LGBTQ+ health education for medical students in the United States: a narrative literature review

Figures & data

Table 1. Inclusion criteria utilized when screening for eligible articles.

Title and abstract screening	Article written in English language Article involves a medical school in the USA Article evaluates medical student education (excluding articles that include only other health professional students such as nursing or psychology students or medical trainees such as residents and fellows) Article includes a component related to LGBTQ+ health
Full text screening	Full text of article is available Article written in English language Article involves a medical school in the USA Article evaluates medical student education related to LGBTQ+ health Article involves collection and analysis of data

Table 2. Overview of reviewed articles.

Studies that evaluate how LGBTQ+ health is covered in an existing curriculum
Author and year	Curriculum type	Methods	Key findings
DeVita, et al. (2018) [14]	Pre-clinical coverage of LGBTQI health topics	Curriculum evaluated based on 30 AAMC competencies and 31 Vanderbilt University learning objectives	Existing curriculum completely covered 7 AAMC competencies, partially covered 8, and did not cover 15 Existing curriculum completely met 12 Vanderbilt learning objectives, partially met 7, and did not meet 13 Slides made to address the gaps with partially met and unmet Vanderbilt learning objectives and were integrated into curriculum
Encandela et al. (2019) [15]	Pre-clinical and clinical coverage of SGM topics	Needs assessment using AAMC SGM health competencies, tracking of change implementation	Gap analysis showed 13 existing components that partially or completely addressed 13 of 30 AAMC SGM health competencies 12 proposals were submitted to address gaps At time of publication there were 22 SGM-related components in curriculum (12 pre-clinical, 8 clinical, 2 electives)
Park and Katz (2018) [16]	American Academy of Dermatology’s online Basic Dermatology Curriculum	Cross-sectional study of online case-based basic dermatology modules	1 of 293 (0.3%) of cases mentioned an LGBT patient (a woman with basal cell carcinoma in a same-sex marriage) No cases included a transgender patient, mentioned same-sex sexual behavior, or specified sexual orientation
Pratt-Chapman and Abon (2021) [17]	Pre-clinical coverage	Curriculum content compared to AAMC competencies and Vanderbilt University learning objectives	28 sessions found to include material specific to SGM patients The pre-clinical curriculum met 10 of the 30 AAMC competencies fully and 11 partially, and of the Vanderbilt topics: 22 were addressed; 5 were partially addressed; and 5 were not addressed
Ton et al. (2016) [18]	Pre-clinical and clinical SOGI curriculum	Retreat, review, and surveys (N=26 pre, 22 post, 18 at 6 months (MS*** in sample, not separated))	No participants were satisfied with SOGI education prior to retreat After retreat, 86% reported satisfaction with proposed curriculum 2 years after retreat, 76% of proposed competencies were addressed in curriculum
Zumwalt et al. (2022) [19]	Pre-clinical and clinical	Curriculum assessment tool developed based on AAMC competencies, this tool was used to assess curriculum	42.9% of course directors reported including any SGM content in their curriculum All 12 SGM topic areas in the tool were covered at some point in the required curriculum, but some were addressed 1-2 times SGM content was over-represented in the pre-clinical curriculum Exposure to SGM content in clinical learning was limited and dependent on a student’s site or preceptor
Studies that evaluate the impact of components of a curriculum
Author and year	Curriculum type	Methods	Key findings	Kirkpatrick model level
Bakhai, Ramos et al. (2016) [20]	Required* pre-clinical session including e-lecture, SP encounter, and small-group debrief	Survey (N=78 MS1)	After the e-lecture, 92% felt more prepared to take an inclusive sexual history with patients who identify as lesbian, gay, or bisexual; compared to 84% following the SP encounter and debrief After the SP encounter and debrief, 85% felt more comfortable discussing sexual orientation with patients and 74% felt more comfortable discussing gender identity with their patients	2
Berenson et al. (2020) [21]	Required pre-clinical** presentation, small-group, and patient panel on transgender care	Surveys (N=161 total pre/post with N=123 matched pairs, MS2)	Significant increase in average confidence describing the following related to transgender patients: health issues/disparities; medical transitioning/hormonal therapies; best practices for promoting culturally competent/affirming care Average ratings were highest for the patient panel component	1, 2
Bi et al. (2020) [22]	Required pre-clinical lecture, patient videos, and discussion on SGM health disparities and intersectionality	Surveys (N=82 pre and N=83 post MS1)	Significant increase in confidence in abilities to: identify barriers to care for LGBTQ patients and ways to help overcome them; ask LGBTQ patients about their identities	2
Cannon et al. (2021) [23]	Required* pre-clinical lecture on basics of HIV and STIs, sexual history-taking and HIV prevention [This paper also describes a variation lecture content given to other learner groups]	Survey (N=127 MS1)	Prior to lecture, 47% were not aware of or unsure if they had heard of PrEP Significant increase in knowledge after lecture	2
Christensen et al. (2019) [24]	Required pre-clinical gender and sexuality curriculum with didactic and small group parts	Surveys (N=244 MS1 pre and N=253 MS1 post)	Significantly increased agreement that: Discordance between birth sex and gender is natural LGB/T populations have unique health risks and health needs Able to empathize with the life experience of an LGB/T patient Motivated to seek opportunities to learn about LGBTQ health	2
Click et al. (2020) [25]	Required pre-clinical* session including didactic lectures, small-groups, and Q&A with transgender patient	Surveys (N=138 pre and immediate post, N=85 2-month post, MS1-2)	Significant increases in comfort with transgender patients and knowledge of transgender medicine from pre to post At 2-month follow-up: 78% felt comfortable asking patients about their gender identity; 77% agreed transgender health should be in the general medical student curriculum	1, 2
Croniger et al. (2022) [26]	Required pre-clinical problem-based learning sessions with ID cards added for each patient, including diverse identities (including LGBTQ+)	Survey (N=178 MS1)	54% reported patient ID cards helped them learn about a diverse population of patients 52% reported patient ID cards helped prepare them to deliver care to a diverse population of patients	1
Eriksson and Safer (2016) [27]	Required pre-clinical lecture about gender identity	Surveys (N=41 MS1 pre and post audience response survey, N=56 pre-exam and N=121 post-exam)	Significant number changed their answer regarding the etiology of gender identity (from ‘Hormones’ to ‘Hypothalamus/Brain’) – question answered correctly by 63% pre and 93% post Treatment question answered correctly by 20% pre and 50% post	2
Gavzy et al. (2019) [28]	Required pre-clinical** workshop including presentation and videos on LGBT health	Surveys (N=165 MS1)	Significant increase in confidence addressing all 3 learning objectives: define/compare terms; describe unique health issues/disparities; develop better practices	2
