Currents in Pharmacy Teaching and Learning 13 (2021) 1351–1357

Contents lists available at ScienceDirect

Currents in Pharmacy Teaching and Learning

journal homepage: https://www.journals.elsevier.com/currents-in-
pharmacy-teaching-and-learning

Experiences in Teaching and Learning

Transgender health education for pharmacy students and its effect

on student knowledge and attitudes
⁎
Michael D. Bear a, , S. Mimi Mukherjee a, Carroll-Ann W. Goldsmith b
a
Pharmacy Practice, MCPHS University, School of Pharmacy-Worcester/Manchester, 40 Foster Street, Worcester, MA 01698, United States
b
Pharmaceutical Sciences, MCPHS University, School of Pharmacy-Worcester/Manchester, 1260 Elm Street, Manchester, NH 03101, United States

A R T I C L E I N F O A B S T R A C T

Keywords: Background and purpose: Increased student pharmacist education on health issues and concerns
Transgender
of the underserved Lesbian, gay, bisexual, transgender, and queer (LGBTQ) population is needed.
LGBTQ
We incorporated pharmacy-specific, transgender-focused education into the curriculum and sought
Pharmacy students
Education to identify whether pharmacy students' knowledge and attitudes towards LGBTQ individuals were
affected by: (1) required online module or in-class lecture and (2) student demographics.
Educational activity and setting: Pharmacy student attitudes and perceptions towards transgender
individuals and the LGBTQ population were assessed before and after online (video) and in-
person education using a modification of the Attitudes towards Lesbian Gay Bisexual Transgender
Patients Scale. Wilcoxon test for non-parametric paired data was used to test for statistically signif-
icant changes between the pre- and post-education surveys, while two-way analysis of variance
was used to analyze correlations between student demographics and responses.
Findings: Changes in students' knowledge and attitudes were observed after exposure to either on-
line or in-person education. Increases in students' perceived competence to provide care to patients
identifying as LGBTQ were associated with both teaching methods. Significant demographic asso-
ciations were seen with specific attitudes; female students and students who knew a transgender
person were more likely to strongly disagree that discussing sexual behavior with LGBTQ patients
is challenging.
Summary: Delivery of transgender-focused education produced observable changes in student
pharmacist perceptions and attitudes towards working with the LGBTQ patient population. Demo-
graphic characteristics, such as being female or knowing a transgender individual, positively corre-
lated with student pharmacists' feeling more comfortable discussing sexual behavior with LGBTQ
persons.
© 2021 Elsevier Inc. All rights reserved.

Background and purpose

Interactions with transgender patients present pharmacists and pharmacy students with a number of unique challenges.1 Providing
optimal care not only requires knowledge of specific treatments, such as high-dose hormone therapies, but also requires understanding
the appropriate use of gender-affirming terminology and appropriate vocabulary, such as the avoidance of misnaming a transgender

⁎ Corresponding author.
E-mail addresses: michael.bear@mcphs.edu (M.D. Bear), mimi.mukherjee@mcphs.edu (S.M. Mukherjee), carrollann.goldsmith@mcphs.edu (C.-A.W. Goldsmith).

http://dx.doi.org/10.1016/j.cptl.2021.07.011

Available online xxx

1877-1297/© 2021 Elsevier Inc. All rights reserved.
M.D. Bear et al. Currents in Pharmacy Teaching and Learning 13 (2021) 1351–1357

