Sexual prejudice among medical students

Despite recent social and legislative efforts to establish equal rights for the lesbian, gay, bisexual and transsexual (LGBT) community, attitudes that derive from sexual prejudice in health care providers are still of concern around the world.1 Sexual prejudice in health care providers has several implications,2-4 which include the stigmatisation and exclusion of LGBT individuals, the imposition of feelings of discomfort, poor communication, the disruption of the development of positive alliances with LGBT patients and the disregard of specific health and health care needs.5-7 In addition, sexual prejudice results in less access to and underutilisation of health care services among the LGBT community, and leads to inequality of treatment and poorer quality of care.5 Attitudes that derive from sexual prejudice in health care providers are of concern around the world The LGBT community represents a minority group with higher levels of risk for psychiatric disorders, sexually transmitted diseases, poor health outcomes, social marginalisation and particular health care needs.6, 8 For these reasons, sexual prejudice in health care providers is likely to have a particularly negative impact on this minority with public health implications.1 Identifying and addressing sexual prejudice in individuals during medical training may represent an initial strategy for improving the provision of health care to the LGBT population.9 High rates of sexual prejudice have been reported in students in training for different health care careers, including medical, nursing and psychology students.2-4 Rates of sexual prejudice among doctors in training range between 15% and 25%,2-4 and are higher in males, individuals without LGBT friends or patients, individuals who have not previously had a sexual partner, people with strong religious beliefs and people on low incomes.2-4 Sexual prejudice in health care providers is likely to have a negative impact with public health implications Sexual prejudice in medical students should be monitored in order that the curriculum can be adapted correspondingly.3 Unless action is taken, sexual prejudice in future doctors may eventually exact a toll on the quality of patient care.3 During graduate education, it is important to create awareness among students of the impact this prejudice may have on the care they provide to patients.2 Identifying predictors of sexual prejudice in medical students is very important because it will allow individuals who carry prejudice to be identified and thereby facilitate the initiation of preventive programmes to decrease such bias. Education directed towards increasing understanding of diversity, and discussions of beliefs associated with this subject may be implemented in order to improve the health care of future LGBT patients. Sexual prejudice in future doctors may exact a toll on the quality of patient care During the 2009–2010 academic year, medical schools in the USA and Canada dedicated an average of 5 hours in the entire curriculum to LGBT-related topics.7 Respondents to a survey reported dissatisfaction with medical school coverage of LGBT content, evidencing the deficiency of education provided in this area.7 Previous attempts to improve medical education concerning sexual prejudice were promising.9 The structure of a formal lecture provides little opportunity for dialogue, but, as lack of contact with LGBT people is highly correlated with sexual prejudice, educational initiatives that facilitate direct contact between students and the LGBT community are predicted to be effective and may improve education.9 However, there are non-formal opportunities to introduce issues of homo- and transsexuality into medical education. Panel discussions with members of the LGBT community and workshops in which opinions and reflections on these issues can be discussed may promote further open-mindedness and decrease sexual prejudice.3, 9 In addition, specialist workshops and daily interaction with openly LGBT students may raise awareness about the rights and visibility of this community.10 Furthermore, discussing homosexuality openly with patients who are willing to do so may benefit not only the patient, but also the doctor in training if it decreases his or her sexual prejudice.9 In addition, essential non-formal educational opportunities in this context depend on the transmission of positive values by mentors and the examples they set. To make use of these, faculty staff and attending physicians should demonstrate clinical empathy for LGBT patients.3, 9, 10 Limited knowledge of LGBT issues in faculty staff should be addressed using methods similar to those used in students. Educational initiatives that facilitate direct contact between students and the LGBT community are predicted to be effective In conclusion, sexual prejudice is a frequent finding in medical students, which, if it is not eradicated, may come to represent an unfortunate barrier in multiple ways to the provision of health care to the LGBT community. Specific groups may require greater levels of sensitisation and education in this area. Medical training includes many opportunities to approach the problem and to implement strategies to decrease sexual prejudice in future doctors. Strategies that involve direct interaction with the LGBT community and reinforcement by faculty members and staff are essential to decrease sexual prejudice in medical students.

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