Grosz et al. (2017) [29]	Required pre-clinical LGBT health presentation, patient panel, small group, and case discussion	Surveys (N=73 MS1)	LGBT health knowledge and familiarity with LGBT terms increased significantly or remained high after the session Significant increase in confidence providing care in all areas except physical exam (which was not covered in the session)	2
Jin and Dasgupta (2017) [30]	Required pre-clinical small group with mandatory prework on LGB reproductive endocrinology and genetics	Surveys: mandatory questions (N=180 MS1) and voluntary pre (35%) and post (17%)	Some results include initially higher rates of student recommendations for assisted reproduction services for same-sex couples compared to heterosexual patients - after the session this difference disappeared, however other results showed a persistent difference or no initial difference	2
Lee et al. (2014) [31]	Required* pre-clinical** lecture and SP cases on sexual history, including LGBT health	Surveys (MS2, N not stated) and faculty debrief	Significant improvement in students reporting increased importance, confidence, and performance of a sexual history Most faculty report a positive experience teaching this session	2
Leslie et al. (2018) [32]	Required pre-clinical LGBTQI+ health equity curriculum on implicit attitudes	IATs (N=146 MS1 and 108 MS2)	Overall student IAT scores demonstrate implicit preferences for “straight” over “gay” people both pre- and post-intervention Significant decrease for MS2 from pre- to post-IAT for sexuality Significant decrease in sexuality IAT for MS1 who completed an initial IAT and debriefing session compared to MS1 that did not	2
Leslie et al. (2017) [33]	Required pre-clinical session with a lecture, community stories, interprofessional group case study discussions and case study debrief	Surveys (N=158 MS1 on teams across total of N=653 students that participated in the session)	Improvement for all LGBT self-reported knowledge items Significant changes in attitudes toward systemic and social factors that affect health for all items except for lifestyle and genetics 51% of student teams report that the top solution in a case was to refer the patient elsewhere	2
Levy et al. (2021) [34]	Required* pre-clinical case-based session on care for LGBTQ+ seniors	Surveys (N=38 MS1)	Significant increase in identification of “heterosexism” as a strong determinant of the health status Significant increases in confidence regarding knowledge of systemic barriers to health and health disparities faced by LGBTQ+ people and practices to promote culturally competent care	2
Marshal et al. (2017) [35]	Required* pre-clinical session with didactic, patient Q&A, mock patient encounter on transgender health	Survey (N=85 MS***)	73% felt more prepared to care for transgender patients In narrative comments, students described learning how to address someone who is transgender and learning about transition options	1, 2
McCave et al. (2019) [36]	Required [for majority] pre-clinical** interprofessional session with panel, SP simulation and large group debrief regarding care for transgender patients	Survey (N=278 students, including 34 MS1; MS not consistently separated in results)	93% of students found the addition of transgender individuals sharing their personal experiences useful or very useful 85% found the discharge planning meeting with SP and observation checklist useful or very useful 61% found the video simulation useful or very useful	1
Najor et al. (2020) [37]	Required pre-clinical** lecture on transgender health	Surveys (N=86 pre, 70 immediate post, and 44 1-year post, MS1)	Significant increase in comfort caring for transgender people from 76% pre to 91% post, and 89% at 1-year follow-up Significant increase in comfort with clinical scenario involving discordance of gender expression and sex listed in health record from 67% pre to 87% post, and significantly to 95% at 1-year	2
Neff and Kingery (2016) [38]	Required* pre-clinical problem-based learning session on DSD	Surveys (N=155 MS1 pre and N=144 MS1 post)	79% report the session changed their knowledge and competence regarding individuals born with a DSD 13% identify barriers to implementing their knowledge of DSD-affected individuals, including: societal norms; religion; parents; and lack of interaction with DSD-affected individuals	1, 2
Potter et al. (2016) [39]	Required* pre-clinical** flipped classroom session including prework, presentation, role-play scenarios, and small-group work on caring for SGM	Surveys (N=5 student representatives (of 175 MS1 and first year dental students) and N=14 faculty)	Increase in students’ awareness of health impacts of identity and intersectionality and clinician’s role in establishing rapport	2
Safer and Pearce (2013) [40]	Required pre-clinical lecture and follow-up small group session on healthcare for transgender people	Surveys (MS2 who took the course N=74 pre and N=66 post; baseline comparison of MS1, MS3, and MS4 not in course N=183 pre and N=168 post)	Significant decrease in percentage of MS2 reporting they would be uncomfortable providing transgender healthcare and non-significant decreases in this observed for MS1, MS3, and MS4 who did not participate in the course No MS2 and a small percent of MS1, MS3, and MS4 reported that transgender medicine was not an appropriate topic for conventional medicine	1, 2
Sanchez et al. (2022) [41]	Required* pre-clinical lecture on human sexuality with a focus on LGBTQI+ health	Surveys (N=103 MS1)	Significant increases in agreement with the statements: “bisexuality is not a choice”; “one is born transgender”; and “LGBTQI+ couples should have the right to adopt children”	2
Sell et al. (2016) [42]	Required small group case study and presentation with discussion** on HIV, including impact on gay and bisexual men	Survey and facilitator feedback (N=21 MS2 randomly selected for survey of 150 total MS2 that attended)	Mean agreement that the lecture supported student mastery of the learning objectives was 4.4 on scale of 1 = strong disagreement to 5 = strong agreement (1 of the 3 learning objectives was “analyze causes of health disparities for marginalized patient populations (e.g., LGBT persons)”)	1
Silverberg et al. (2021) [43]	Required* pre-clinical encounter with transgender SPs and panel discussion	Survey (N=126 MS2)	92% felt more confident using their patient’s identified pronouns 95% improved confidence taking history from a transgender patient Students found interaction with transgender individuals the most valuable aspect of the session	1, 2
Singh and Lee (2022) [44]	Required* pre-clinical session with didactic material and actor scenarios	Surveys (N not stated, MS1)	Significant increase in knowledge and comfort levels	2
Song et al. (2018) [45]	Required pre-clinical case-based session on social determinants of health, including LGBT health	Surveys (N=186 pre and N=111 post, MS1)	Significant increase in confidence in knowledge with terms “gender identity” and “sexual orientation” Significant increase in knowledge and comfort discussing topics covered in session with patients 94% rated the LGBT health component as “good” or “excellent”	1, 2
Stumbar et al. (2022) [46]	Required* sexual history workshop** for MS2 including lecture, small group, and SGM SP interview	Survey (N=87 MS2)	86% felt better prepared to care for transgender patients 97% reported increase in knowledge and 75% reported increase in skills on effectively providing medical care for transgender patients	2
