Faculty and students at the Yale School of Medicine have been awarded the Innovation in Medical Education Award for a project that places a new emphasis on addressing LGBTQI issues and intersectionality in medical school curricula.
Medical students Nix Sitkin MED ’18 and Michael Solotke ’13 MED ’20 as well as medical school professors John Encandela and Michael Schwartz were recognized for their work in improving awareness of health care needs specific to historically marginalized populations, such as the LGBTQI community. The award, which includes a $3,000 stipend, was presented by the Northeast Group on Educational Affairs, part of the Association of American Medical Colleges.
The curriculum development collaboration began during the 2014–15 academic year. Sitkin approached Schwartz, the associate dean for curriculum at the Yale School of Medicine, with a presentation on LGBTQI health disparities and ways to improve Yale’s existing curriculum. Sitkin had experience working with LGBTQI health issues before medical school, which helped inform her of the “extensive mental and physical health disparities experienced by the LGBTQI community,” she said.
“Unfortunately, one of the many reasons these disparities exist — in addition to social stigma and structural bias — is the provider,” Sitkin said. “Physicians are members of society, and they can perpetuate social stigmas if they are not knowledgeable and engage in non-inclusive behavior.”
Sitkin pointed out that historically, identifying as LGBTQI has been interpreted as a medical condition. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders — a widely used resource that lists all classifications of mental disorders — labeled homosexuality as a diagnosable disorder until 1973. The DSM also considered transgender people to suffer from a “gender identity disorder” until 2013, when the term was replaced with “gender dysphoria.”
Sitkin’s proposal coincided with an ongoing push to re-evaluate and redesign the medical school’s curriculum, according to Schwartz. Since 2010, the medical school had been looking to create a new set of overarching goals emphasizing patient needs, in addition to the application of science to clinical medicine, he said.
“New physicians have to be much more aware of a diversity of sociological as well as patient-centered issues,” Schwartz said. “This makes you think about how traditional medical students have been trained to treat their patients and now we also work with patients of diverse backgrounds in terms of sex, gender, ethnicity and culture,” Schwartz said.
With Schwartz’s support, Sitkin began developing the new curriculum in spring 2015 alongside Solotke and Encandela, the associate director for curriculum and educator assessment at the medical school’s Teaching and Learning Center. The team met with educational leaders at the medical school and created pitches for learning activities designed to meet the specific learning objectives and competencies outlined by the AAMC, Encandela said.
The new curriculum components were introduced for the matriculating class in fall 2015. According to Encandela, the team provided recommendations for faculty members to add new activities or enhance existing instruction, but they did not design a set curriculum.
“One thing we said was, ‘we’re not going to develop this for you — we’ll help you, recommend resources and design small components for you, but you have to own this,’” Encandela said. “It was a great step in hindsight because faculty ownership is a way to institutionalize these things so they don’t fall out of the curriculum in the future.”
Sitkin noted that the previous lack of attention given to LGBTQI topics was not specific to Yale’s curriculum, but rather was characteristic of most medical schools around the country. She added that she was pleased to see a positive reaction from the Yale community, noting that some faculty members have even begun developing their own content on LGBTQI-specific concepts.
Pediatrics professor Eve Colson MED ’89, who serves as chief of the Pediatric Department’s section of education, said that her department has added new sessions on topics such as the care of transgender youth.
“It is important to be aware of and to know how to address some of the unique psychological, social and medical issues that might arise for this population, in order to provide health care focused on the needs of the individual patient,” Colson said.
The new curriculum now incorporates lectures and workshops that provide instruction on a variety of previously under-addressed issues, such as treating transgender and intersex patients in the emergency room, Schwartz said.
Sitkin and Schwartz both pointed to implicit bias training as a highlight of the new curriculum. Now a mandatory activity for all Yale students entering their clinical year, the training equips them with the skills needed to counteract implicit biases in the clinic in terms of diagnoses and treatment, Sitkin said. She added that these workshops focus on teaching students about intersectionality and how to treat patients with complex histories.
“Unless we learn and encounter different identities, we won’t be able to interact with them in the real world,” Sitkin said. “Patients don’t come as just a person of color or just a woman or just a lesbian — they can come as a queer black lesbian who has had many other experiences as well.”
The team hopes to attract more course directors, administrators and students who are interested in incorporating the integration of these concepts into curricula, Sitkin said. Encandela said that this curriculum model does not have to be limited to LGBTQI issues, adding that other subpopulations of patients can also benefit from a more comprehensive medical school curriculum.