patient.2 Appropriate education on how to provide suitable gender and sexual minority patient care is essential for all healthcare pro-
fessionals; when care is inadequate, Lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients often avoid or delay care due to
fear of discrimination.3,4 Further, transgender individuals and those within the broader LGBTQ community experience increased sub-
stance abuse, homelessness, and suicidality.4 Though the elimination of these healthcare disparities and reducing the shortage of ade-
quately trained healthcare professionals competent in LGBTQ health was a goal for the Healthy People 2020 initiative and remains a
goal in the proposed 2030 initiative, the training of pharmacists in providing care to this population is minimal when compared to
other health professions.4,5
Multiple professional healthcare organizations, including those for pharmacy, acknowledge the importance of this issue by prioritiz-
ing respect for patients regardless of gender or sexual orientation and the need for dissemination of knowledge on LGBTQ issues.5–7
Previous studies have determined that medical schools spend around five hours on LGBTQ topics to address the Association of
American Medical Colleges' recommendation to provide specific training for this population.8 In contrast, pharmacy curricula designate
limited, if any, time to LGBTQ health and cultural competency.9 Most of the literature indicates that education related to general
LGBTQ health has been provided primarily in elective courses or co-curricular programs to select pharmacy students.5,9 As a result,
most pharmacy students will leave their programs of study feeling underprepared and generally unaware of how to provide care to
LGBTQ patients, including transgender individuals on pharmacologic endocrine treatment who may benefit from support from pharma-
cists.10 Though the Accreditation Council for Pharmacy Education (ACPE) Accreditation Standards specifically refer to healthcare dis-
parities, there is no direct mention of specific transgender or general LGBTQ-related curricular content or guidance for how to
provide education on LGBTQ topics to pharmacy students.11 In addition, to date there has been no broad assessment of how this ma-
terial is being delivered at various schools of pharmacy (SOP). Of the limited data evaluating pharmacy students who received educa-
tion related specifically to transgender health, only one study assessed both knowledge gained and changes in attitudes.12
The primary objective of this work was to identify whether a short, required online module or an in-class lecture on LGBTQ patients
with a focus on pharmacy-specific transgender issues affected the knowledge and/or attitudes of pharmacy students towards the trans-
gender and LGBTQ populations. The secondary objective was to assess whether students felt prepared for professional encounters with
the LGBTQ population after education. Finally, we sought to determine if demographic characteristics affected pharmacy students'
knowledge and/or attitudes towards the LGBTQ population. The hypotheses were that the class material would have a positive effect
on student knowledge and attitudes on transgender health, students would feel more prepared to work with this population in the com-
munity after education, and that students' demographic characteristics would correlate with knowledge and attitudes towards the
LGBTQ population.

Educational activity and setting

The students who participated in this study were enrolled in an accelerated doctor of pharmacy (PharmD) program. Due to the ac-
celerated nature of the PharmD program, curricular content that is deemed important but “nice to know” rather than “need to know” is
often jettisoned so that all “need to know” content is covered with sufficient depth and breadth in the required curriculum. In an at-
tempt to improve students' understanding of the pharmacy-focused health concerns of the transgender and broader LGBTQ community,
a topic that is considered “nice to know” within the curriculum, the authors developed and delivered material focused specifically on
transgender patients to two separate cohorts of pharmacy students in consecutive years, classes of 2019 and 2020. As described in more
detail below, the means of delivery varied from one year to the next as a result of student feedback and facilitated by a course mod-
ification, but was consistently brief (30 min) to accommodate the limited time within the accelerated curriculum. The instructor was
a faculty member and pharmacist with an interest in LGBTQ health, but was not specialized in this area. Resources used to create
the educational lecture were recognized guidelines and websites from leaders in LGBTQ health including the Human Rights Campaign
Foundation, the National LGBTQIA+ Health Education Center, genderbread.org, the 2017 Endocrine Society guidelines, the University
of California San Francisco 2016 guidelines, the World Professional Association for Transgender Health 2011 standards, and the Na-
tional Transgender Discrimination Survey (NTDS).13–19
Educational material focused on the following topic areas: health disparities, terminology, the basics of pharmacologic endocrine
treatment, how to approach collecting data on sexual orientation and gender identity, and providing an inclusive environment for
LGBTQ patients in the context of pharmacy practice. Definitions of transgender, gender incongruence, and gender non-conforming in-
dividuals were provided. The Genderbread Person was used to help students understand that gender identity, gender expression, ana-
tomical sex, sexual attraction, and romantic attraction may be different in an individual in comparison to cultural gender norms.15
Quotes from the NTDS were shared with the class to exemplify discrimination and violence faced by transgender individuals from
law enforcement, teachers, landlords, and healthcare professionals.19 The concept of intersectionality, when individuals from multiple
minority groups experience additive discrimination, and the concept of minority stress, when stigmatized minority groups experience
health disparities due to chronically high stress levels, were also introduced during the session.20,21 Additionally, the resilience of the
transgender community in overcoming discrimination to access hormone therapy, establish housing, and achieve educational goals
was highlighted.19 Discussion of pharmacologic endocrine treatment included fostering student understanding regarding delaying pu-
berty such that patients can be of sufficient maturity to make treatment-related decisions, important counseling points regarding adverse
effects and permanent changes from treatment, and the negative mental health consequences of withholding pharmacologic endocrine
treatment.16–18 Students were provided with LGBTQ-inclusive terms recommended for use in healthcare settings and suggestions on
how to make pharmacy settings welcoming for LGBTQ patients, such as signs that include LGBTQ symbols and gender-neutral
restrooms.22