Stumbar et al. (2021) [47]	Required pre-clinical lecture and small group SP case on inclusive sexual history	Surveys (N=110 MS2 including 73 for pre/post responses)	Significant increase in number who felt comfortable taking a sexual history from a transgender patient More than 90% felt better equipped to care for transgender patients	2
Stumbar, Garba, and Holder (2018) [48]	Required* pre-clinical** lecture, case-based learning session, and community member panel	Surveys (N=90 MS2)	Significant increase in number of students comfortable discussing sexual history related to gender and treating transgender patients 93% agreed that patient panel helped them identify their own biases when addressing issues related to sexual orientation/gender	2
Thompson H. M. et al. (2022) [49]	Required* lecture, patient panel, and small group sessions** on transgender health	Survey (N not stated, MS2)	Significant changes in student knowledge, attitudes, and perceived readiness to work with transgender patients	2
Thompson H et al. (2020) [50]	Required pre-clinical videos followed by case-based workshop and panel	Surveys (N=77 MS2)	Gender Identity Competency significantly improved Significant improvement in skills and self-reported knowledge Significantly more experience using/role-playing pronouns in a clinical setting	2
Turban et al. (2018) [51]	Required* pre-clinical and clinical sessions on transgender pediatric patient care	Survey (N=162 MS1-4)	Majority correctly answered questions about terminology, psychiatric co-morbidities, diagnostic criteria, estrogen/testosterone, and long-term benefits of interventions Gaps in knowledge existed for GnRHa and spironolactone as therapies, and time requirement for diagnostic criteria for GD 14% felt it was unethical to give hormonal interventions	2
Weingartner L et al. (2022) [52]	Required* pre-clinical SP case on gender-affirming care; students in second iteration received targeted LGBTQ+ clinical skills training prior to session	Post encounter note, preventive care survey, course director viewed encounters, and debrief with SPs in both iterations; student reflections in second iteration only	After targeted training there was a reduction in number who would refer TGD patients to endocrinology for hormones and increase in proportion willing to prescribe hormones in a primary care setting Across both iterations, 83% of TGD SPs reported being misgendered at some point during the encounter Across both iterations, 21% of students made one or more incorrect sex-specific cancer screening recommendations to TGD patients	2, 3
Wong (2014) [53]	Required* pre-clinical problem-based learning (PBL) cases	Describes rationale and process for curriculum updates	Updates to PBL case with a young male patient with two mothers New PBL case with a male-to-female transgender patient who presents to begin hormone replacement therapy	N/A
Gomez and Gisondi (2020) [54]	Elective* pre-clinical peer education program on SGM health	Surveys (N not stated, MS1 and first year PA students)	In 2019, 80% reported increase in confidence in knowledge of SGM health disparities and comfort caring for SGM patients In 2019, 100% of peer educators reported improvement in facilitation skills and understanding of SGM health issues Challenge with this is burden on SGM students to educate others	2
Greene RE et al. (2014) [55]	Elective* pre-clinical** SP encounter with debrief on transgender healthcare	Debrief discussion (N=18 MS1)	Students felt that the session was constructive and very useful for their education	1
Johnson et al. (2015) [56]	Elective pre-clinical** course on sexual health, including LGBTQI topics	Surveys (N=13 MS1)	Immediately after the course, knowledge increased on 8/15 items, decreased on 1/15, and was the same on 6/15 3 months after the course, knowledge increased on 7/15, decreased on 2/15, and the same on 6/15 Increased comfort on topics related to sexuality and sexual health	2
Kutscher and Boutin-Foster (2016) [57]	Elective pre-clinical course with community members, including LGBT people	Survey (N=16 MS1)	Satisfaction with the course was high 71% felt there was excellent applicability to medical practice 50% felt this course should be required for all MS1	1
Minturn et al. (2021) [58]	Elective pre-clinical didactic presentations, case discussions, community panel, and SP session	Survey (N=49 MS1-2)	Significant increase in self-reported confidence in actions related to LGBTQ+ healthcare Average total knowledge score improved minimally	2
Pathoulas et al. (2021) [59]	Elective pre-clinical didactic and interactive lecture on GAHT	Surveys (N=54 MS2)	Significant increases in familiarity with common medications, dosing, informed consent in clinic, and providing GAHT in primary care Significant increases in confidence finding resources for GAHT and understanding the difference between legal and chosen names	2
Sequeira et al. (2012) [60]	Elective pre-clinical didactic sessions (3) on LGBT health and followed by required LGBT SP encounter	Surveys for didactic sessions (N=35 pre-clinical MS for survey #1, 39 for #2, & 30 for #3)	After session 2, 82% could articulate how to inquire appropriately about the gender of a patient’s sexual partners After session 3, 87% agreed that the content was relevant enough to be incorporated into the required curriculum Key theme identified was current lack of exposure to LGBT content	1, 2
Wright and Campedelli (2022) [61]	Elective* pre-clinical 2-week virtual course on gynecologic care for transgender patients	Surveys (N=8 MS2-3)	Significant increase in knowledge of gynecologic needs of transgender individuals 100% “agreed” or “strongly agreed” that course built confidence in clinical care for transgender patients	2
Zheng et al. (2022) [62]	Elective pre-clinical modified jigsaw session on GAHT	Surveys (N=89 MS1-2 participants, immediate pre/post N varied by item, N=20 follow-up 1 year)	Significant increase in trans-specific topic knowledge, confidence discussing trans health with peers/patients, and confidence taking history from trans patient from pre- to immediate post-session 1-year post-session knowledge scores and comfort discussing GAHT were lower than immediately post- but higher than pre-session	2
Bakhai et al. (2016) [63]	Required clinical session on caring for SGM youth	Surveys (N=40 pre and N=39 post, MS3-4)	Significant improvement in self-reported comfort, preparedness, and skills knowledge related to care for SGM youth	2
Cooper et al. (2018) [64]	Required* didactic lecture** given to MS3 on the impact of social determinants of health on care for LGBT patients	Survey (N=63 MS3)	Significant change in mean rating of knowledge of lecture objectives (e.g. “describe the unique health risks and challenges often encountered by LGBT and gender-diverse patients”)	2
Dowshen et al. (2014) [65]	Required* lecture on transgender health in family medicine clerkship	Survey (N=204 clerkship MS)	Participants in transgender health lecture reported significantly higher levels of competency compared with non-participants Over 2 hours of instruction on transgender health associated with higher mean scores for overall self-reported knowledge and skills	2
Mayfield et al. (2017) [66]	Required* clinical lecture on taking a sexual history followed by SP encounters	Surveys (N=84 clerkship MS)	Significant increase in students’ comfort taking sexual history from patients with sexual orientation/identity different from their own Significant increase in knowledge of sexual health and practices of MSM and WSW	2
