新加坡的女同性恋、男同性恋、双性恋、跨性别、酷儿和双性人（LGBTQI+）医疗保健：非政府组织和临床实习医学生的观点。
Lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) healthcare in Singapore: perspectives of non-governmental organisations and clinical year medical students.
机构信息
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
National Center for Infectious Diseases, National University of Singapore, Singapore.
出版信息
Med Educ Online. 2023 Dec;28(1):2172744. doi: 10.1080/10872981.2023.2172744.
PURPOSE
International studies document that lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) patients face significant health disparities. Studies exploring the attitudes, knowledge, preparedness and comfort levels of healthcare students towards LGBTQI+ health have been conducted in the United States, United Kingdom and Malaysia. This study aims to investigate stigma in healthcare for LGBTQI+ patients in Singapore, and possible upstream factors within medical education.
METHODS
This mixed-methods study adopts a convergent parallel design. The Health Stigma and Discrimination Framework was referenced to devise in-depth interviews with representatives from 13 LGBTQI-affirming non-governmental organisations, analysed through thematic analysis. 320 clinical medical students were surveyed about attitudes, knowledge, comfort, preparedness, and perceived importance of/towards LGBTQI+ health, analysed via descriptive statistics and multivariate regression.
RESULTS
Prevailing stigma in Singaporean society against LGBTQI+ individuals is exacerbated in healthcare settings. Doctors were cited as unfamiliar or uncomfortable with LGBTQI+ health, possibly from lack of training. Among medical students surveyed, the median composite attitudes, comfort and preparedness index was 3.30 (Interquartile Range (IQR) = 0.50), 3.17 (IQR = 0.83), 2.50 (IQR = 1.00) respectively. Only 12.19% of students answered all 11 true-false questions about LGBTQI+ health correctly.
CONCLUSION
Medical students in Singapore have scored sub-optimally in their knowledge and preparedness towards LGBTQI+ health, while interpersonal and structural stigma in healthcare towards LGBTQI+ people in Singapore negatively affects health and wellbeing. These findings are an impetus to improve medical training in this area. High scores among medical students in attitudes, comfort and perceived importance of LGBTQI+ topics demonstrate that there is space for LGBTQI+ health in the local medical education curriculum. Curricular interventions can prioritise content knowledge, communication skills and sensitivity.
目的
国际研究表明，同性恋、双性恋、跨性别、酷儿和双性人（LGBTQI+）患者面临着严重的健康差距。在美国、英国和马来西亚都开展了探索医学生对 LGBTQI+健康的态度、知识、准备情况和舒适度的研究。本研究旨在调查新加坡医疗保健中 LGBTQI+患者的污名化问题，以及医学教育中的潜在上游因素。
方法
本混合方法研究采用收敛平行设计。参考健康污名和歧视框架，对 13 个支持 LGBTQI+的非政府组织的代表进行深入访谈，通过主题分析进行分析。对 320 名临床医学生进行调查，了解他们对 LGBTQI+健康的态度、知识、舒适度、准备情况以及对 LGBTQI+健康的重视程度和态度，通过描述性统计和多元回归进行分析。
结果
新加坡社会对 LGBTQI+个人的普遍污名化在医疗保健环境中加剧。医生被认为对 LGBTQI+健康不熟悉或不自在，可能是因为缺乏培训。在所调查的医学生中，综合态度、舒适度和准备指数的中位数为 3.30（四分位距（IQR）= 0.50）、3.17（IQR= 0.83）、2.50（IQR= 1.00）。只有 12.19%的学生答对了关于 LGBTQI+健康的 11 个是非题。
结论
新加坡的医学生在 LGBTQI+健康知识和准备方面的得分较低，而新加坡医疗保健中针对 LGBTQI+人群的人际和结构性污名化对他们的健康和幸福感产生负面影响。这些发现促使我们在这一领域改进医学培训。医学生在 LGBTQI+话题的态度、舒适度和重视程度方面的高分表明，当地医学教育课程中有 LGBTQI+健康的空间。课程干预可以优先考虑内容知识、沟通技巧和敏感性。
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