Journal of Interprofessional Care

ISSN: 1356-1820 (Print) 1469-9567 (Online) Journal homepage: https://www.tandfonline.com/loi/ijic20

Health professional student preparedness to care

for sexual and gender minorities: efficacy of an
elective interprofessional educational intervention

Mandi L. Pratt-Chapman & Serena Phillips

To cite this article: Mandi L. Pratt-Chapman & Serena Phillips (2020) Health professional
student preparedness to care for sexual and gender minorities: efficacy of an elective
interprofessional educational intervention, Journal of Interprofessional Care, 34:3, 418-421,
DOI: 10.1080/13561820.2019.1665502

To link to this article: https://doi.org/10.1080/13561820.2019.1665502

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JOURNAL OF INTERPROFESSIONAL CARE
2020, VOL. 34, NO. 3, 418–421
https://doi.org/10.1080/13561820.2019.1665502

SHORT REPORT

Health professional student preparedness to care for sexual and gender minorities:
efficacy of an elective interprofessional educational intervention
Mandi L. Pratt-Chapman and Serena Phillips
Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, Washington, DC, USA

ABSTRACT ARTICLE HISTORY

Lesbian, gay, bisexual, transgender, queer, and intersex people have unique health and health care Received 28 March 2019
needs that are inadequately met. An eight-hour symposium was developed at the George Washington Revised 27 August 2019
University (GW) to better prepare health professional students and faculty to care for sexual and gender Accepted 31 August 2019
minority patients. This study compared surveyed learner knowledge, attitudes, and clinical prepared- KEYWORDS
ness, as well as perceived value of interprofessional learning, before and after the symposium. Learners LGBTQI; sexual and gender
at post-test were compared to an interprofessional group who did not attend the symposium. Results minority health; health care
indicated statistically significant improvements for confidence in all learning objectives (p < .05) and for professional education;
two of three factors (knowledge and clinical preparedness) of the Lesbian, Gay, Bisexual, and evaluation
Transgender Development of Clinical Skills Scale (LGBT-DOCSS). In contrast to the comparison group,
symposium participants at posttest rated higher on learning objectives, the attitudes and knowledge
LGBT-DOCSS factors, and perceived value of interprofessional learning as measured by four items from
the Interprofessional Learning Scale. This innovation is a starting point to address an identified learning
gap. Findings support the benefit of greater curricular integration of sexual and gender minority health
content through interprofessional learning to ensure preparedness of all practitioners.

Introduction knowledge, and overall clinical preparedness in caring for

Lesbian, gay, bisexual, transgender, queer, and intersex peo-
ple – more inclusively termed “sexual and gender minorities”
(SGM) – have unique health and health care needs that are
not being met by most healthcare providers. SGM are more
likely to experience chronic stress from social stigma and
family rejection, discrimination and denial of health care,
and sexually transmitted infections and human immunodefi-
ciency virus (Obedin-Maliver et al., 2011).
Medical schools teach a median of five hours focused on SGM
health, and most medical students consider what is offered for
SGM curriculum only “fair” or worse (Obedin-Maliver et al.,
2011; White et al., 2015). Other health profession schools, includ-
ing nursing and dentistry, clock even fewer hours (Anderson,
Patterson, Temple, & Inglehart, 2009; Lim, Johnson, & Eliason,
2015). Researchers conducted a curriculum audit to examine
SGM content at The George Washington University (GW)
School of Medicine and Health Sciences. This paper describes
evaluation findings from a one-day symposium, entitled
Improving Care for Sexual and Gender Minorities, designed to
address identified curricular gaps.
Methods
Our evaluation used a pre/post-test with comparison group
design and answered the following questions: 1) Did the
learning intervention improve learner confidence, attitudes,
SGM?, 2) Following the intervention, did the intervention
group and the comparison group differ in confidence, atti-
tudes, knowledge, or overall clinical preparedness in caring
for SGM?; and 3) Were there between-group differences in
appreciation for interprofessional learning?
Intervention description
A steering committee of interprofessional stakeholders was
established to guide the content and format of the learning
intervention. It consisted of three community members, one
community-based organization representative, one PhD-
prepared nurse, two medical students, and one physician.
Most members identified as part of the SGM community.
The eight-hour symposium took place on November 17,
2018. Learning objectives were designed to fill known gaps in
GW’s School of Medicine and Health Science curricula. The
symposium consisted of the following: 1) a lecture entitled,
Sex, identity and health care: What do health care providers
need to know?; 2) a Jeopardy game, LGBTQI facts and fig-
ures; 3) Q&A with a panel of SGM community members; 4)
facilitated table discussions of challenging SGM health
cases; 5) a lecture entitled, Trauma-Informed Care for
LGBTQI Patients; 6) a role play on how to respond to insen-
sitive behaviors from colleagues; 7) a discussion of sex and
gender-based medicine; and 8) a lecture on SGM curricular