Noonan et al. (2021) [67]	Required* clinical skills session with GM SPs with rising MS3	Focus groups on SP experience (N=10 GM SPs)	SPs experiences included: microaggressions; identified benefits to community; provided informed feedback Gaps in care: communication skills; foundational SGM knowledge; cisnormative and heteronormative assumptions	N/A
Norwood et al. (2022) [68]	Required* clinical case-based session with TGD patient collaborators	Surveys (N=44 MS2 pre and N=36 MS2 post)	Significant increases in all TGD healthcare competency items except for discussing sexual health practices No significant change for perceived value of TGD healthcare training	1, 2
Ojo et al. (2022) [69]	Required clinical** case-based sessions on reproductive justice, including LGBTQIA+ health	Surveys (N=28 pre, N=31 post, N=15 both) and focus group (N=4), MS3 and MS4	No significant change in self-reported preparedness to use gender-affirming language when discussing reproductive anatomy and reproductive health with SGM Focus group theme: appreciation for intersectionality in cases	1, 2
Roth et al. (2020) [70]	Required clinical problem-based Introduction to LGBTQ Health session	Survey (N=103 MS4)	Regarding relevance, rated mean 4.8 out of 5 (1=little relevance, 5=very impactful) Total mean score 4.6/5 for first session and 4.7/5 for the second	1
Schmidt et al. (2022) [71]	Required clinical module on care for transgender and gender diverse patients	Surveys (N=65 MS3)	Significant increase in comfort caring for transgender patients Significant improvement in knowledge of healthcare maintenance and gender-affirming care	2
Underman et al. (2016) [72]	Pilot* clinical SP encounter with debrief discussion on transgender healthcare	Survey (N=64 MS4)	Almost 80% agreed or strongly agreed the session increased knowledge and skills to care for transgender patients Students discussed gaps in medical training on LGBT health and interest in more information on transgender health	1, 2
Park JA and Safer (2018) [73]	Elective clinical rotation on transgender medicine	Surveys (N=20 MS4)	Significant increase in report of ‘‘high’’ level of comfort providing care for transgender patients Significant increases in knowledge and skills caring for transgender patients (including asking about gender identity, providing general care, and providing hormone treatment)	2
Srinivasan et al. (2022) [74]	Elective clinical course on LGBTQIA+ health	Qualitative review of student experiences (N=30) and course evaluations (N=10 MS***)	Overall rating for the course on evaluations was “excellent” Students on average reported the course enhanced their interest in LGBTQIA+ health and helped them master core related knowledge	1, 2
Vance et al. (2021) [75]	Elective clinical SP encounters with e-learning on care for transgender youth in adolescent medicine rotation	Checklists by faculty and SPs and surveys by trainees (N=43 including 9 MS4)	Significant improvement in MS4 total checklists scores from case 1 to 2 Significant improvements in MS4 self-efficacy scores	2, 3
Vance et al. (2020) [76]	Elective clinical modules and observational experiences on transgender health added to adolescent medicine rotations	Surveys (for full curriculum total N=20 including 2 MS4 and for modules only total N=31 including 5 MS4; MS not consistently separated in results)	After full curriculum, participants had significant improvement in self-perceived knowledge/awareness of transgender-related considerations After the modules only, participants had significant improvements in knowledge scores and clinical self-efficacy in evaluating and counseling transgender youth High satisfaction scores with both learning experiences	1, 2
Vance et al. (2018) [77]	Elective clinical online modules on caring for pediatric transgender patients during adolescent medicine rotation	Surveys (N=28 including 5 MS4; MS not consistently separated)	Significant increases in median overall objective knowledge score, overall self-perceived knowledge score, and overall self-efficacy scores	2
Vance et al. (2017) [78]	Elective clinical modules and observational experiences on transgender health added to adolescent medicine rotation	Survey (N=20 total learners, including 2 MS4; MS not consistently separated in results)	Significant increases in knowledge and awareness scores on every queried transgender youth-related benchmark High satisfaction with the curriculum	1, 2
Alzate-Duque et al. (2021) [79]	Elective* workshop** about PrEP and communication skills including a didactic component and video-based scripted MSM patient encounter	Surveys (N=18 total across 3 sites including 9 MS***; MS not separated)	All postworkshop mean scores on agreement or confidence in learning objectives (eg “I feel comfortable identifying at-risk MSM who may benefit from PrEP”) increased, however there were only significant changes at 1 site for 4 of 7 objectives	2
Barrett et al. (2021) [80]	Elective* interactive online didactic session** on care for LGBTQ patients in dermatology	Survey (N=29 total pre with 14 MS and 18 post with 10 MS; MS responses not consistently separated)	Significant increases in mean LGBT-DOCSS overall scores as well as the self-reported clinical preparedness and basic knowledge domain scores	2
Braun, Garcia-Grossman, et al. (2017) [81]	Elective lunch-hour multidisciplinary course** in transgender health	Surveys (N=46 students pre and immediate post, including 11 MS***, N=14 students completed 3 months post, MS not separated)	Significant increase in knowledge of 11/14 transgender health topics from baseline to immediately post (N=46) Increase in knowledge immediately post to 3 months post in cultural competency, state policy, and federal policy (N=14) No significant decreases in knowledge in any category from immediately post to 3 months post (N=14)	2
Braun, Ramirez, et al. (2017) [82]	Elective LGBTI Health Forum**	Surveys (N=273 forum participants including N=39 from the school of medicine***, N=140 pre and N=192 post-surveys)	Students reported lack of LGBTQI health-related content in their core curricula (rating 2.98/6) Significant improvement in comfort interacting with LGBTQI patients and conducting accurate and inclusive medical history with LGBTQI patients following participation in Forum	1, 2
Bunting et al. (2019) [83]	Elective*, interprofessional, community-specific module** on HIV and PrEP	Survey (N=4 MS*** on the team of 11 total students who developed the module; MS not separated in results)	Overarching theme in student reflections was comfort in discussing sexual health with future patients, including addressing aspects of LGBTQ+ health care Participation in development of the module increased student knowledge about HIV risk factors and PrEP access	2
Calzo et al. (2017) [84]	Optional* interprofessional case-based modules** on LGBT adolescent health	Surveys (total N unspecified, 4 years and N of 6-10 each year, learners from medicine***, nursing, nutrition, social work, and psychology)	One year used pre and post surveys that showed an improvement in their confidence “identifying community resources for LGBT adolescents” and a slight decrease in confidence in both “taking sexual health, sexuality health, and sexuality history from adolescents” and “counseling LGBT adolescents”	2