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Student participants' knowledge and attitudes were assessed pre- and post-education using questions adapted from the Attitudes to-
wards Lesbian Gay Bisexual Transgender Patients Scale (ATLPS), which uses Likert scales (1 = strongly disagree to 5 = strongly
agree).23 Although the objective and educational materials were primarily related to transgender health, the ATLPS assesses attitudes
as they pertain to the greater LGBTQ community. The authors recognize the differences between transgender individuals and the
LGBTQ population as a potential limitation of the survey. Despite this limitation, the ATLPS was chosen for this work because the lim-
ited survey instruments available in the literature to evaluate attitudes specifically towards transgender individuals have not been used
in healthcare education as extensively as the ATLPS. Demographic information was also obtained. The survey was distributed in two
consecutive years to convenience samples of pharmacy students in their second professional year of study in the three-year accelerated
PharmD program.
The delivery of this content varied between Year 1 and Year 2, and completion of the surveys was voluntary in both years. For the
first class (Year 1), educational material was delivered online in the form of a recorded lecture and corresponding slides with a required
online graded assessment. Survey instruments and consent documents were distributed in person and completed by students who chose
to participate prior to delivery of the online content. The required online content was available for students to complete at their con-
venience over a three-week period. Students were then presented with a second informed consent document and follow-up survey at a
later date during another class. For the second class (Year 2), material was delivered during a live 30-min lecture, consent obtained for
those who chose to participate, and pre−/post-surveys were completed on the same day. The changes in content delivery from one year
to the next resulted from recommendations in course evaluations by the students in Year 1 requesting that the session be taught live
and by a restructuring of a required course in Year 2, which provided an opportunity to make this recommended change. The survey
was also adjusted from Year 1 to Year 2 to provide more streamlined and focused questioning, with two questions being removed from
the survey due to high baseline scores in the pre-questioning phase of Year 1.
A minimum sample size of 58 participants per class was needed to identify a 25% difference in survey answers with an alpha of 5%
and a power of 80%. Data were analyzed only for those students who answered both pre- and post-surveys and who responded to every
survey question. Sub-analyses of the data based upon demographic information was performed. Prism version 8.4.1's (GraphPad
Software) Wilcoxon matched pairs signed-rank test for non-parametric paired data was used to test for statistically significant
changes between the pre- and post-education surveys. Two-way analysis of variance was used to analyze demographic correlations.
A P value ≤ .05 was considered statistically significant; P values ≤ .1 are highlighted. This study received “exempt” status from the
university's institutional review board.

