National Partnership for Women & Families

Monthly Women's Health Research Review

Review examines educational strategies to help students provide respectful sexual health care to LGBT patients

Summary of "Educational strategies to help students provide respectful sexual and reproductive health care for lesbian, gay, bisexual, and transgender persons," Kelly Walker et al., Journal of Midwifery & Women's Health, Oct. 26, 2016.

In this study, Kelly Walker, assistant professor and program director of the Nurse Midwifery Program at Stony Brook University School of Nursing, and colleagues outlined the increased risk of poor health outcomes among lesbian, gay, bisexual and transgender (LGBT) individuals and "address[ed] the need for targeted education for health care professional students." According to the researchers, "this can be accomplished by offering easy-to-implement didactic strategies for faculty who teach students how to provide respectful sexual and reproductive health (SRH) to persons of all sexual orientations [and gender identities]."

The researchers explained that among other risk factors, LGBT individuals are "less likely to have health insurance, [have] a higher risk for obesity, [have] increased rates of smoking, and [are more likely to] participat[e] in binge and heavy drinking more frequently" than non-LGBT individuals. In addition, "lesbian and bisexual women may receive fewer colon, breast, and cervical cancer preventative screening tests than heterosexual women, due in part to a fear of not receiving respectful health care," the researchers wrote. Meanwhile, according to the researchers, competency requirements from the American College of Nurse-Midwives and the American Association of Colleges of Nursing, as well as materials from Healthy People 2020 and the World Health Organization, "highlight the need for targeted instruction that addresses SRH for all persons, including LGBT clients, in midwifery and graduate nursing curricula."

Integration of sexual and reproductive health content into an education program

Noting that "[e]ducation about SRH for LGBT clients may be delivered in traditional on-site, hybrid, or online systems," the researchers addressed the "[k]ey components of SRH educational content specifically for LGBT clients," including "terminology, identification of personal bias, sexual health history taking, determination of appropriate referrals, and application of learned content through an exemplary case study."


"A lack of knowledge regarding terminology is often a barrier to care for LGBT clients," the researchers wrote, citing several key terms, such as "sexual orientation, gender identity, gender expression, and biologic sex development." According to the researchers, "Terminology can be taught in a variety of ways including lectures, discussions, or live presentations."

Identifying personal bias

The researchers wrote that educators can "help students identify personal bias" and cultivate cultural competence "by presenting students with clinical scenarios that may expose them to ideas and persons who may be perceived as different." This exercise can enable students "to examine personal experiences, upbringing, background, and personal cultural factors that might impact their beliefs regarding LGBT SRH." After students identify "a potential personal bias, the faculty can work with the student to find ways to provide nonjudgmental, respectful care in spite of a personal bias," the researchers wrote.

Sexual health history

According to the researchers, "The sexual health history is a large component of SRH and provides the opportunity for a provider to assess sexual well-being and self-sexual image, as well as reinforce education regarding safe sexual practices." They recommended that faculty teach students "to obtain a thorough and respectful sexual health history" via the PLISSIT model, which involves asking patients for permission to inquire about their sexual health, obtaining limited information specific to patients' sexual concerns, providing specific suggestions to offer patients "respectful and appropriate sexual health counseling" and initiating therapy by providing patients with appropriate referrals for care.

The researchers wrote that students can practice this model of assessment in pairs via virtual classrooms, submit write-ups of the encounter for faculty evaluation and watch video enactments to learn appropriate use of the model.

Use of case studies

The researchers recommended that case studies used to teach SRH for LGBT patients "address problems that are specific to the LGBT community such as barriers to care, specific sexual health needs, sexually transmitted infection (STI) screening, and intimate partner violence (IPV) screening." Such case studies "may be designed to elicit one or more of the following outcomes from students: identification of personal bias, sexual health history taking skills, pertinent health promotion topics, a plan of care, and appropriate referrals as needed for the LGBT client."

The researchers outlined one case study in which a medical student "first builds a knowledge-base by reviewing pertinent" materials, responds to "questions that are designed to elicit assumptions and any personal bias regarding the client in a private blog or journal," works with faculty "to find ways to provide respectful care in spite of a bias," collaboratively works "to obtain a sexual health history" and shares the client's diagnosis "in a sensitive manner, providing opportunity for questions and offering support."


"The responsibility to teach graduate nursing and midwifery students how to provide respectful and comprehensive SRH to all is great but does not need to be overwhelming to the faculty member," the researchers wrote.

They outlined the wide range of ways faculty can integrate didactic exploration of personal bias in the classroom and develop case studies sensitive to "the cultural setting in which the school or students are located." Further, they wrote that such material "can be conveyed in person or online and may be interwoven through currently existing courses," such as by developing "one focused case study pertaining to SRH with LGBT clients in each didactic course for midwifery students (ie, primary care, well-woman gynecology, antepartum care, intrapartumcare courses)." According to the researchers, "This way, the students may more readily see the applicability of the content in each clinical area and can integrate lessons learned into the clinical setting."

Noting that "[m]idwives and advanced practice nurses can help reduce health care disparities in the LGBT population by providing respectful SRH," the researchers concluded, "Graduate nursing and midwifery education programs have the opportunity to sensitize students toward the needs of LGBT clients now and in their practice after graduation."