Cherabie et al. (2018) [85]	Elective* presentation** including section by patients on transgender health	Surveys (N=163 pre (including 13 MS***), 115 post (13 MS***), 18 at 90-day follow-up (6 MS***))	Significant increase in comfort treating transgender patients from pre to post, no significant change from post to 90-day follow-up Significant increase in knowledge regarding transgender patients from pre to post, no significant change from post to 90-day follow-up	2
Congdon et al. (2021) [86]	Elective seminar** on transgender healthcare	Survey (N=100 total, includes 7 MS***)	Significant increase in self-perceived proficiency and confidence in caring gender-diverse patients	2
Gibson et al. (2020) [87]	Elective LGBTQ Health Pathway	Survey (N=6 MS in the first cohort of the pathway)	All reported the Pathway having a positive impact on their medical education and career goals as well as improved their abilities to care for LGBTQ patients	1
Grant et al. (2023) [88]	Elective modules** on PrEP, PEP, and STI/HIV testing	Surveys (N=123 pre, N=89 post: includes MS1-4+)	Increase in comfort providing sexual health care to LGBTQ individuals and perception of sexual history–taking abilities Increase in median HIV and STI screening and prevention knowledge scores	2
Guss et al. (2022) [89]	Optional video** on transgender and nonbinary health	Surveys (N=68 including 37 MS***, MS not separated)	Significant increase in knowledge on terminology and patient care Increase in agreement with feeling competent to provide primary care to a transgender patient	2
Ingraham et al. (2016) [90]	Optional training** on bias in care for lesbian and bisexual women who are overweight	Surveys (N=66 including 39 MS***, MS not separated)	Significant increase in knowledge about barriers to care and delays in care related to weight stigma for lesbian and bisexual women	2
Perucho et al. (2020) [91]	Elective* workshop** with didactic component about HIV prevention and PrEP and scripted MSM patient encounter about PrEP	Surveys (N=43 MS2-4)	Significant increase in comfort discussing sexual behaviors with MSM, identifying at-risk MSM who may benefit from PrEP, and prescribing PrEP to MSM Significant improvement in knowledge of the indications for prescribing PrEP to MSM and indications for PrEP discontinuation for MSM	2
Pfaff et al. (2020) [92]	Elective* lecture and cadaver laboratory** on facial feminization	Surveys (N=5 MS*** and N=11 residents; MS not separated in results)	Significant improvement between pre and post scores within each self-assessment category Increase on the knowledge-based section of the assessment	2
Pratt-Chapman and Phillips (2020) [93]	Optional* symposium on improving care for SGM including clinical and pre-clinical MS	Surveys (N=29 intervention including 1 pre-clinical MS and 1 clinical MS; N=134 comparison including 40 pre-clinical MS and 32 clinical MS, MS not separated)	Significant improvements in self-reported clinical preparedness to care for SGM patients and knowledge about SGM Significant improvement in overall LGBT-DOCSS scale score Those who completed the intervention had significantly higher confidence in all learning objectives and scores on LGBT-DOCSS overall and subscales for attitudes and knowledge	2
Sawning et al. (2017) [94]	Elective LGBT Health Certificate Program sessions**	Survey (N=39 MS1-4)	Significant increase in knowledge after session(s) Significant increase in agreement that same‐sex sexual behavior and transgender identities are natural After the session(s), MS reported it was more challenging to take a history with an LGB patient than a heterosexual patient	2
Thomas et al. (2020) [95]	Optional journal club** for MS1 and MS2	Surveys (N=7 MS1-2)	Increase from 71 to 100% of students that said they were familiar with LGBTQ healthcare issues Increase from 43 to 83% on confidence in ability to identify harmful medical provider practices and provide culturally competent care	2
Block et al. (2020) [96]	Educational* program** on caring for LGBTQIA+ patients	Survey, OSCE, essay (N not stated, MS***)	Significant increase in knowledge about LGBTQIA+ community, confidence engaging LGBTQIA+ patients, and comfort using correct terminology Significant increase in understanding of importance of and comfort providing culturally competent care for LGBTQIA+ patients	2
Studies that evaluate student knowledge and learning experiences
Author and year	Item assessed	Methods	Key findings	Kirkpatrick model level
Beck Dallaghan et al. (2018) [97]	Knowledge, preparedness, and attitude in caring for LGBT patients, recommendations for curriculum change, inventory of LGBT curriculum at each school	Survey and curriculum inventories (N=766 MS*** on survey with N=377 responding to qualitative questions)	96% agreed they would feel comfortable LGBT patients 55% agreed they know what to do if a patient came out as LGBT 32% agreed they know appropriate terminology for working with someone who is transgender No relationship between number of hours of LGBT curriculum and overall attitudes, knowledge, preparation, and campus climate	2
Bleasdale et al. (2022) [98]	Coverage of LGBT health topics in their curriculum	Survey (N=733 total students including 370 MS*** at 2 schools)	Overall average coverage was “too little” or “basic” for all items MS reported significantly more coverage of 10 topics in their curricula than pharmacy (PharmD) and nursing (DNP) students PharmD students reported greater coverage of HIV, safer sex, and STIs compared to MS and DNP students	1
Bidell (2017) [99]	LGBT clinical self-assessment for health and mental health providers	Surveys (Study 1 N=602 trainees, practitioners, & educators in US and UK, including 21 MS***; Study 3 N=564 including 29 MS***)	LGBT-DOCSS survey developed and validated with 3 subscales (Clinical Preparedness, Attitudinal Awareness, Basic Knowledge)	2
Bohnert et al. (2021) [100]	How GM and SM are portrayed in SP cases	Survey (N=59 schools) and follow-up interview (N=24 schools)	53% portrayed GM patients, 90% portrayed SM patients 59% knowingly used GM SPs GM cases overwhelmingly had a positive impact on learners Barriers included curriculum time, recruitment, fear of disrespecting gender minority communities, and transphobia	N/A
Bunting et al. (2022) [101]	Perceived complexity of patient and confidence in caring for patient, comprehensiveness of training in SGM health	Survey (N=665 MS1-4 across 12 schools)	Mean comprehensiveness of training about SGM health was 5.37 (1=minimal, 10=comprehensive) Gay male patient was viewed as the most medically and therapeutically complex Bisexual male was viewed as the most socially complex Perceived medical and social complexity predicted lower confidence caring for the patient	1, 2
Bunting, Chirica, et al. (2021) [102]	Comprehensiveness of medical school education on SGM health	Survey (N=1,007 MS1-4 across 12 schools)	Regarding training received on SGM health: 12.9% reported minimal training; 34.8% reported moderate training; 45.1% reported adequate training; and 7.2% reported comprehensive training	1
Bunting, Feinstein, Hazra, Sheth, et al. (2021) [103]	Knowledge about HIV and PrEP	Survey (N=2,159 MS1-4+, also N=194 pharmacy students, MS sometimes separated in results)	Mean HIV knowledge score was 79.6%, PrEP knowledge 84.1% Greater knowledge of HIV and PrEP among gay/lesbian participants compared to heterosexual Greater knowledge of HIV and PrEP among those later in their training compared to early	2
