Medical education aspires to mitigate bias in future professionals by providing a robust curriculum that includes perspectives and practices for caring for sexual and gender minority (SGM) populations, including lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI) persons. To provide medical schools with a more systematic, uniform approach to teaching these topics in their curriculum, the Association of American Medical Colleges (AAMC) in 2014 published 30 SGM competencies and topics that curricula should address. However, implementation of these ideals remains challenging.

Building off the AAMC's comprehensive resource guide, medical education leaders at Boston University School of Medicine (BUSM) have developed a curriculum assessment tool to efficiently assess whether a medical school adequately incorporates recommended SGM core competencies.

"Medical schools vary in how they cover SGM topics and to what extent graduating students feel prepared to meet the needs of these populations. Medical school leaders motivated to improve curricula on caring for SGM populations must survey their school's current curricula to identify their school's strengths and opportunities for improvement," said corresponding author Ann Zumwalt, Ph.D., associate professor of anatomy and neurobiology at BUSM and chair of the Gender and Sexual Diversity Vertical Integration Group (GSD VIG).

In 2018, the school convened the GSD VIG, comprising a group of BUSM faculty and students with experience and expertise regarding SGM health, to examine the state of BUSM's curriculum on SGM health. The group distilled the 30 AAMC competencies into 12 SGM topic areas that should be addressed in any medical school curriculum. They then developed the SGM Curriculum Assessment Tool (SGM-CAT), which employs targeted curriculum assessment questions to assess whether these topic areas are addressed within the curriculum—and, if they are, how and where.

This tool was distributed to all course and clerkship directors responsible for the required curriculum at BUSM to investigate where these core topics are addressed. The curriculum assessment tool identified several strengths in the pre-clerkship and clerkship curricula, including faculty willingness and enthusiasm to include SGM topics, but also revealed that some SGM topics are underrepresented in the BUSM curriculum.

"What is exciting about our tool is that we used our proficiency to distill the 30 AAMC competencies into 12 easily understandable topics that should be taught in any curriculum. We then surveyed all course and clerkship directors on whether they teach any of those 12 topics. The process/tool we developed is a straightforward way to get a snapshot of what is being taught where across the entire curriculum," added Zumwalt.

"As it is still not a requirement of medical training, identifying where SGM content even exists in medical schools is extremely difficult. This tool aims to easily and quickly reveal where SGM content is addressed in undergraduate medical education, thereby allowing for more rapid and comprehensive interventions to improve training," explained co-author Carl Streed, Jr., MD, MPH, FACP, assistant professor of medicine at BUSM and a primary care physician and research lead in the Center for Transgender Medicine & Surgery at Boston Medical Center (BMC).

According to the researchers, many faculty may miss opportunities to teach about SGM health because they do not recognize how the material fits with their topic. "The tool was designed to be used by individuals who are less familiar with SGM health and makes curricular change easier by helping users understand how SGM health is incorporated into existing curricula," added Jenny Siegel, MD, assistant professor of medicine at BUSM and medical director, Center for Transgender Medicine & Surgery at BMC.

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