A practical, evidence-based curriculum for internal medicine residents improved knowledge, confidence, and attitudes toward gender and sexual diverse (GSD) health care, offering 'one of the first systematic frameworks, with immediately useable materials, to address GSD health.'
Key Findings
Results
Residents' perceived confidence in providing GSD sexual health care and prescribing PrEP and GAHT increased significantly after the curriculum sessions.
Improvement in confidence was statistically significant (p < .001)
The curriculum covered STI screening and treatment, PrEP prescription, and gender-affirming hormone therapy (GAHT) initiation
46 internal medicine residents at an urban safety-net hospital participated
Wilcoxon signed-rank tests were used to compare pre- and postsession survey responses
Results
Residents' attitudes regarding the importance of GSD-related clinical practices increased significantly after the sessions.
Improvement in attitudes was statistically significant (p < .001)
Specific attitude domains that improved included: obtaining comprehensive sexual histories, discussing gender identity, assessing gender dysphoria, and offering GAHT for GSD patients
Attitudes were assessed via survey with pre- and postsession comparison
Results
Residents' knowledge of GSD health topics improved substantially following the curriculum.
The median number of correct responses to five knowledge-based questions increased from 1 to 4 (p < .001)
This represents an increase from 20% to 80% median correct response rate on the knowledge assessment
Improvement was measured using Wilcoxon signed-rank tests
Methods
The curriculum used a case-based, small-group, interactive format centered on a clinical scenario involving a transgender woman.
Two 2-hour sessions were conducted
The scenario involved screening and treatment of sexually transmitted illnesses (STIs), PrEP prescription, and GAHT initiation
One-page handouts with step-by-step instructions were provided as practical reference tools
The curriculum was implemented at an urban safety-net hospital
Background
Internal medicine residents commonly lack the knowledge, comfort, and competency needed to care for gender and sexual diverse patients, contributing to health disparities.
This gap in training served as the primary motivation for developing the curriculum
The curriculum is described as providing 'one of the first systematic frameworks' for addressing GSD health in internal medicine residency training
46 IM residents participated in the implementation study
What This Means
This study developed and tested a training program to help internal medicine doctors-in-training better care for gender and sexual diverse (GSD) patients — including lesbian, gay, bisexual, transgender, and other individuals. The two-session, four-hour curriculum used realistic patient case scenarios and simple reference handouts to teach residents how to take sexual histories, screen for sexually transmitted infections, prescribe HIV prevention medication (PrEP), and start gender-affirming hormone therapy. The program was tested with 46 residents at an urban safety-net hospital.
The results showed striking improvements across all measured areas. Before the training, residents answered a median of only 1 out of 5 knowledge questions correctly; after the training, that rose to 4 out of 5. Residents also reported feeling more confident in performing GSD-related clinical skills and placed greater importance on tasks like discussing gender identity and assessing gender dysphoria with patients — all with statistically significant improvements (p < .001).
This research suggests that a relatively brief, structured educational intervention can meaningfully improve how prepared internal medicine residents feel to care for GSD patients. Because GSD individuals often face significant barriers and disparities in healthcare, better-trained physicians could help reduce those gaps. The authors note this is one of the first systematic, practical frameworks of its kind for internal medicine training, and the ready-to-use handouts make it potentially easy for other residency programs to adopt.
Suarez S, Lupton Lupez E, Modzelewski K, Hinkle C, Streed C, Siegel J. (2025). A Systematic and Practical Framework on Gender and Sexual Diverse (GSD) Health for Internal Medicine Residents.. MedEdPORTAL : the journal of teaching and learning resources. https://doi.org/10.15766/mep_2374-8265.11535