Findings

Twenty-four of a possible 283 students completed all survey responses in Year 1 (video module) and 141 of 273 students did so in
Year 2 (in-class; Table 1). Only responses of students who answered all demographic questions and responded to every statement on
both the pre- and post-surveys were included in analyses. For the Year 1 population, 6 students identified as cisgender male and 18
as cisgender female. Thirteen students indicated they did not know a person who identifies as transgender and 11 respondents indicated
they did know a person who identifies as transgender. For the Year 2 population, 42 students identified as cisgender male and 91 as
cisgender female, with 82 not knowing a transgender person and 59 knowing an individual who identifies as transgender.
In the first year, when educational content was offered via video recording and despite low participant numbers, there was a statis-
tically significant improvement after education in one of the nine survey items, the perception that the curriculum adequately addresses
the concerns of the LGBTQ population (P = .002), and nearly significant improvement in the perceived competence to talk to patients
identifying as LGBTQ (P = .09, Table 2). In the second year, with live content delivery and a greater number of respondents, there was
statistically significant improvement after education in three of the seven survey items, the perceived competence to provide care (P =
.02), competence to talk to patients identifying as LGBTQ (P < .001), and belief that the curriculum adequately addresses the concerns
of the LGBTQ population (P < .001, Table 2).
Sub-analyses of the effects of gender or of knowing a transgender person provided several correlations with survey statements. For
example, a respondent's degree of disagreement that discussing sexual behavior with LGBTQ patients is challenging showed correlations
with both respondent gender and whether the respondent knew a transgender person (Table 3). Female students were more likely than
male students to strongly disagree that discussing LGBTQ sexual health with patients is challenging (P = .1 Year 1 and P = .08 Year 2),
as were students who knew a transgender person than those who did not (P = .07 Year 1 and P = .02 Year 2). Moreover, in Year 2, in
which there was a greater number of participants, there were correlations between knowing a transgender person and several other sur-
vey statements. For example, compared to respondents who did not know a transgender person, respondents who knew a transgender
person: agreed more strongly that all medical professionals have a responsibility to provide care to LGBTQ patients (P = .006);
disagreed more strongly that LGBTQ patients do not have any specific health needs (P = .05); agreed more strongly that they feel pre-
pared to talk with a patient who identifies as LGBTQ in a sensitive and appropriate manner (P = .05); and agreed more strongly that
they would comfortable if they became known among professional peers as someone who cares for LGBTQ patients (P = .001).

Discussion

Despite recommendations by professional pharmacy organizations24,25 to include LGBTQ education in the PharmD curriculum and
calls by ACPE4 and Healthy People 2020 and 203011 that emphasize the need for healthcare professionals competent in LGBTQ health
so that healthcare disparities can be addressed, the inclusion of LGBTQ health topics in the PharmD curriculum is deficient.5 Training
healthcare professionals has been shown to improve knowledge and attitudes towards care and can be effective with discussions of key

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Table 1
Demographic information.

Video module (Year 1) In-class module (Year 2)

N (%a) N (%a)

Gender
Cisgender man 6 (25%) 42 (29.79%)
Cisgender woman 18 (75%) 91 (64.54%)
Gender queer 0 1 (0.71%)
Non-gender 0 1 (0.71%)
Transgender man 0 1 (0.7%)
Transgender woman 0 0
None of the above/Prefer not to answer 0 5 (3.55%)
Age (years)
18–30 20 (83.33%) 119 (84.4%)
31–50 4 (16.67%) 20 (14.18%)
51–64 0 1 (0.71%)
None of the above/Prefer not to answer 0 1 (0.71%)
Raceb
African/Black/African American 1 (4.17%) 21 (14.89%)
Asian/Asian American 7 (29.17%) 50 (35.46%)
Bi-racial/multi-racial 1 (4.17%) 5 (3.55%)
Caucasian/White 11 (45.83%) 39 (27.66%)
Latino/Hispanic 2 (8.33%) 5 (3.55%)
Middle Eastern 2 (8.33%) 13 (9.22%)
Native American/American Indian 0 0
Pacific Islander 0 2 (1.42%)
None of the above/Prefer not to answer 0 6 (4.26%)
Sexual orientation
Asexual 2 (8.33%) 14 (9.93%)
Bisexual 1 (4.17%) 4 (2.84%)
Gay 0 3 (2.13%)
Heterosexual 21 (87.5%) 104 (73.76%)
Lesbian 0 0
Pansexual 0 1 (0.71%)
Queer 0 2 (1.42%)
Questioning 0 1 (0.71%)
Same-gender-loving 0 1 (0.71%)
None of the above/Prefer not to answer 0 11 (7.8%)
Know someone who identifies asb:
Transgender 11 (45.83%) 59 (41.84%)
LGBT 24 (100%) 117 (82.98%)
Queer 12 (50%) 49 (34.75%)

LGBT - lesbian, gay, bisexual, transgender.

a
Due to rounding, percentages may not add up to 100%.
b
Due to the nature of a “select all that apply” statement, total numbers and percentages may differ from previous Ns (number of
participants) and may not total 100%.