Bunting, Garber, et al. (2021) [104]	Knowledge about PrEP including questions asking about MSM, transgender women, and gay men	Survey (N=2,085 students including MS***, MS not separated)	60% MS and PA students received education about PrEP in training 78.2% of MS and PA students scored in the high knowledge range 65% of MS and PA students indicated complete/strong agreement that PrEP is effective in transgender women and 72% reported complete/strong agreement that PrEP is effective in MSM	2
Bunting, Feinstein, Hazra, Garber, et al. (2021) [105]	PrEP and HIV care for patients with various sexual orientations and gender identities	Survey (N=670 MS1-4 across 12 schools)	Less likely to identify the heterosexual female patient as a PrEP candidate (despite behavioral risk factors for HIV being identical) Reported lowest confidence caring for heterosexual female patient seeking PrEP	2
Bunting et al. (2020) [106]	PrEP awareness and education on HIV and PrEP	Survey (N=1,859 students including 902 MS1-MS4+, MS sometimes separated)	Among MS and PA students, 83.9% were taught about HIV risk, 88.6% were aware of PrEP, and 60% were taught about PrEP MSM were most frequently presented as candidate patient population for PrEP TWSM were the least frequently presented patient population indicated for PrEP	2
Calabrese et al. (2018) [107]	Likelihood of prescribing PrEP to male patients with varying condom use and sexual partners	Survey (N=111 MS1-4+)	Most willing to prescribe to patients with sustained condom use and multiple male partners (86%) and a single male partner (93%) Fewer willing to prescribe if patient had multiple partners vs. single partner with sustained condom use and sustained condom nonuse	2
Cooper RL et al. (2021) [108]	Pre-clinical and clinical regarding PrEP, focus on PrEP in MSM and transgender patients, and student preparedness to perform skills for PrEP delivery	Survey (N=71 medical school administrators)	38% of schools reported offering any PrEP content 15.4% of schools reported specific training regarding PrEP particularly for LGBT patients Lectures and problem-based learning were the most common teaching methods used	N/A
Dimant et al. (2019) [109]	Hours of formal transgender and gender nonbinary (TGNB) health education received in medical school	Survey (N=36 total including 21 current MS***, MS not sometimes separated)	20 (56%) participants received formal TGNB health education in medical school 35% received 2 hours or less 17.6% received 3 or more hours	1
Green et al. (2017) [110]	Preparedness and skillfulness at providing cross-cultural care, including LGBT patients	Survey (N=1,369 MS1-4 includes multiple responses from same individuals at different times in study)	Mean absolute percent difference between beginning fourth-year students and beginning first year students regarding caring for LGB patients was 15% and 7% for transgender patients	2
Greene MZ et al. (2018) [111]	Perspectives on curriculum and preparedness	Survey (N=1,010 total students, including 495 MS***; MS sometimes separated)	86% of all respondents felt comfortable treating LGBQ patients, 66% felt comfortable treating trans-identified patients 48% agreed their training prepared them to care for LGBTQ patients 52% report school integrated LGBTQ content in formal curriculum	1, 2
Hayes et al (2015) [112]	Comfort, knowledge, and training with sexual history taking in LGBTQ and non-LGBTQ patients	Survey (N=74 MS1-4 and N=84 residents/fellows; MS sometimes separated)	Learners were less comfortable taking a sexual history and discussing safe sexual practices with LGBTQ patients compared to other patients Decreasing level of comfort with taking a sexual history with LGBTQ patients as learners advanced through their training	2
Lapinski et al (2014) [113]	Medically relevant knowledge of the health issues of LGBT individuals	Survey (N=972 osteopathic MS1-4 across 6 schools that completed the knowledge assessment)	12.9% of MS received a passing knowledge score of 7 or greater LGB students had higher knowledge scores than heterosexual students	2
Leandre et al. (2021) [114]	Knowledge, comfort, and amount of LGBTQ+ patient interaction	Survey (N=77 MS3-4, residents and fellows; MS not separated in results)	About half of MS and residents had minimal or no interaction with LGBTQ+ patients during training Most felt comfortable treating LGBTQ+ patients Respondents who had some level of discomfort treating LGBTQ+ patients cited lack of education as a reason for this 39% did not feel that they received sufficient training	1, 2
Liang et al. (2017) [115]	Knowledge and comfort related to LGBTQI patient care	Surveys (N=218 MS1-4 in #1 and N=123 MS1-4 in #2)	Average self-reported knowledge and comfort regarding transgender and intersex health issues were lower than for LGB Students who identified as LGBTI had significantly higher knowledge for and comfort with LGB and transgender health issues Student knowledge in pre-clinical years (MS1 & MS2) was significantly lower than in clinical years (MS3 & MS4)	2
Lindberg et al. (2019) [116]	Faculty perception of adequacy of coverage LGBT concepts within curriculum	Survey and interview (N=24 faculty involved in curriculum)	Overall, curricular content on terminology, history-taking skills, preventive medicine, transgender health, use of evidence-based medicine, and prevention of discrimination in care of LGBT patients was rated as “poor” to “adequate”	N/A
Mani et al. (2018) [117]	Knowledge of HIV and HIV exposure prophylaxis with some questions including MSM and gay/bisexual men	Survey (N=459 MS1)	MS average 57.8% of knowledge questions correct Knowledge gap found for question asking to rank 3 situations from highest to lowest HIV infection risk, one of them being “An African American male engaging in unprotected sex with a male”	2
Muns et al. (2022) [118]	Knowledge, experience, and comfort regarding care for transgender patients	Survey (N=141 MS1-4+)	87% reported transgender patient care was part of their curriculum 82% reported exposure to transgender patients Students reported lack of knowledge related to surgical and hormonal aspects of gender-affirming care On average students felt comfortable working with transgender patients	1, 2
Newsom, Carter, et al. (2022) [119]	Students’ clinical practice asking about sexual orientation and gender identity (SOGI)	Survey (N=364 MS2-4)	As year in school increased, students were less likely to consistently ask patients about SOGI As year in school increased, students were more likely to cite negative influence from their attendings and question the relevance of obtaining the information as reasons for not consistently asking about SOGI	1, 2
Nowaskie and Patel (2020) [120]	LGBT-DOCSS, number LGBT patients seen, LGBT curricular hours, LGBT total hours	Survey (N=940 MS1-4+ across 3 schools)	Significantly higher Basic Knowledge than Clinical Preparedness Significantly less adequate clinical training/supervision, experience, and competence for transgender compared to LGB patients MS who cared for 35+ LGBT patients and/or received 35+ LGBT total hours had significantly higher LGBT-DOCSS scores Of the 35 total hours higher-competent MS received, 25 were extra-curricular	2
Nowaskie et al. (2020) [121]	Basic knowledge and amount of experience related to LGBTQ+ health	Survey (N=1,701 total health professional students across 3 schools, 55.3% are MS1-4+)	Significant differences among disciplines on the number of LGBT patients the student worked with annually and the number of LGBT curricular hours they received annually Number of LGBT patients and LGBT curricular hours were significant predictors for Overall LGBT-DOCSS, Clinical Preparedness, and Basic Knowledge Number of LGBT patients was a significant predictor for Attitudinal Awareness	2
