Lesbian, Gay, Bisexual, and Transgender Health: a Survey of Attitudes, Knowledge, Preparedness, Campus Climate, and Student Recommendations for Change in Four Midwestern Medical Schools

  • Gary L. Beck Dallaghan
  • Jim Medder
  • Jeffrey Zabinski
  • Sabrina M. Neeley
  • Brenda Roman
  • Jeffrey L. Emrich
  • Nicole Borges
  • Dawn Bragg
Original Research


Medical school curricula addressing the unique healthcare needs and disparities of lesbian, gay, bisexual, and transgender (LGBT) patients are insufficient. National organizations have recommended curricular and institutional climate changes to address this problem. This study examined students’ perceived attitudes and knowledge regarding LGBT patient care and campus climate at four Midwestern US allopathic medical schools. During 2013, all medical students at the four institutions were invited to participate in the online anonymous survey. We used descriptive statistics for survey item results and qualitative methods to analyze responses to open-ended questions about curricular changes. Survey results were obtained from 34.6% of students and demonstrated that attitudes, knowledge, preparedness, and campus climate across all institutions were generally positive for LGBT patients and students. A negative correlation was found between overall campus climate and discrimination practices. Four themes emerged from students’ recommendations to improve their training, which included more clinical experiences with LGBT patients, more formal curricula on LGBT topics, establishment of safe learning environments, and addition of specific topics related to LGBT health. Due to the low prevalence of LGBT populations, reluctance to disclose sexual orientation or gender identity, and lack of LGBT-specific clinics, required experiences with LGBT patients during clinics or clerkship rotations may be more difficult in smaller urban communities in which some Midwestern medical schools are located. Potential alternatives include using multiple teaching modalities in the pre-clerkship years to expose students to LGBT-identified patients in clinical simulations and settings.


Lesbian Gay Bisexual Transgender LGBT Patient care Attitudes Knowledge Medical education 



The authors wish to thank Jenenne Geske, PhD, Associate Professor in the Department of Family Medicine, College of Medicine, University of Nebraska Medical Center, for assistance with statistical analyses and editorial review and support.

