Enactment of LGBTQ Health in Medical Curriculum

This dissertation examined the extent to which medical educational institutions adapt their curriculum to meet the needs of a marginalized patient population, lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. Because LGBTQ populations experience significant health and health care disparities in comparison to heterosexual and cisgender populations, medical education and medical curriculum about LGBTQ health has been described as a key area of intervention for improving doctor-patient interactions and health system structures to better accommodate these populations. Through a 10-month long ethnography of a medical school, I examined the formal, informal, and hidden curricula surrounding LGBTQ health to explore how medical schools train and thus adequately prepare medical students to provide care to these patients. To investigate these issues, I conducted over 100 hours of participant observation of medical classes and clinical rotations, with particular attention to clinical case studies and online learning modules that are relevant to LGBTQ health, and LGBTQ health initiatives on the academic medical center campus. I also conducted 46 semi-structured interviews with faculty, students, administrators, LGBTQ Health Center employees, and LGBTQ patients about LGBTQ health care at the medical school and about how these groups define and implement LGBTQ health at the institution. Findings suggest that the content, placement, and delivery of LGBTQ health in the curriculum influence how medical students learn to see themselves as capable of providing care to these patients. In particular, the nebulous nature of LGBTQ health makes it difficult for students to learn to enact it in practice. This research asserts that to create medical curriculum about LGBTQ health that will help alleviate health care disparities, medical schools cannot simply add LGBTQ health into their curriculum without fundamentally changing how they teach sex/gender and sexuality to their students as well as centering intersecting inequalities in their teaching. As such, this dissertation calls for a shift to queer health to decentralize sex/gender and sexuality binaries and focus on the practice of learning about LGBTQ health rather than fulfilling a competency. Ultimately, this research theorizes medical education as a space for the enactment of LGBTQ health whereby the complexity of sex, gender, sexuality, and identity gets negotiated by medical faculty, students, administrators, and LGBTQ community members.