“What is making you so anxious, Michael?” the medical intern asked me at my hometown doctor’s office. I hesitated for what felt like hours and finally whispered: “I’m — I’m — gay.”
This was the first time I uttered those words to anyone in my hometown. Although I was out to a few people in my college town, the small community I grew up in never felt like a safe place to be myself.
Health care workers have unique positions in that they work one on one with community members. This revered position can be used to create safe, judgment-free environments that foster supportive relationships and dialogue. Accordingly, our future health care professionals must be trained to support and care for their LGBTQ patients. That sensitivity and safety training need to begin right here at the Yale School of Medicine, the Yale Physician Associate Program and the Yale School of Nursing.
On May 4, 2017, known to some as the National Day of Prayer, President Donald Trump signed a watered-down executive order giving religious organizations “regulatory relief” around offering contraception to their employees. A previous version of the bill leaked one day prior, promising to give “religious liberty” for organizations — including for-profit businesses — to deny services to LGBTQ Americans. Thankfully, this proposition was removed from the current iteration of the order.
Nonetheless, if you look at where members of the Trump administration stand on gay rights, it is easy to predict the Right’s desire to roll back protections and civil rights for sexual minorities. Recently, Trump tweeted that transgender individuals would be banned from the military, without seemingly consulting the Pentagon (or, of course, trans* groups themselves). On Aug. 25 Trump signed an official executive order for the trans* ban. Vice President Mike Pence similarly has a consistent record of endorsing LGBTQ exclusion and has even expressed support for conversion therapy.
With this attack on LGBTQ Americans, health care providers must create safe environments (like the one I experienced when I came out) that allow LGBTQ individuals who are suffering in silence find a safe ally.
Thankfully, the School of Medicine and School of Nursing have made steps to incorporate LGBTQ health into their curriculum. The School of Medicine recently revealed that a student/faculty group won a Medical Education Award, which provided funding to implement LGBTQ education into the curriculum.
The School of Medicine also offers a directory for students wishing to connect with LGBTQ-oriented educators. One first-year medical student I spoke to said he received one lecture on LGBTQ health and one ethics lecture that included gay issues.
The School of Nursing is also rumored to be starting an LGBTQ health minor for its advanced practice registered nurse students, which is a good start. Nevertheless, this is an “opt-in” strategy, which does not ensure LGBTQ issues are weaved in throughout the curricula. The caveat with this approach is if you decide to do another minor such as oncology nursing, your access to LGBTQ health education has become incredibly limited. (Note: LGBTQ people can get cancer.) The School of Nursing has hired a new APRN faculty member whose clinical specialty is LGBTQ health (specifically transgender primary care and postoperative support), which I am hopeful signifies a culture shift at the school.
There are additional LGBTQ-oriented lectures now built into the curriculum. But although there is change beginning at our schools, we must strengthen our curriculum to include training in LGBTQ cultural sensitivity and a trauma-informed approach to care.
As a current APRN student, it should not be so difficult for me to find basic training around transgender care: hormone care, postoperative support, legal issues. Additionally, LGBTQ issues can easily be woven into medical case studies, standardized and digital patients, the simulation lab and exam questions. There is no reason the School of Nursing and School of Medicine cannot collaborate with the already established LGBT Studies and Women’s, Gender and Sexuality Studies departments here at Yale.
Being LGBTQ is not a singular experience; it is enriched by all of our other identities — racial, cultural, origin, socioeconomic status, ability, religious. The incredibly short training we receive at the School of Medicine, the Physician Associate Program and School of Nursing around LGBTQ health typically presents the information from a monolithic white perspective.
Sexuality is more complex than being taught to ask the patient: “Do you have sex with men, women or both” or “Do you identify as male, female or prefer not to answer.” If, or when, the School of Medicine, School of Nursing and the Physician Associate Program initiate comprehensive LGBTQ education, I plead that they approach and present the topic from an intersectional and holistic approach.
With the current presidential administration’s attempts to roll back health care, disband rights for trans* peoples and remove protections for LGBTQ communities, it is our duty as future health care leaders to advocate for our LGBTQ patients — and it is the duty of our schools to provide that education.
Michael Anthony Moore is a second-year graduate student at the Yale School of Nursing. Contact him at firstname.lastname@example.org .
Correction, Sept. 13: A previous version of this column stated that a student-faculty group at the Yale School of Medicine received funding to begin implementing an LGBTQ curriculum. Actually, the award was a prize for an already-implemented curriculum sequence at the medical school.