Table 2
Video module (Year 1; N = 24) and in-class module (Year 2; N = 141): pre- to post-intervention comparison on LGBTQ-related (ATLPS) statements.

ATLPS item Content delivery method Pre: Post: P valuea,b

Mean ± SD Mean ± SD

LGBTQ patients deserve the same level of quality of care Video (Year 1) 4.79 ± 0.83 4.63 ± 1.14 .75
from medical professionals as non-LGBTQ patients. Live (Year 2) Not asked Not asked NA
LGBTQ patients should only seek health care from LGBTQ health clinics. Video (Year 1) 1.75 ± 0.85 1.88 ± 0.9 .65
Live (Year 2) Not asked Not asked NA
All medical professionals have a responsibility to provide care Video (Year 1) 4.63 ± 1.14 4.42 ± 1.25 .5
for LGBTQ patients. Live (Year 2) 4.77 ± 0.61 4.75 ± 0.67 .79
I feel competent to provide care for LGBTQ patients. Video (Year 1) 3.04 ± 1.27 3.38 ± 1.25 .09
Live (Year 2) 3.77 ± 1.21 3.93 ± 1.01 .02
LGBTQ patients do not have any specific health needs. Video (Year 1) 1.58 ± 0.88 1.54 ± 0.59 >1
Live (Year 2) 1.89 ± 1.04 1.84 ± 1.08 .31
I feel prepared and able to talk with a patient who identifies as Video (Year 1) 3.42 ± 1.25 3.71 ± 1.27 .21
LGBTQ in a sensitive and appropriate manner. Live (Year 2) 3.77 ± 1.19 4.09 ± 0.82 <.001
I believe the curriculum in which I am enrolled adequately Video (Year 1) 2.42 ± 1.02 3.29 ± 1 .002
addresses the concerns of the LGBTQ population. Live (Year 2) 3.21 ± 1.07 3.75 ± 0.97 <.001
It is more challenging to discuss sexual behavior with LGBTQ Video (Year 1) 2.92 ± 1.32 2.79 ± 1.22 >1
patients than with heterosexual patients. Live (Year 2) 3.02 ± 1.17 3.11 ± 1.2 .41
I would be comfortable if I became known among my Video (Year 1) 4.08 ± 1.28 4.13 ± 1.23 >1
professional peers as someone who cares for LGBTQ patients. Live (Year 2) 4.18 ± 0.84 4.23 ± 0.89 .23

ATPLS = Attitudes towards Lesbian Gay Bisexual Transgender Patients Scale; LGBTQ = lesbian, gay, bisexual, transgender, queer; NA = not applicable.
a
P ≤ .05.
b
P ≤ .10.
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Table 3
Sub-analyses by gender and by knowing a transgender individual comparison on LGBTQ-related (ATLPS) statements.

ATLPS item Content delivery Effect of student gender on response: Effect of student knowing transgender individual
method (Video, P-valuea,b (meanc male response, N = 6 on response: P-valuea,b (meanc not knowing
year 1; Live, year 2) video; N = 42 live; meanc female transgender person, N = 13 video; N = 82 in
response, N = 18 video; N = 91 live); person; meanc knowing transgender person,
95% CI of mean difference N = 11 video; N = 59 in person);
95% CI of mean difference

