Scholarly Concentration in LGBTQ Healthcare and Advocacy

Concentration Directors

Michelle Forcier, MD, MPH
Department of Pediatrics
3055 Coro West 1 Hoppin St; 245 Chapman St
Providence, RI 02903
401-256-0920
mforcier1205@gmail.com

Overview

Lesbian, Gay, Bisexual, and Transgender and Queer (LGBTQ) people comprise a significant portion of every patient population in the United States and around the world. Social stigma and prejudice surrounding LGBTQ identities has often created barriers to health care for these vulnerable populations, resulting in significant health disparities within the LGBTQ population. The purpose of the LGBTQ Healthcare and Advocacy Scholarly Concentration is to prepare medical students to serve gender and sexual minority populations as future clinicians. This scholarly concentration strives to delve deeper into the issues faced by all gender and sexual minority individuals at the intersections of their socioeconomic, political, racial, and ethnic backgrounds. Upon completion of this program, participants must demonstrate their mastery of and sensitivity to, the social, political, and cultural context of health issues facing the diverse LGBTQ community through clinical expertise, research, service, and advocacy.

The general curricula with include LGB youth, aging, sexual health and behavioral health with attention to the intersections of LGB identities with race, ethnicity, and socioeconomic status. Special focus will be given to sexual minority health issues such as: gender nonconforming children, adolescent sexuality, risk and resiliency among young adults, social stigma and sexual minority issues in the workplace and home, as well as issues relevant to an increasingly numerous aging LGBTQ population. Curricula related to gender and gender diversity will include: gender nonconforming children and social transition, adolescent and adult hormonal transition, surgical components of care, risk and minority stress theory, family and social acceptance paradigms, and civil rights advocacy. Curricula related to sexual minorities will include: STI screening, prevention; PEP and PrEP; and comprehensive sexuality counseling.

The role of physician as educator and leader provides additional opportunities for students to learn how to best serve as social and cultural role models as advocates for gender and sexual human rights, and participating in political, legislative, insurance, and other community activism.  

Curriculum

Learning Objectives

  1. Provide patient-centered counseling for health issues relevant to the LGBTQ patient, including: primary care, reproductive health and justice, mental health, and risk resiliency counseling.
  2. Apply advanced knowledge in one or more of the following health content areas to care of patients: human development in gender and sexuality, sexual health counseling and support, prevention of sexually transmitted diseases and unintended pregnancy, healthcare for gender and sexual minorities in children, adolescents, adults, and mature populations.
  3. Discuss the effects of minority stress theory and social stigma on gender and sexual minorities, along with promoting skills for advocacy within the clinic and within communities.
  4. Apply principles of medical ethics to resolve dilemmas regarding: limited access to resources and providers, inequities in social justice, and conflicts between providers' beliefs and patient autonomy in health decision making.
  5. Recognize the physician's role in protecting and advocating for gender and sexual justice.

Evaluation

For each learning objective, mastery will be evaluated as follows:

1-2. Each student will participate in a clinical elective involving gender, sexuality or reproductive health in the 3rd or 4th year. This may also be done as a longitudinal during years MS2-4.
2-5. During the 2nd year, students will attend the women’s reproductive health seminar series.  During the 3rd and 4th year, students may attend as able with their other clinical rotations.
2-5. During the course of the concentration, each student will work on a project that is meaningful to them.

This may include such activities as:

  • position paper on a reproductive health issue, addressing gender inequality, legal, and/or public health issues that affect LGBTQI health
  •  project involving research, education, or advocacy related to gender and sexual health
  • other clinically or socially relevant publications (AMICUS brief, legislation, clinical guidelines, etc).