Compliance with Ethical Standards

The study protocol was approved by the institutional review boards of all participating institutions and was granted an exempt status at all schools.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Institute of Medicine Committee on lesbian, gay, bisexual, and transgender health issues and research gaps and opportunities. The health of lesbian, gay, bisexual, and transgender people. Building a Foundation for Better Understanding http://www.iom.edu/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-Transgender-People.aspx. Accessed 2 June 2016. The National Academies Press, Washington, DC, 2011.
  2. 2.
    Petroll AE, Mosack KE. Physician awareness of sexual orientation and preventive health recommendations to men who have sex with men. Sex Transm Dis. 2011;38(1):63–7.  https://doi.org/10.1097/OLQ.0b013e3181ebd50f.CrossRefGoogle Scholar
  3. 3.
    Meckler GD, Elliott MN, Kanouse DE, Beals KP, Schuster MA. Nondisclosure of sexual orientation to a physician among a sample of gay, lesbian, and bisexual youth. Arch Pediatr Adolesc Med. 2006;160(12):1248–54.  https://doi.org/10.1001/archpedi.160.12.1248.CrossRefGoogle Scholar
  4. 4.
    Mayer KH, Bradford JB, Makadon HJ, Stall R, Goldhammer H, Landers S. Sexual and gender minority health: what we know and what needs to be done. Am J Public Health. 2008;98(6):989–95.  https://doi.org/10.2105/AJPH.2007.127811.CrossRefGoogle Scholar
  5. 5.
    Burke BP, White JC. The well-being of gay, lesbian, and bisexual physicians. West J Med. 2001;174(1):59–62.  https://doi.org/10.1136/ewjm.174.1.59.CrossRefGoogle Scholar
  6. 6.
    Przedworski JM, Dovidio JF, Hardeman RR, Phelan SM, Burke SE, Ruben MA, et al. A comparison of the mental health and well-being of sexual minority and heterosexual first-year medical students: a report from the medical student CHANGE study. Acad Med. 2015;90(5):652–9.  https://doi.org/10.1097/ACM.0000000000000658.CrossRefGoogle Scholar
  7. 7.
    Lapinski J, Sexton P. Still in the closet: the invisible minority in medical education. BMC Med Educ. 2014;14:171–6920–14-171.Google Scholar
  8. 8.
    Eliason MJ, Dibble SL, Robertson PA. Lesbian, gay, bisexual, and transgender (LGBT) physicians' experiences in the workplace. J Homosex. 2011;58(10):1355–71.  https://doi.org/10.1080/00918369.2011.614902.CrossRefGoogle Scholar
  9. 9.
    U.S. Department of Health and Human Services. Healthy people 2020—improving the health of America. http://healthypeople.gov/2020/default.aspx. Accessed 2 June 2016.
  10. 10.
    The Joint Commission. Advancing effective communication, cultural competence, and patient- and family-centered care for the lesbian, gay, bisexual, and transgender (LGBT) community: a field guide. Oak Brook, IL: Joint Commission, 2011.Google Scholar
  11. 11.
    Association of American Medical Colleges. Implementing curricular and institutional climate changes to improve health Care for individuals who are LGBT, gender nonconforming, or born with DSD http://offers.aamc.org/lgbt-dsd-health. Accessed 2 June 2016. Association of American Medical Colleges, Washington, DC, 2014.
  12. 12.
    Obedin-Maliver J, Goldsmith ES, Stewart L, White W, Tran E, Brenman S, et al. Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education. JAMA. 2011;306(9):971–7.  https://doi.org/10.1001/jama.2011.1255.CrossRefGoogle Scholar
  13. 13.
    Burke SE, Dovidio JF, Przedworski JM, Hardeman RR, Perry SP, Phelan SM, et al. Do contact and empathy mitigate bias against gay and lesbian people among heterosexual first-year medical students? A report from the medical student CHANGE study. Acad Med. 2015;90(5):645–51.  https://doi.org/10.1097/ACM.0000000000000661.CrossRefGoogle Scholar
  14. 14.
    Pew research center. Growing support for gay marriage: changed minds and changing demographics http://www.people-press.org/2013/03/20/growing-support-for-gay-marriage-changed-minds-and-changing-demographics/. Accessed 21 November 2016. The Pew Research Center for the People & the Press, Washington, DC, 2013.
  15. 15.
    Mujawar I, Sabatino M, Ray Mitchell S, Walker B, Weissinger P, Plankey M. A 12-year comparison of students' perspectives on diversity at a Jesuit medical school. Med Educ Online. 2014;19(1):23401.  https://doi.org/10.3402/meo.v19.23401.CrossRefGoogle Scholar
  16. 16.
    Dhaliwal JS, Crane LA, Valley MA, Lowenstein SR. Student perspectives on the diversity climate at a U.S. medical school: the need for a broader definition of diversity. BMC Res Notes. 2013;6:154–0500–6-154.Google Scholar
  17. 17.
    White W, Brenman S, Paradis E, Goldsmith ES, Lunn MR, Obedin-Maliver J, et al. Lesbian, gay, bisexual, and transgender patient care: medical students' preparedness and comfort. Teach Learn Med. 2015;27(3):254–63.  https://doi.org/10.1080/10401334.2015.1044656.CrossRefGoogle Scholar
  18. 18.
    Kelley L, Chou CL, Dibble SL, Robertson PA. A critical intervention in lesbian, gay, bisexual, and transgender health: knowledge and attitude outcomes among second-year medical students. Teach Learn Med. 2008;20(3):248–53.  https://doi.org/10.1080/10401330802199567.CrossRefGoogle Scholar
  19. 19.
    Sequeira GM, Chakraborti C, Panunti BA. Integrating lesbian, gay, bisexual, and transgender (LGBT) content into undergraduate medical school curricula: a qualitative study. Ochsner J. 2012;12(4):379–82.Google Scholar
  20. 20.
    Butler M, McCreedy E, Schwer N, et al. Improving cultural competence to reduce health disparities. Rockville (MD): Comparative Effectiveness Review No. 170, 2016.Google Scholar
  21. 21.
    Sanchez NF, Rabatin J, Sanchez JP, Hubbard S, Kalet A. Medical students' ability to care for lesbian, gay, bisexual, and transgendered patients. Fam Med. 2006;38(1):21–7.Google Scholar
  22. 22.
    Thomas DD, Safer JD. A simple intervention raised resident-physician willingness to assist transgender patients seeking hormone therapy. Endocr Pract. 2015;21(10):1134–42.  https://doi.org/10.4158/EP15777.OR.CrossRefGoogle Scholar
  23. 23.
    Johnson K, Rullo J, Faubion S. Student-initiated sexual health selective as a curricular tool. Sex Med. 2015;3(2):118–27.  https://doi.org/10.1002/sm2.57.CrossRefGoogle Scholar
  24. 24.
    Hasenbush a, Flores AR, Kastanis a, Sears B, gates GJ. The LGBT divide: a data portrait of LGBT people in the Midwestern, Mountain & Southern States http://williamsinstitute.law.ucla.edu/wp-content/uploads/LGBT-divide-Dec-2014.pdf. Accessed 20 November 2016. The Williams Institute, UCLA School of Law, Los Angeles, CA, 2014.
  25. 25.
    Solotke M, Sitkin NA, Schwartz ML, Encandela JA. Twelve tips for incorporating and teaching sexual and gender minority health in medical school curricula. Med Teach. 2017:1–6.  https://doi.org/10.1080/0142159X.2017.1407867.

Copyright information

© International Association of Medical Science Educators 2018

Authors and Affiliations

  • Gary L. Beck Dallaghan
    • 1
  • Jim Medder
    • 2
  • Jeffrey Zabinski
    • 3
  • Sabrina M. Neeley
    • 4
  • Brenda Roman
    • 5
  • Jeffrey L. Emrich
    • 6
  • Nicole Borges
    • 7
  • Dawn Bragg
    • 8
  1. 1.Office of Medical Education, College of MedicineUniversity of Nebraska Medical CenterOmahaUSA
  2. 2.Family Medicine, College of MedicineUniversity of Nebraska Medical CenterOmahaUSA
  3. 3.Psychiatry ResidencyJohns Hopkins School of MedicineBaltimoreUSA
  4. 4.Population and Public Health Sciences, Boonshoft School of MedicineWright State UniversityDaytonUSA
  5. 5.Psychiatry, Boonshoft School of MedicineWright State UniversityDaytonUSA
  6. 6.Pre-Clinical Curriculum, Carver College of MedicineUniversity of IowaIowa CityUSA
  7. 7.Pediatrics, University of Mississippi School of MedicineJacksonUSA
  8. 8.Student Affairs/Diversity, Office of Measurement and Evaluation, Pediatric-Medical EducationMedical College of WisconsinMilwaukeeUSA

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