Chandra Hartman, MD, FAAFP, Asst Prof Family Medicine, Rose

1. Session #__2258046___ Friday, October 11, 2013 or Saturday, October 12, 2013 Attending to Lesbian, Gay, Bisexual and Transgender Health: Improving Health Disparities Through Physician Education Chandra Hartman, MD, FAAFP, Asst Prof Family Medicine, Rose Arwen Johnson, MD, PGY2 Rose Family Medicine Residency Ben Kirkley, MD, PGY2, Rose Family Medicine Residency Collaborative Family Healthcare Association 15th Annual Conference October 10-12, 2013 Broomfield, Colorado U.S.A.

2. Faculty Disclosure We have not had any relevant financial relationships during the past 12 months.

3. Objectives • Review existing health disparities within the LGBT community • Current physician residency curriculums • Curricular blueprint • Design • Staff involvement • Behavioral Health integration • Moving forward

4. Learning Assessment Audience Question & Answer

5. A Brief History of LGBT Health in the United States

8. LGBT persons constitute sexual and gender minorities who have unique healthcare needs

10. Current Status of LGBT Health in Medical Education

11. Existing LGBT Curricula in Residency Programs in the US

12. AAFP Curricular Guidelines Attitudes Knowledge Skills

13. Rose Family Medicine Curriculum R1 • Implicit Bias Test, CAVP Video/TED Talk • Understanding Terminology • Background Knowledge on Health Research & Training, Review of Current Care, Barriers to Care, SOCE, Social Determinants of Health • Health/Sexual History – LGBT Inclusive • Primary Care for LGBT/Transgender • STI Prevention • Community Resources • R2 & R3 • STI Prevention; Safer Sex Recommendations • Cancer Risk Review • Special Populations – Elders, Youth, People of Color • Transgender Care & Screening Exams • Community Resources • Transgender Hormones & Referral Options • Legal Issues • Longitudinal • LGBT Physical Exam • LGBT Counseling Skills – psychosocial, behavioral, sexual, & reproductive • Review National Resources & Guidelines for Future Practice

14. R1

15. R2 & R3

16. Staff & Faculty

17. Office

18. Moving Forward

19. Research • IOM/NIH Recommendations • Healthy People 2020

20. What can I do? • Review current office status • Identify Champion(s) • “Cultural Humility” sessions for staff/providers • Review and update forms • Review and update mission statement • Brochures

21. Resources • Fenway Guide to Lesbian, Gay, Bisexual and Transgender Health . Makedon, H. et al. American College of Physicians, 2008 • Guidelines for Transgender Care. Bockting, W. and Goldberg, J., editors. The Haworth Medical Press, 2006. • Principles of Transgender Medicine and Surgery Ettner, R., Monstrey, S., Eyler, A.E., editors. The Haworth Press, 2007 • www.glma.org : The Gay and Lesbian Medical Society • www.wpath.org :The World Professional Association for Transgender Healthcare • www.vch.ca/transhealth/resources : Vancouver Coastal Health: Transgender Health Project The Center www.glbtcolorado.org AAFP GLBT Listserv AAFP Curricular Guidelines

22. Sources • Mayer KH, Bradford JB, Makadon HJ, et al. Sexual and gender minority health: What we know and what needs to be done. American Journal of Public Health. 2008:98; 989-995. http://www.lmunet.edu/dcom/hec/PDFs/Sexual%20and%20Gender%20Minority%20Health.pdf • Boehmer U. Bowen DJ, Bauer GR. Overweight and obesity in sexual minority women: evidence from population-based data. American Journal of Public Health. 2O07; 97: 1134-1140. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377288/ • Haas, et al. Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations. Journal of Homosexuality. 2011; 58:10–51. American Foundation of Suicide Prevention. http://www.tandfonline.com/doi/pdf/10.1080/00918369.2011.534038 • American Lung Association Report. Disparities in Lung Health Series. Smoking Out a Deadly Threat: Tobacco use in the LGBT Community. http://www.lung.org/assets/documents/publications/lung-disease-data/lgbt-report.pdf • Sanchez, et al. Health Care Utilization, Barriers to Care, and Hormone Usage Among Male-to-Female Transgender Persons in New York City. Am J Public Health. 2009 April; 99(4): 713–719. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2661470/ • Tesar CM, Rovi SLD. Survey of Curriculum on Homosexuality/Bisexuality in Departments of Family Medicine. Fam Med 1998;30(4):283-7. http://www.stfm.org/fmhub/Fullpdf/April98/ERM3.pdf

23. Sources • Obedin-Maliver, et al. Lesbian, Gay, Bisexual, and Transgender–Related Content in Undergraduate Medical Education. JAMA. 2011;306(9):971-977. doi:10.1001/jama.2011.1255. http://jama.jamanetwork.com/article.aspx?articleid=1104294 • Carolyne Krupa. New doctors trained to overcome LGBT health care gap. American Medical News. http://www.amednews.com/article/20121105/profession/311059955/2/ • UCSF's Center for LGBT Health & Equity: http://lgbt.ucsf.edu/services_health.html#education • AMSA LGBT Health in the Medical School Curriculum: http://www.amsa.org/AMSA/Homepage/About/Committees/GenderandSexuality/ImproveCurriculum.aspx • AAFP Recommended Curricular Guidelines for Family Medicine Residents: http://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint289D_LGBT.pdf • Beth Israel Medical Center Internal Medicine Residency – LGBT Health Callen-Lorde Elective. http://www.bimcmedicine.org/program-curriculum

24. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!