CONTACT Mandi L. Pratt-Chapman mandi@gwu.edu Associate Center Director, Institute for Patient-Centered Initiatives and Health Equity, GW Cancer
Center, 2600 Virginia Ave. NW, #324, Washington, DC 20037
Supplemental data for this article can be accessed on the publisher’s website.
© 2019 The Author(s). Published with license by Taylor & Francis Group, LLC.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/),
which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.

resources. The free event was available to any health profes-
sional student, faculty, or staff member at GW.
Data collection
Symposium participants were recruited through an invitation
extended by the GW medical school Dean’s Office to all
medical students, and messages to GW’s public health, psy-
chology, and health sciences programs’ listservs.
Anonymous pen-and-paper surveys were administered at the
beginning and end of the symposium. The pre-survey contained
demographic questions. Both pre- and post-surveys requested
self-ratings of confidence in five symposium learning objective
topics; attitudes, knowledge, and clinical preparedness using the
validated 18-item Lesbian, Gay, Bisexual, and Transgender
Development of Clinical Skills Scale (LGBT-DOCSS); and self-
report scores for four items from the Value of Interprofessional
Learning Scale (Bidell, 2017; King, Shaw, Orchard, & Miller,
2010). At post-test, participants rated components of the event
on usefulness to future clinical practice and had the opportunity
to leave comments.
Ratings for learning objectives, LGBT-DOCSS items, Value of
Interprofessional Learning items, and satisfaction were on Likert
scales ranging from 1 to 5 with 1 reflecting the most negative
views (e.g. “Strongly disagree,” “Never,”) and 5 reflecting the
most positive views (e.g. “Strongly agree,” “Always,”) depending
on the nature of the question. A ranking of 3 reflected “not sure”
or “no opinion.” As appropriate, items for the LGBT-DOCSS
were reverse coded as directed by the scale author to ensure that
highest scores reflected the most affirming attitudes, knowledge,
and preparedness of respondents when items were summed
(Bidell, 2017).
The same health professional graduate school listservs used
to recruit symposium participants were used to recruit
a comparison group that did not attend the symposium.
This group completed an online survey containing the same
items as the intervention group’s pre-session survey.
Analytic approach
All quantitative analysis was conducted using SPSS and Stata
14.2, starting with descriptive statistics. We used paired sam-
ples t-tests to assess pre-to-post changes for symposium par-
ticipants, and independent samples t-tests to assess differences
in survey responses between the intervention group post-
symposium and the comparison group. Qualitative sympo-
sium feedback was reviewed and summarized.
Ethical considerations
The GW IRB determined this evaluation to be exempt (IRB
#180645).
Results
Of the 38 learners who attended the symposium, 29 returned pre-
and post-surveys. Intervention participants most commonly iden-
tified as female (n = 23, 79.3%), straight (n = 19, 65.5%), white
(n = 13, 44.8%), and students (n = 21, 72.4%) (Supplement 1).
JOURNAL OF INTERPROFESSIONAL CARE 419
They represented public health (n = 9, 31.0%); medicine (n = 7,
24.1%); nursing (n = 6, 20.7%); and physical, occupational, or
speech therapy (3, 10.3%) professions. 134 individuals completed
the comparison group online survey. These respondents were also
majority students (n = 118, 88.1%) but had higher representation
from medicine (n = 87, 64.9%).
The educational intervention yielded statistically significant
improvements in confidence for all learning objectives from
pre- to post-assessment (Table 1). The largest gain was in
learners’ ability to describe strategies to make reforms improv-
ing SGM care (mean 2.9 to 4.5, p < .001). We also observed
statistically significant pre-to-post improvements in self-
reported clinical preparedness to care for SGM patients (mean
16.3 to 22.6, p < .001) and knowledge about SGM (mean 16.8 to
18.8, p = .001) as well as in the overall LGBT-DOCSS scale score
(mean 66.7 to 75.1, p < .001). There were no statistically sig-
nificant changes in LGBT-DOCSS attitudes subscale scores or
perceived value of interprofessional learning items.
At post-test, the intervention group rated itself higher for
all learning objectives than the comparison group at
a statistically significant level (p < .001). Differences in mean
scores for attitudes (p = .045), knowledge (p = .004), and the
LGBT-DOCSS overall (p = .020) were found between inter-
vention post-test and comparison group responses. The inter-
vention group’s post-test clinical preparedness scores did not
statistically significantly differ from the comparison group’s.
Statistically significantly greater appreciation for interprofes-
sional learning was found in the intervention versus the
comparison group (p < .001).
Overall, there was a high level of satisfaction with the
symposium. Participants rated all educational activities at
the event somewhat to very useful for future clinical practice,
with the lowest rating for the presentation on resources to
enhance SGM health curricula (mean 4.0 SD 1.1) and highest
rating for the LGBTQI patient panel Q&A session (mean 4.7
SD 0.5). All logistical aspects of the event, including speakers,
patient panelists, table facilitators, event space, refreshments,
ease of registration, and convenience of location, rated above
average to excellent (mean 4.5–4.9).
Qualitative feedback revealed enthusiasm for the educa-
tional opportunity with comments like “Fantastic sympo-
sium!” and “amazing event.” One learner wrote:
The seminar was extremely enlightening. I learned a lot & can’t
wait to incorporate my learnings into practice.
Another learner felt the symposium was “Very accessible and
it delved into quite salient topics with regards to LGBTI
health.” Learners also expressed that the event filled critical
gaps in the existing curricula:
Thank you for this opportunity to learn about such an important
topic that I likely will not get in my education otherwise!
It was great to work with a professor with clinical experience to
really shine a light on the fact that LGBTI affirming care is a skill
& cannot be passively performed by simply being accepting of
LGBTI individuals.
Feedback for improvement included the need for greater
racial/ethnic diversity in the patient panel and more attention
to asexual orientation.
420 M. L. PRATT-CHAPMAN AND S. PHILLIPS