LGBTQ patients deserve the same level of Video .3687 (5.000; 4.611); .7538 (4.654; 4.773);
quality of care from medical −.4899 to 1.268 −.8953 to .6576
professionals as non-LGBTQ patients. Live Not asked Not asked
LGBTQ patients should only seek health Video .3794 (1.583; 1.889); .8095 (1.846; 1.773);
care from LGBTQ health clinics. −1.012 to .4008 −.5508 to .6976
Live Not asked Not asked
All medical professionals have a Video .7969 (4.417; 4.556); .4132 (4.346: 4.727);
responsibility to provide care for LGBTQ −1.245 to .9670 −1.329 to .5666
patients. Live .6450 (4.762; 4.808); .0063a (4.646; 4.915);
−.2419 to .1503 −.4606 to −0.07724
I feel competent to provide care for LGBTQ Video .0246a (4.000; 2.944); .7832 (3.154; 3.273);
patients. 0.1484 to 1.963 −10
.004 to .7662
Live .1106 (4.048; 3.747); .1136 (3.738; 4.008);
−.06949 to .6702 −.6068 to .06548
LGBTQ patients do not have any specific Video .4371 (1.750; 1.500); .0982b (1.769; 1.318);
health needs. −.4050 to .9050 −.09067 to .9928
Live .4635 (1.929; 1.802); .0468a (2.000; 1.678);
−.2137 to .4664 0.00467 to .6394
I feel prepared and able to talk with a Video .1503 (4.083; 3.389); .6071 (3.462; 3.682);
patient who identifies as LGBTQ in a −.2717 to 1.661 −1.096 to .6553
sensitive and appropriate manner. Live .9530 (3.940; 3.951); .0468a (3.799, 4.110);
−.3477 to .3275 −.6184 to −0.004419
I believe the curriculum in which I am Video .2954 (3.167, 2.750); .8496 (2.885; 2.818);
enrolled adequately addresses the −.3895 to 1.223 −.6516 to .7845
concerns of the LGBTQ population. Live .0010a (3.869; 3.346); .8844 (3.470; 3.492);
0.2155 to .8303 −.3208 to .2768
It is more challenging to discuss sexual Video .1000b (3.500; 2.6398); .0690b (3.231; 2.409);
behavior with LGBTQ patients than with −.1790 to 1.901 −.06971 to 1.713
heterosexual patients. Live .0777b (3.310; 2.956); .0247a (3.238; 2.831);
−.03982 to .7468 0.05268 to .7619
I would be comfortable if I became known Video .8722 (4.167; 4.083); .4871 (3.962; 4.273);
among my professional peers as someone −.9786 to 1.145 −1.224 to .6019
who cares for LGBTQ patients. Live .0788b (4.036; 4.297); .0005a (4.006; 4.475);
−.5524 to .03042 −.7277 to −0.2093

LGBTQ: Lesbian, gay, bisexual, transgender, queer.

ATPLS: Attitudes towards Lesbian Gay Bisexual Transgender Patients Scale.
a
P ≤ .05.
b
P ≤ .10.
c
Likert scale: 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree.

terms, stigmas, and discrimination through a variety of pedagogical methods.12 Clinical exposure to LGBTQ patients has resulted in im-
provement in knowledge and delivery of healthcare services, such as a comprehensive history by medical students.26 As noted by
Grundmann et al.,27 a pharmacist can be an LGBTQ person's ally; the present study provides a framework for facilitating this by includ-
ing this topic in an accelerated PharmD curriculum.
In the present study, we found that prior to receiving educational material, pharmacy students were motivated to learn the content
and believed the content was important to their training. This is indicated by the strong agreement of both Year 1 and Year 2 students'
pre-educational content responses to the statement that all medical professionals have a responsibility to provide care to LGBTQ patients
(mean scores of 4.63 ± 1.14, Year 1 video-content, and 4.77 ± 0.61, Year 2 live-content). These perceptions were maintained after the
content was delivered in both years.
With ACPE's emphasis on cultural competency and the continued uncertainty facing the protections for the LGBTQ community, stan-
dardizing and understanding how best to train pharmacists to meet the needs of this population is essential.5,11,28 Using a modification
of the ATLPS survey, we found significant changes pre- to post-LGBTQ-focused content in both years (Table 2), which are results similar
to those seen in other work.12 For example, students' belief that the curriculum prepared them for transgender patient care increased, as
did their perceived competency to provide care and preparedness to talk to LGBTQ patients in a sensitive and appropriate manner.
Though there were some statistically significant improvements in these areas, the overall scores post-intervention relating to the phar-
macy curriculum, competency to provide care, and preparedness were ≤4 on the Likert scale, suggesting further attention is needed.
Two interesting findings in this study deserve further consideration: those of the effect of the participant's gender on responses and
the effect of the participant's prior knowledge of a transgender individual on responses (Table 3). Studies have shown that there are

