Sawning Susan, Steinbock Stacie, Croley Rachel, Combs Ryan, Shaw Ann, Ganzel Toni
Office of Undergraduate Medical Education, School of Medicine, University of Louisville, Louisville, Kentucky, USA.
LGBT Center - Health Sciences Center Campus, University of Louisville, Louisville, Kentucky, USA.
Educ Health (Abingdon). 2017 May-Aug;30(2):108-114. doi: 10.4103/efh.EfH_78_16.
Individuals who are lesbian, gay, bisexual, transgender (LGBT), gender nonconforming, and/or born with differences of sex development have specific health needs and significant health disparities exacerbated by a lack of training among health professionals. The University of Louisville LGBT Health Certificate Program used an interdisciplinary approach to increase training, potentially enabling future physicians to provide quality healthcare to LGBT patients.
A pretest-post-test design was used to investigate medical students' (n = 39) attitude and knowledge outcomes after program participation. Attitudinal items with Likert-type responses were analyzed using the Wilcoxon signed-rank test. Baseline frequency and percentage of correct responses were tabulated for knowledge questions. At both pre- and post-test, the 11 knowledge items were summed to establish a total knowledge score, creating two total scores. The paired sample t-test was used to evaluate the pre- and post-change, and Cohen's D was used to assess effect size. All P values were two-tailed. Statistical significance was set by convention at P < 0.05.
Students correctly answered 69% or less of the knowledge questions at baseline. Total correct knowledge scores significantly increased post intervention with the effect size being large (Cohen's D = 0.90, P < 0.001). Attitudes significantly increased post intervention on two items (P = 0.019 and P = 0.037). Some attitude items decreased post intervention: students felt it is more challenging to conduct a patient history with a LGB patient (pre-mean agreement = 2.44; post-mean agreement = 2.97, P = 0.018).
Medical educators can play a critical role in decreasing LGBT healthcare disparities. The University of Louisville LGBT Health Certificate Program played an important first step in increasing medical students' knowledge and improving certain attitudes about LGBT patients.
女同性恋、男同性恋、双性恋、跨性别者（LGBT）、性别不符者和/或出生时性发育异常者有特定的健康需求，且由于卫生专业人员缺乏培训，他们面临着显著的健康差距。路易斯维尔大学LGBT健康证书项目采用跨学科方法来增加培训，有望使未来的医生为LGBT患者提供高质量的医疗服务。
采用前测-后测设计，调查医学生（n = 39）参与该项目后的态度和知识成果。对采用李克特量表式回答的态度项目，使用威尔科克森符号秩检验进行分析。将知识问题的基线正确回答频率和百分比制成表格。在前测和后测时，将11个知识项目的得分相加，得出总知识分数，从而得到两个总分。使用配对样本t检验评估前后变化，使用科恩d值评估效应大小。所有P值均为双侧。按照惯例，设定P < 0.05为具有统计学意义。
在基线时，学生对知识问题的正确回答率为69%或更低。干预后，总正确知识分数显著提高，效应大小为大（科恩d值 = 0.90，P < 0.001）。干预后，有两个态度项目的态度显著改善（P = 0.019和P = 0.037）。一些态度项目在干预后有所下降：学生们认为与LGB患者进行病史询问更具挑战性（前平均同意率 = 2.44；后平均同意率 = 2.97，P = 0.018）。
医学教育工作者在减少LGBT医疗差距方面可发挥关键作用。路易斯维尔大学LGBT健康证书项目在增加医学生对LGBT患者的知识和改善某些态度方面迈出了重要的第一步。
