MedEdPORTAL (Apr 2014)
Depression in the LGBT Patient: A Standardized Patient Encounter
Abstract
Abstract Introduction The healthcare needs of lesbian, gay, bisexual, and transgender (LGBT) patients can differ significantly from those of their cisgender and/or heterosexual counterparts, and a modern medical education must be able to provide the training necessary to provide appropriate medical care for this patient population. Healthcare professionals may often consider themselves to be “neutral” or “unbiased” towards LGBT-identifying patients, and assert that sexual identity does not affect their ability to provide care. Despite this, significant disparities can be found regarding not only health care needs, but also the care of LGBT and non-LGBT identified patients. This case provides a standardized patient encounter that allows examinees to evaluate their comfort working with a young patient that identifies as a part of the LGBT community. Methods Students have 15 minutes to elicit a focused history and physical examination while building rapport and maintaining professionalism with an LGBT-identified standardized patient. They then have a separate 10-minute block to type out a note detailing their findings, an assessment, and a plan. After the encounter is complete, students attend a short presentation about the topics of LGBT patients, depression, and HIV infection. Moreover, if the student's performance on the exam overall is unsatisfactory, they are given a one-on-one review with a member of the faculty. Results The case was used as one of 10 cases on the required third-year clinical exam at the University at Buffalo School of Medicine and Biomedical Sciences. To date, the case has been run in a live examination setting twice with minor adjustments after each exam. Discussion This case provides a standardized patient encounter that allows students to evaluate their comfort working with a young patient that identifies as a part of the LGBT community. Moreover, it highlights three important aspects of LGBT health care, namely HIV, depression, and building rapport with a patient that identifies as a part of the LGBT community. The educational value of these resources is limited by the gender and age of the patient, as well as sexual practices and social setting. There are many other topics in the healthcare of LGBT youth that require attention in the medical school curriculum, including, but not limited to, high school harassment and bullying, high rates of tobacco and alcohol use, and eating disorders.
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