In an effort to shed light on the importance of incorporating LGBTQ+ health in medical curriculums and understanding the role that dermatologists play in caring for LGBTQ+ patients, Next Steps in Derm reached out to Dr. Kara Sternhell-Blackwell, Assistant Professor of Dermatology and Director of LGBTQ Initiatives in Medicine at Washington University School of Medicine. Dr. Blackwell’s active involvement in diversity efforts led to the creation of OUTMed, an organization for LGBTQ-identified faculty, residents, fellows and staff at Washington University School of Medicine. Read on to learn more about OUTMed and Dr. Blackwell’s insightful answers on caring for LGBTQ+ patients.
How did OUTMed come about? Was there a particular need at your University?
OUTmed was started as a Forum within the Department of Medicine. The Department of Medicine also has a Forum for Underrepresented In Medicine and a Forum for Women in Medicine. While there had been an organization for LGBTQIA medical students and allies for some years, there was no similar organization for LGBTQIA faculty or residents. We organized a core group of LGBTQIA-identified faculty, staff and allies to form an advisory board, and with the support of Joe Pangelinan and the Office of Inclusion and Diversity, we drafted our mission statement, created a website, and began hosting formal events.
What are some of the features that make your organization unique?
OUTmed is supported by the Department of Medicine and is open to members of the entire School of Medicine, regardless of departmental affiliation. It includes faculty, residents, fellows and staff. We work closely with LGBTQMed, our medical student organization, and many of our projects, such as developing an OUTlist and ALLYlist, and participating in the PrideFest Parade, are joint efforts between the two groups. Having the input of a diverse group of voices from many areas of our institution really helps to shape our programs.
Our goals include:
- Increasing visibility of the LGBTQIA community at Washington University School of Medicine
- Fostering networking and mentoring relationships for LGBTQIA students, faculty, residents and staff
- Facilitating communication among members of the Washington University School of Medicine interested in LGBTQIA-related health care and research topics
Our initiatives have been as broad as our goals – we have hosted networking events and panels to talk about the experience of being LGBTQIA-identified in medicine, brought national experts in LGBTQIA health to WUSM, and developed a directory for patients to find LGBTQIA-friendly providers at WUSM, to name a few.
What do you think LGBTQ+ initiatives at other institutions can learn from OUTMed?
Having a group to support LGBTQIA-identified faculty and staff and allies can generate a lot of progress even beyond the formal activities of the group. OUTmed has connected and supported people who are pursuing projects to make individual clinic sites more LGBTQIA-friendly, make recruiting or admissions process more inclusive for sexual and gender minority applicants, and include more LGBTQIA-health material in the curriculum.
Institutional champions are essential to this work. Dr. Vicky Fraser, the Chair of the Department of Medicine, has been a strong ally and supporter from the beginning, and the success of OUTmed would not have been possible without her support.
What kind of community outreach does your organization do?
We have participated in the PrideFest St. Louis parade each year. This is a great opportunity to show the St. Louis LGBTQIA community that there is a group of WUSM physicians, staff and students that are passionate about LGBTQIA health.
We are a sponsor of the annual Human Rights Campaign Dinner in St. Louis and we are a sponsor of the Transgender Spectrum Conference. We have also sponsored an LGBTQ Professional Women’s Panel.
We have served as a resource to connect community organizations and other parts of Washington University with faculty members that can speak on panels or serve as mentors.
Our faculty have held meetings with multiple groups representing different parts of the St. Louis LGBTQIA community to better understand their members health needs.
We developed the LGBTQIA Health Provider Directory to help community members find LGBTQIA-friendly providers within the WUSM/BJC system.
Your institution has been hosting a yearly Transgender Spectrum Conference. Tell us more about this conference and its take-aways.
The Transgender Spectrum Conference is in it’s sixth year and has been hosted by both Washington University and the University of Missouri – St. Louis. The conference is organized by Washington University Arts and Sciences faculty members, UMSL faculty members, and community members with the goal of increasing visibility and knowledge of the transgender and gender expansive community. The Department of Medicine has supported this conference through sponsorship, and several OUTmed faculty and staff members have been speakers at this conference. This conference incorporates many different perspectives and fields in its programming – social work, mental health, faith and religion, community organizing, arts, law and medicine.
Do think the future of LGBTQ+ health care in the United States is directly affected by the institutions that train future physicians? If so, why do you think there are still so many institutions that haven’t made LGBTQ+ care part of their curriculums?
Absolutely. Health People 2020 cites a “Shortage of healthcare providers who are knowledgeable and culturally competent in LGBT health” as one of the main social determinants affecting the health of LGBT individuals. Training future physicians to be knowledgeable about LGBTQIA-health issues and to be culturally competent in caring for LGBTQIA patients will be essential to improving health outcomes for LGBTQIA populations.
I think many institutions are beginning to recognize the importance of incorporating LGBTQIA health in their curriculum, and students are asking for more education in this area.
When thinking of dermatology care in particular, can you name the main barriers LGBTQ+ patients encounter when seeking care?
Finding a dermatologist who is culturally competent and knowledgeable about LGBTQIA issues in dermatology can be a barrier to care. For many dermatologists, this was not emphasized in their medical education, so it takes extra effort to pursue this knowledge and stay up to date. Fortunately, the AAD has been increasing the availability of these educational opportunities including talks on LGBT health at the annual and summer meetings and a live-patient course focused on care of transgender patients at the annual meeting.
Do you think dermatologists should take sexual history? What do you think are the barriers dermatologists experience in doing so?
All dermatologists should be able to take a culturally competent sexual history from all patients, including sexual and gender minority patients. As dermatologists, we care for patients with sexually transmitted infections and prescribe teratogenic medications, so there are many times when taking a sexual history can be necessary. Sometimes it’s not clear to patients how their sexual behavior could be connected to their rash, so it’s essential to communicate to the patient about why you as a dermatologist are asking for that information.
Dermatologists often don’t receive much if any training in sexual history taking beyond medical school – and the terminology and best practices have changed significantly over the years. There have been talks at the AAD annual meeting for the past couple of years that covered this topic – they are a great educational opportunity for anyone who feels that their knowledge could use an update.
It is important to note that taking a sexual history is different than collecting sexual orientation and gender identity demographic information. A sexual history should be taken only when it is relevant for the medical care that the patient is seeking. Many organizations now recommend that sexual orientation and gender identity demographic information be collected routinely for all patients, and we follow this recommendation in our dermatology clinic.
Do you believe LGBTQ physicians are better equipped to treat LGBTQ patients? Why?
I think all physicians can and should learn to care for LGBTQIA patients in a culturally competent manner. All physicians should also strive to have an awareness about LGBTQIA health issues in their field of practice so that they can provide the best possible care to all of their patients. All physicians, including LGBTQIA-identified physicians, need and benefit from formal education in LGBTQIA health.
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