Table 1. Changes in pre- and post-intervention learning objective, LGBT-DOCSS, and value of interprofessional learning scores among interprofessional participants
(n = 29a) of an elective educational intervention on care for sexual and gender minorities, and comparison of intervention post-test and comparison group (n = 134)
scores.
Intervention Group
Comparison Independent
Pre-Session Post-Session Paired t-test Group samples t-test
Survey Item Mean (SD) Mean (SD) P-value Mean (SD) P-value
Learning Objectives (Range 1–5)
I recognize the unique health challenges of LGBTQI people. 4.4 (0.7) 4.8 (0.4) .005 4.4 (0.8) <.001
I can describe the contribution of bias to increased health disparities among LGBTQI 4.0 (0.9) 4.7 (0.5) <.001 4.1 (1.0) <.001
people.
I can identify and partner with community resources to address the needs of LGBTQI 3.5 (1.2) 4.4 (0.8) <.001 3.6 (1.1) <.001
people.
I can describe strategies to enact reform within existing health care institutions to 2.9 (1.1) 4.5 (0.5) <.001 3.3 (1.2) <.001
improve care for LGBTQI patients and their loved ones.
I can identify resources for sexual and gender health curricular improvement. 3.2 (1.2) 4.5 (0.5) <.001 3.4 (1.2) <.001
Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS) Scores
Clinical Preparedness subscale (Range 7–35) 16.3 (5.5) 22.6 (5.1) <.001 21.6 (6.8) .377
Attitudes subscale (Range 7–35) 33.8 (2.9) 33.9 (3.1) .867 32.4 (4.2) .045
Knowledge subscale (Range 4–20) 16.8 (2.5) 18.8 (1.9) .001 17.3 (2.6) .004
LGBT-DOCSS overall (Range 18–90) 66.7 (6.9) 75.1 (7.1) <.001 71.3 (9.3) .020
Value of Interprofessional Learning
Shared learning will help me to think positively about other professionals. 4.7 (0.5) 4.9 (0.3) .096 4.5 (0.7) <.001
Shared learning will help me to understand my own limitations. 4.8 (0.4) 4.9 (0.3) .264 4.6 (0.6) <.001
Shared learning will help to clarify the nature of patient problems. 4.8 (0.4) 4.9 (0.3) .161 4.6 (0.7) <.001
Shared learning in training will help me to become a better team worker. 4.8 (0.4) 4.9 (0.3) .103 4.6 (0.7) <.001
a
Sample sizes are smaller for specific items with non-response.

