered resistance, usually based on deep-seated religious beliefs. In those cases, we have discussed the need to provide quality healthcare to all people, whether we agree with the diverse belief systems or practices of others. Most religious value systems endorse kind and considerate treatment of others and a nonjudgmental attitude. Many religions are welcoming and inclusive of LGBTQ people, and no religion advocates discriminating against others by refusing to care for people in need, or offering poor quality care to underserved and marginalized populations.
How do I get the program approved for continuing education credit?
We have supplied many of the elements needed for you to submit the program for approval from your local continuing education provider. We have included biographical sketches of the course writers, course objectives, and suggested items for a post-test. You will need to supply your own presenter bios and explain how you will use the materials—particularly the length of the program, the methods of teaching, and the expected outcomes, in order to get local approval.