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differences in the way men and women perceive transgender persons.29–34 The results of this study align with this previous work in that
study participants' genders affected their attitudes, as assessed with the modified ATLPS instrument. With regard to knowing a transgen-
der person, our results suggest that having a transgender patient speak with students to increase the number of students who know or
have met a transgender individual is worth pursuing in future studies, as it may improve attitudes towards LGBTQ persons. This high-
lights a limitation in the delivery of our course content, which was primarily didactic and did not provide students with direct contact
with transgender patients. Providing such interaction may be an important and potentially effective way to improve the course content.
Assessment of pharmacy students' attitudes in this study was done using a modified survey incorporating items from the ATLPS in-
strument, because the ATLPS is well-recognized in this area. Of note, the original ATLPS instrument was developed over 10 years ago,
and since then, the understanding of the diverse experiences of sexual and gender minorities has evolved. As such, a limitation of this
study is that the assessment of students' attitudes evaluated sexual and gender minorities as a group without acknowledging the differ-
ence in patients' experiences or the different competencies needed by healthcare providers working with these populations. Future work
to develop survey tools specific to these individual populations in the context of healthcare education is needed.
Additional limitations of this work relate to differences in participation rate between Years 1 and 2. The participation rate and num-
ber of respondents in Year 1 (video module, 8.48% participation rate) was lower than in Year 2 (in-person, 51.65% participation rate).
We believe this difference occurred because the content in the first year was delivered online, outside of class, while in the second year
the content was delivered in person during class time. This change in content delivery in Year 2 also allowed for a shorter gap between
pre- and post-survey assessments, which may further explain the increased response. Moreover, the numbers of participants in Year 1
did not meet the estimated minimum sample size to see differences before and after content delivery. Despite this lack of power, there
were some statistically significant differences before and after content delivery in this cohort, which underscores the fact that these dif-
ferences were greater than anticipated when calculating the estimated minimum sample size. Nonetheless, the difference in participa-
tion rate, coupled with the difference in mode of delivery of content and the small Year 1 sample size, ought to be considered when
viewing the data.
An additional limitation of this study includes potential response bias, as students may have felt pressure to answer in a way they
felt was socially acceptable. Students may also have been influenced inadvertently in how they answered the questions because the au-
thors distributed the surveys. Additionally, though there were statistically significant changes in Likert scale responses on certain items,
this may not yield clinically significant effects in practice. Nevertheless, our study shows that a brief recorded or live didactic lecture
can significantly affect student understanding of, and preparation for, serving this underserved patient population.

Summary

While multiple national organizations have called for increased attention to respect for all patients regardless of gender or sexual
orientation and on providing healthcare students with knowledge on LGBTQ issues, there is limited information as to how SOP are pro-
viding this education to their students. In our accelerated curriculum, little time was available to educate students on pharmacy-specific
LGBTQ topics to ensure cultural competency. To address this perceived gap in the curriculum, a brief session was developed and deliv-
ered in two consecutive years by two different methods of dissemination. After one short session of content delivery on pharmacy-
specific transgender topics, students in our accelerated curriculum felt better prepared to interact with transgender patients and,
more broadly, with LGBTQ individuals, regardless of whether that content was delivered live or via video. These findings suggest
that providing short educational activities on LGBTQ topics can help pharmacy students develop the aforementioned respect for
LGBTQ persons and improve their knowledge of LGBTQ health-related concerns. Nevertheless, more consistent exposure throughout
the pharmacy curriculum, including discussion of clinical scenarios and interaction with LGBTQ persons, is necessary to ensure cultural
competency.

Disclosure(s)

None.

Declaration of Competing Interest

None.

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