Discussion a starting point to address an identified learning gap. Next

The inaugural symposium was exceptionally well-received by
participants. Strong learner satisfaction coupled with statisti-
cally significant intervention group improvements in knowl-
edge, clinical preparedness, and confidence for every learning
objective suggest that the symposium was effective in filling
a gap in education for interprofessional learners. Between
group differences indicating statistically significantly more
affirming attitudes and greater knowledge for the intervention
group at post-test versus the comparison group further sup-
port this conclusion. Lack of pre-post difference in attitudes
and perceived value of interprofessional learning can be
explained by high baseline scores among learners.
This study was limited by a small intervention sample size,
decreasing statistical power and ability to conduct subgroup
analyses. Several survey items did not follow a normal distribu-
tion. A convenience sample was used. The more affirming
attitudes and greater valuation of interprofessional learning at
pretest among the intervention group imply self-selection bias.
This finding may suggest that students, faculty, and staff who
did not attend may be in most need for the learning interven-
tion. The comparison group differed from the intervention
group by role and discipline, weakening its ability to serve as
a counterfactual. Given the self-reported nature of the data, it is
likely that social desirability bias played a role for both groups.
Conclusion
Findings support the need for enhanced curricula to better
prepare all health professional students to care for SGM
patients. The evaluation indicates that the symposium was
an effective approach to supplementing education on SGM
topics among interprofessional learners. This innovation is
steps should include greater integration of SGM health con-
tent into interprofessional learning approaches.
Acknowledgments
This work was supported by a George Washington University School of
Medicine and Health Sciences Education Research Grant. The authors
would like to thank the steering committee for the symposium: Nina
Abon; Tony Burns; Amy Caggiula, MD; Eman Dadashian; Wallace
Corbett; Jeanne Murphy, PhD, CNM, FACNM, Josh Riley, and
Rachelle Tepel. Infrastructure that made this project possible was par-
tially supported by Award Number UL1TR001876 from the NIH
National Center for Advancing Translational Sciences. Its contents are
solely the responsibility of the authors and do not necessarily represent
the official views of the National Center for Advancing Translational
Sciences or the National Institutes of Health.
Disclosure statement
The authors report no conflicts of interest.
Data availability statement
Data is available upon request to the corresponding author.
Funding
This work was supported by the George Washington University School
of Medicine and Health Sciences.
Notes on contributors
Mandi L. Pratt-Chapman, MA, PhD, serves as Associate Center Director
for Patient-Centered Initiatives and Health Equity and is part of the
executive leadership team for the GW Cancer Center. Her personal
mission is to make evidence-based health care and disease prevention

strategies available to more people as quickly as possible. Her research
focuses on patient navigation, cancer survivorship, evidence-based can-
cer control, and health equity for lesbian, gay, bisexual, transgender,
queer and intersex (LGBTQI) communities.
Serena Phillips, DrPH, MPH, has a strong interest in cancer disparities
and health equity. After graduating from the GW Milken Institute School
of Public Health, she recently transitioned from her research associate
role at the GW Cancer Center to data scientist at Georgia State
University.
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