Obedin-Maliver et al. (2011) [122]	Hours of LGBT curricular content and coverage of LGBT-related topics	Survey (N=132 US and Canadian medical schools, including 121 US medical schools which are sometimes separated)	Median reported pre-clinical hours dedicated to LGBT content at US medical schools was 4 hours (IQR 2-6, range 0-24) Median reported clinical hours dedicated to LGBT content at US medical schools was 2 hours (IQR 0-4, range 0-15) 63% of all schools teach at least half of the 16 LGBT-related topics	N/A
Phelan et al. (2017) [123]	Preparedness caring for LGB patient, skill at counseling LGBT patients on safer safe practices, favorability and frequency of interactions with LGBT patients	Surveys (N=3,492 MS that completed initial survey as MS1 and follow-up as MS4)	Mean score for preparedness to care for LGB patient was 4.1/5 Mean score for skill at counseling LGBT patients on safer sex practices was 3.0/5	2
Robertson (2017) [124]	Experiences in medical school, including lack of education on queer health issues	Semi-structured interviews (N=11 including N=8 MS1-4)	Expressed concern for inadequate training on queer health issues Queer health issues came up in formal curriculum related to social history or with an HIV-positive gay male patient in case studies	1
Talbott et al. (2023) [125]	Pre-clinical and clinical	Survey (N=51 medical school administrators)	13.7% of administrators reported including LGBTQ+ patients in their human trafficking curriculum	N/A
Thompson Hale M et al. (2018) [126]	Knowledge and comfort caring for LGB and transgender patients	Survey (N=137 MS1)	Significantly less knowledge of health care needs and health care issues for transgender patients compared to LGB patients Significantly lower comfort levels working with transgender patients compared to LGB patients	2
Varas-Díaz et al. (2019) [127]	Clinical practice scores in observed SP scenarios	Survey and assessment of skills in SP scenarios (N=237 MS4)	Mean physical exam score significantly worse for MSM scenario Scores for history taking, including communication, were significantly lower for scenarios with patient using IV drugs and MSM patient compared to female patient	2, 3
Vasudevan et al. (2022) [128]	Knowledge, skills, and attitudes towards healthcare for transgender patients	Survey (N=302 total students including N=178 MS1-4)	35% of MS had provided clinical care to a transgender patient 89% of MS reported “low” or “intermediate” knowledge regarding medical management of patients with gender dysphoria Among MS, self-reported knowledge about medical management and skill level in providing medical care to transgender patients increased with year in school (p = .007 and .002, respectively)	2
Warner et al. (2018) [129]	Sexual health knowledge including sexual minority health	Survey (N=1,014 MS1-4+)	63% average correct on sexual minority health section Students who learned about sexuality in a dedicated course performed significantly better than students who learned about sexuality in other courses (e.g. psychiatry, microbiology)	2
White et al. (2015) [130]	Preparedness and comfort in caring for LGBT patients	Survey (N=4,262 MS2-4+: of which 3,956 in US, 306 in Canada), focus group (N=29 MS***)	76% US DO and 65% US MD MS described curriculum as “fair,” “poor,” or “very poor” 47% US DO and 66% US MD MS felt “more prepared” by their medical education 84% all MS felt “comfortable” or “somewhat comfortable” caring for LGBT patients Required pre-clinical learning (37%), interactions with LGBT patients (25%), and personal experiences (24%) were most influential in increasing comfort with LGBT patients	1, 2
Wilson et al. (2014) [131]	Comfort caring for LGBT patients	Survey (N=975 total students including N=270 MS***)	MS responses to “It would be more challenging to gather a history from an LGBT patient than from a heterosexual patient” were an average of 3.6 (SD 1.1) (1=‘‘strongly disagree’’ - 5=‘‘strongly agree’’) MS responses to “It is more challenging to discuss sexual behavior with LGBT patients than with heterosexual patients” were average of 3.3 (SD 1.2)	2
Zelin et al. (2018) [132]	Comfort and confidence caring for SGM patients, perceived adequacy of curriculum	Survey (N=658 MS1-4)	84% somewhat/very competent in their ability to sensitively interview patients about sexual orientation, history, and practices 23% & 19% somewhat/very competent describing treatment options for patients who are transgender or have DSD, respectively 60% did not feel curriculum had adequate SGM health information 56% did not believe their curriculum adequately prepared them to comfortably and competently care for SGM patients	1, 2
Studies that describe the development of broad curriculum objectives or changes, including planning aspects
Author and year	Curriculum type	Methods	Key findings
Coleman et al. (2013) [133]	Sexual health curriculum including LGBTQI health	Summit (N not stated, US and Canadian medical educators, sexual health educators, and interested parties at the national level)	Proposed including sexual health for LGBTI populations within the sexual health curriculum Stressed need for clarification of the relationship between sexual health and LGBTI health
Coria et al. (2013) [134]	Social justice curriculum including gender and sexual identity in social determinants of health	Multidisciplinary committee developed (N=19 members including 8 MS***)	Committee compiled topics that should be included in a social justice curriculum, including gender and sexual orientation in social determinants of health Recommendations from committee implemented in existing materials, new materials, and elective social justice track
Eckstrand et al. (2016) [135]	Medical education related to care for people who are LGBT, gender nonconforming (GNC), and/or born with DSD	Identify competencies (N=9 members on AAMC Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development)	Adapted Physician Competency Reference Set (PCRS) framework to refine competencies required for care of people who are LGBT, GNC, and/or born with DSD Defined 30 qualifiers of competence for 20 PCRS competencies, including at least 1 qualifier in each of the 8 domains
Holthouser et al. (2017) [136]	Development and implementation of inclusive, comprehensive curriculum on LGBT/GNC/DSD patient care	Steering committee, involved stakeholders, evaluated gaps in curriculum to develop implementation plan and executed this	Content incorporated into 50.5 hours of required MS1-2 curriculum In pilot year 320 MS received the new curriculum and 23 faculty members taught some component of this New sessions included direct interaction with LGBT/GNC/DSD patients through patient panels and small groups
Katz-Wise et al. (2022) [137]	Integration of LGBTQIA + community experiences and perspectives into curriculum	Authors describe approach for integration including 2 community advisory groups (CAG) of young adults (N=10) and adults (N=12)	Approach detailed for integration of LGBTQIA+ community members into medical education using CAGs, community panel events, SPs, and community member interviews Main theme from CAG meetings was LGBTQIA+ education and training with subthemes of the needed education/training, patients at educators, key concepts, and learning methods Panelists discussed “What advice do you have for medical students who are still in training about caring for LGBTQIA+ people?”
