Evaluating the inclusion of lesbian, gay, bisexual, transgender, and queer-related content in graduate medical education: a national survey of program directors

BackgroundNational organizations have identified incorporation of LGBTQ-health content into graduate medical education programs as key action items; however, there has been no systematic study of LGBTQ-health content in these programs using a unified survey instrument across all specialties. The primary objective of this study was therefore to systematically evaluate the quantity of LGBTQ-related didactic and clinical education in graduate medical education programs using a unified survey.MethodsA cross-sectional, internet-based survey study of programs participating in the 2023-2024 Electronic Residency Application System, performed from September 2023-August 2024.ResultsOf 4,512 programs, 1,048 programs responded (23.2%). The median and mean number of didactic hours per year dedicated to LGBTQ-related content was 2.0 (IQR, 1.0-5.0, range, 0.0-200.0) and 4.0 (SD 9.1), respectively. The median and mean number of clinical hours per year dedicated to LGBTQ-related content was 10.0 (IQR, 1.5-40.0, range, 0.0-2000.0) and 61.0 (SD 188.4), respectively. Multiple programs reported that residents received no exposure to LGBTQ-related health content in either didactic settings (15.8%; 95% CI, 13.5-18.5%) or clinical settings (19.4%, CI 16.1 - 23.0%). The most covered didactic topics were gender identity (43.6%), sexual orientation (41.6%), and barriers to care (32.0%). The most covered clinical topics were Pre-Exposure Prophylaxis/Post-Exposure Prophylaxis (77.0%) and facial masculinization/feminization surgery (68.4%). The most cited barriers to including LGBTQ-related health topics were the lack of faculty with requisite knowledge/expertise (56.1%, CI 52.3 - 59.9%) and the lack of time (48.3%, CI 44.5 - 52.1%).ConclusionsMultiple programs provide no didactic or clinical exposure to LGBTQ-related health topics, which does not align with the goals outlined by national organizations.