Exploring a case for education about sexual and gender minorities in postgraduate emergency medicine training: forming recommendations for change

ABSTRACT

Social medicine and health advocacy curricula are known to be uncommon in postgraduate medical education. As justice movements work to unveil the systemic barriers experienced by sexual and gender minority (SGM) populations, it is imperative that the emergency medicine (EM) community progress in its efforts to provide equitable, accessible, and competent care for these vulnerable groups. Given the paucity of literature on this subject in the context of EM in Canada, this commentary borrows evidence from other specialties across North America. Trainees across specialties and of all stages are caring for an increasing number of SGM patients. Lack of education at all levels of training is identified as a significant barrier to adequately caring for these populations, thereby precipitating significant health disparities. Cultural competency is often mistakenly attributed to a willingness to treat rather than the provision of quality care. However, positive attitudes do not necessarily correlate with trainee knowledge. Barriers to creating and implementing culturally competent curricula are plentiful, yet facilitating policies and resources are rare. While international bodies continuously publish position statements and calls to action, concrete change is seldom made. The scarcity of SGM curricula can be attributed to the universal absence of formal acknowledgment of SGM health as a required competency by accreditation boards and professional membership associations. This commentary synthesizes hand-picked literature in an attempt to inform healthcare professionals on their journey toward developing culturally competent postgraduate medical education. By thematically organizing evidence into a stepwise approach, the goal of this article is to borrow ideas across medical and surgical specialties to inform the creation of recommendations and make a case for an SGM curriculum for EM programs in Canada.

KEYWORDS:

• Emergency medicine
• Social medicine
• 2SLGBTQIA +
• Medical education
• Residency curriculum
• Equity
• Diversity
• Inclusion

Declaration of funding

This paper was not funded.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgement

This literature review was performed in preparation for the 2021 Canadian Association of Emergency Medicine Academic Symposium. The authors used this review to help form the recommendations presented by the 2SLGBTQIA+ research panel at this symposium.

Author contributions

A Burcheri took the lead in conducting the search and selecting pertinent articles to inform this narrative literature review. A Burcheri also wrote the manuscript and made edits based on feedback. All other authors contributed equally to editing the manuscript, providing feedback, critical revisions, and guidance from its inception, and provided their permission to publish the manuscript. A Coutin performed the final edits and review, refined the tables and figure, and reviewed references. R Primavesi was the supervisor for this work and provided oversight to all processes from inception to submission. He also contributed to the final edit and greenlit the manuscript.