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Park AJ, Katz KA. Paucity of Lesbian, Gay, Bisexual, and Transgender Health-Related Content in the Basic Dermatology Curriculum. JAMA Dermatol. 2018;154(5):614–615. doi:10.1001/jamadermatol.2017.6531
Lesbian, gay, bisexual, and transgender (LGBT) persons in the United States account for 2.2% to 4.0%1 of the population and face considerable health disparities, generally and specifically related to dermatology.2-4 According to Healthy People 2020, the federal government’s public health agenda, these disparities partially arise from a shortage of health care professionals who are knowledgeable and culturally competent in LGBT health.2 Mitigating LGBT health disparities is a focus of Healthy People 2020 and the Association of American Medical Colleges (AAMC).2,5 The AAMC guidelines recommend that medical schools integrate LGBT health-related competencies throughout their curricula, especially through use of clinical scenarios that incorporate discussion points specific to this population.5 We investigated the extent to which an online dermatology curriculum for medical students incorporated LGBT health-related content.
We conducted a cross-sectional study of the American Academy of Dermatology’s (AAD) online Basic Dermatology Curriculum, which consists of case-based modules. The curriculum was created by the AAD in collaboration with the Society for Pediatric Dermatology (SPD). Most modules have an associated learner quiz, allowing students to assess their knowledge after module completion.
All curriculum modules (in PDF format) and quizzes were downloaded from the American Academy of Dermatology Association Basic Dermatology Curriculum Website (http://www.aad.org/education/basic-derm-curriculum) on November 20, 2017. Patients’ gender or sex, dating or marriage status, sexual orientation, and sexual behavior were all recorded. For pediatric modules, patients’ parents were characterized by parental status (mother, father) and marriage status.
The curriculum consisted of 293 patients, with 157 in 40 modules and 136 from 36 quizzes, including 121 pediatric patients. Characteristics of patients and, for pediatric cases, patients’ parents are shown in the Table. One of 293 (0.3%) cases mentioned an LGBT patient, a woman with basal cell carcinoma (BCC) in a same-sex marriage. No cases included a transgender patient, mentioned same-sex sexual behavior, or specified sexual orientation.
This study shows a near-absence of LGBT-related content in the AAD and SPD’s Basic Dermatology Curriculum. This paucity of content represents a missed opportunity to educate medical students in providing medically appropriate and culturally competent care to LGBT persons in dermatology settings, even as the importance of these competencies to dermatologists is increasingly noted in the medical literature.3,4,6 This absence might also signal to medical students potentially interested in pursuing dermatology, and to residents, dermatology faculty, and other educators who use this curriculum, that LGBT health is not important in dermatology.
It is possible that other dermatology-related educational materials besides the Basic Dermatology Curriculum not assessed in this study incorporate more LGBT health-related content. However, considering this study’s findings and recommendations from Healthy People 2020 and AAMC, AAD, and SPD should include more cases involving LGBT persons in the curriculum. Some cases should highlight dermatologic issues of specific importance to LGBT health.3 For example, some evidence suggests that lifetime prevalence of nonmelanoma skin cancer in sexual-minority women is lower, and in sexual-minority men is higher, than in heterosexuals.6 As in the case of the woman with BCC in a same-sex marriage, other cases should feature patients without LGBT-specific dermatologic concerns (or parents of children with dermatologic concerns); in line with AAMC recommendations, those cases can sensitize students to general issues of LGBT-related cultural competency (for example, appropriate use of pronouns and other terminology).5 Per AAMC recommendations, to ensure that medical students are achieving relevant competencies through the online curriculum and other sources, medical student evaluations should include LGBT-related content in examination questions, evaluation scenarios, and patient scenarios.5 Graduate and continuing medical education in dermatology should also include LGBT health-related content to help dermatologists provide appropriate care to LGBT persons.
Corresponding Author: Kenneth A. Katz, MD, MSc, MSCE, Department of Dermatology, Kaiser Permanente, 1600 Owens St, Ninth Floor, San Francisco, CA 94158 (email@example.com).
Accepted for Publication: December 27, 2017.
Published Online: March 28, 2018. doi:10.1001/jamadermatol.2017.6531
Author Contributions: Dr Katz and Mr Park had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: All authors.
Acquisition, analysis, or interpretation of data: Park.
Drafting of the manuscript: Park.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Park.
Study supervision: All authors.
Conflict of Interest Disclosures: Dr Katz is a former shareholder of Arrowhead Pharmaceuticals, Inc, and Prevention Health Labs, Inc. Dr Katz is cochair and Mr Park is a member of the AAD’s Expert Resource Group on Lesbian, Gay, Bisexual, and Transgender/Sexual and Gender Minority Health. No other disclosures are reported.
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