Keuroghlian et al. (2022) [138]	Longitudinal SGM health curriculum (in existing curriculum and broader learning environment)	Multi-year initiative involving a core team, stakeholders, Professional Advisory Council, and Community Advisory Groups	Defined 9 core SGM health competencies mapped onto the 6 MD program competencies/objectives based on the 30 competencies in the AAMC guidelines on improving LGBTQIA+ health care Made additions to pre-clinical and clinical curriculum based on inventory of full curriculum Held 2-day symposium exploring best practices for integrating SGM health content across the curriculum
Loder et al. (2020) [139]	Reproductive justice (RJ) medical education	Delphi (N=41 RJ advocates and leaders on the expert panel)	“LGBTQI health” was noted as a core area that all physicians should receive education in Highlighted that physicians should learn about transgender healthcare and the difference between sex and gender
Matthews-Juarez et al. (2020) [140]	Broad discussion of how medical schools should train students to care for LGBTQ+ and other vulnerable groups	Community of Practice (N=62)	Created space for stakeholders to discuss how MS should be trained to provide high-quality, patient-centered care for LGBTQ+ people
Newsom, Buehler, et al. (2022) [141]	Development of student-run LGBT+-focused clinic	Previous survey of MS*** followed by needs assessment from community	Based on findings from a survey for medical students and needs assessment from community, student-run LGBT+-focused clinic developed to increase MS training and provide care for LGBT+ people in the community
Noonan et al. (2018) [142]	Overall undergraduate medical education	Community forum (N=59) and follow-up survey (N=100)	Curricula revised to include small-group sessions between MS and LGBT patients and education on specific transgender health needs Updated teaching and assessments about patient interaction to combat heteronormative and cisnormative bias in communication Integrated material on the following topics into the required curriculum: cross-gender hormone therapy, evaluation of patients for gender dysphoria, provider bias, and best practices for cancer screening in transgender patients
Pratt-Chapman (2020) [143]	Examined implementation factors that facilitated SGM health curricular integration in training for health professionals including MS at different institutions	Interviews (N=16 faculty and MS*** that were identified as champions for SGM curricular change)	Most successful interventions had a combination of student and faculty engagement Successful implementation relied on at least one institutional champion Major themes included need to increase student exposure to SGM community & how availability/lack of expertise shaped curriculum Key themes on future directions included need for evaluation tools and need to incentivize inclusion of SGM curricula
Raygani et al. (2022) [144]	LGBTQ+ health topics in pre-clinical and clinical curriculum	Topic Steward oversaw integration of LGBTQ+ content in curriculum	Pivoted from concentrated curriculum to series of facilitated discussions in LGBTQ+ health topics over 3 years Incorporated use of pronouns in first week of school Added lecture and small group on inclusive terminology, social determinants of health related to discrimination, and sexual health Added lecture and small group on inclusive sexual history taking LGBTQ+ content added to relevant existing pre-clinical lectures Expanded clerkship opportunities
Stumbar et al. (2020) [145]	Development and implementation of longitudinal, feasible, and comprehensive sexual health curricular objectives	Needs assessment including review of course syllabi and conversations with course directors, review of existing objectives	12 sexual health curricular objectives including: “sex and gender” (addressed in years 1 and 2) “skills for sexual history taking” (including inclusive sexual history, addressed in years 2 and 3) “social determinants of sexual health” (including LGBTQ communities, addressed in years 2 and 3)
Weingartner LA et al. (2022) [146]	Gender-affirming care education across medical school curriculum	Utilization of epistemic peerhood model to consider gender-affirming care in medical education at their institution	Training should include discussions of authoritative and embodied knowledge of gender-diverse patients Importance of forming partnerships between academic health centers and local gender-diverse communities Importance of including gender-diverse people as SPs
Yehia et al. (2015) [147]	Development of interprofessional program on LGBT health	Interprofessional retreat including community members	Penn Medicine Program for LGBT Health developed Includes health education area of focus, with an achievement being delivery of 10 LGBT health-themed lectures

*it was not explicitly stated in the article if the learning activity was required, or elective/optional, the label here was implied based on how the activity was described; **unspecified if this was part of a clinical or pre-clinical curriculum; ***year in medical school not specified.

Abbreviations: AAMC: Association of American Medical Colleges; DSD: differences of sex development; GAHT: gender-affirming hormone therapy; GM: gender minority; GNC: gender nonconforming; IAT: implicit association test; LGB: lesbian, gay, and bisexual; LGBT: lesbian, gay, bisexual, and transgender; LGBT-DOCSS: LGBT-Development of Clinical Skills Scale; MSM: who have sex with men; MS: medical student; MS1: first-year medical student; MS2: second-year medical student; MS3: third-year medical student; MS4: fourth-year medical student; MS4+: student that has >4 years of medical training (i.e., dual degree or research year); N/A: not applicable; PA: physician assistant; PrEP: pre-exposure prophylaxis; SGM: sexual and gender minorities; SM: sexual minority; SOGI: sexual orientation and gender identity; SP: standardized patient; TGD: transgender and gender diverse; TGWM: transgender women who have sex with men; WSW: women who have sex with women.

Figure 1. Article identification and screening process.

Figure 2. Frequency of articles included in review published per year. Note that only articles published through 6 February 2023 were included.

Table 3. The most common intervention classification was required in the pre-clinical curriculum.

Curriculum type	Required or elective for students	Number of articles (%), of 77 total
Clinical (N = 16)	Required	9 (11.7)
	Elective	6 (7.8)
	Unspecified	1 (1.3)
Pre-clinical (N = 42)	Required	33 (42.9)
	Elective	8 (10.4)
	Both elective and required elements	1 (1.3)
Unspecified or combination (N = 19)	Required	1 (1.3)
	Elective	18 (23.4)

Figure 3. Frequency of teaching modalities and learning features among the studied curriculum interventions.

Figure 4. Frequency of theme evaluation. ‘LGBT-DOCSS’ stands for the ‘LGBT-Development of Clinical Skills Scale’. This was developed by Bidell (2017) [99] and was used as a measurement tool in two additional studies represented in this figure [120,121]. Of note, the LGBT-DOCSS includes assessment of preparedness and knowledge, and these articles are additionally included in the frequency displayed above for the categories ‘preparedness’ and ‘knowledge’ in addition to ‘LGBT-DOCSS’.

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