Students will identify a faculty advisor to mentor their project activities and will submit a project plan to be approved by the concentration directors

  • Students will submit annual written reports describing progress on their concentration project
  • Students are encouraged to present their projects at national conferences in their field of study
  • Students will prepare a portfolio of their concentration work including their final project for a review committee of reproductive health professionals  
  • Students will present their projects to the concentration faculty and students

 

Coursework

Year 1

Year 2

Year 3

Year 4

  • Attend Seminar Series (4-5/semester)

 X

X

X

X

  • Participate in below related preclinical electives                  




  • Participate in LGBT health
    • Pre-clinical elective(s) (3rd or 4th Year)
    • Clinical electives

 


      X


       X
        (X)

Concentration Project





  • Identify “focus” of scholarly concentration (Fall)
  • Identify faculty mentor (Fall)
  • Establish concentration project with faculty mentor and apply for summer research assistantship (Spring)
  • Summer Research Assistantship

X
X
X
X




  • Project progress reports

X

X


  • Present project at concentration symposium  (concentrators present all work to date at AMS)
  • Submit report for publication (if applicable)

X

X

X

  • Complete LGBT Health Portfolio



X

Concentration Related Electives
Pre-clinical 

Two preclinical electives over the course of two years will be required for members of the “LGBTQ Healthcare and Advocacy” concentration

  1. BIOL6508: Gender and Sexuality in Health Care: Caring for All Patients (Required)- Fall

      2. BIOL6657:  Sexual Health Elective (Required)

Students may also elect to take additional already established pre-clinical electives, participate in other SC activities if they support the focus of their concentration

  • Women’s Reproductive Health pre-clinical elective may have great applicability for a student who wishes to focus in Lesbian & Bisexual Health, LGBT Geriatrics & Aging, Queer Sexual Health, Transition Medicine, etc.
  • SC in Global Health, Advocacy, Medical Education, and Women’s Reproductive Health, etc.

Clinical

  • Gender and sexual development
  • Clinical care of issues related gender and sexuality across the lifespan: children, adolescents, adults, mature persons
  • Care of patients with gender dysphoria and transition medicine
  • Care of patients with minority stress and psychiatric sequelae
  • Care of patients with surgical needs and surgical transition
  •  
    • Primary care for LGBTQ populations
    • Specialty care for LGBTQ populations, including psychiatry, endocrinology, obstetrics and gynecology, urology, and plastic surgery
    • Infectious disease prevention and health maintenance

Project Examples

Scholarly products will most likely take the form of written reports and/or presentations.  Project topics may include:

  • Evaluation of current standards of care and guidelines for gender and sexual minority patient care
  • Needs analysis of community partners and resources
  • Quality of care and insurance coverage for gender and sexual minorities
  • Evaluation of institutional processes for gender and sexual minority patients, and their partners or family members
  • High-risk sexual behaviors among  sex workers
  • Quality of care after physical or sexual assault
  • Family planning experiences for transgender men and women requiring assisted reproductive technology

Maximum Number of Students


The scholarly concentration will be limited to 2-4 medical students per year.  

Faculty Mentors

Faculty(including but not limited to the following)

  • Kelly McGary, MD (General Internal Medicine): women’s health, lesbian health
  • Michelle Forcier MD, MPH (Pediatrics, Adolescent Medicine): gender and sexual health services across the lifespan, family planning
  • Phil Chan, MD (Infectious Disease) - sexual health among gay, bisexual and other men who have sex with men.
  • Amy Goldberg, MD (Pediatrics): Aubin Center for Sexual Abuse and Child Abuse
  • Melissa Clark, PhD (Epidemiology) – expertise is in survey research, healthcare access, women's health issues, and cancer.
  • David Hughes, PharmD (Phusion Pharmacy): pharmaceutical options, compounding hormonal treatment for gender minorities
  • Don Operio, PhD (School of Public Health ): Men’s Health Initiative (MHI) Community Advisory Board (CAB)
  • Alexis Drutchas, MD (Fenway Health): Director RI Trans Health Initiative and annual RI Brown Trans Health Education Summit
  • Chelsea Graham, MD (Family Medicine) : Fellow in Global and Reproductive Justice
  • Jason Rafferty, MD MPH (Psychiatry, Pediatrics): program director adolescent substance abuse services and psychiatric consultant youth gender clinic
  • Aga Janicka MD (Psychiatry): program director adult gender mental health services