Military university expands curriculum to include LGBT+ healthcare guidelines

By Christopher Austin

Maj. (Dr.) Kevin Semelrath was looking for a project; a final project for his American College of Emergency Physicians’ fellowship program. The program required Semelrath to develop a new curriculum idea.

“During the student interest group fair last year, I saw there was a LGBT+ [ lesbian, gay, bisexual, transgender+] student group called Spectrum. So I signed up and became one of their faculty mentors, because I’m part of the LGBT+ community myself,” he said. “I worked with a couple of students who graduated in 2016 to do a gap analysis and saw that at the time [the Uniformed Services University of the Health Sciences] only specifically addressed [the LGBT+ community] for about five to seven hours throughout the whole curriculum.”

USU’s resident LGBT+ student group, Spectrum, which Semelrath is a 
faculty mentor for, aided him in conducting a gap analysis to see how 
the SOM’s curriculum might belacking in educating students in 
how to address LGBT+ healthcare concerns.
(Image credit: courtesy of Navy ENS Paolo Rigo)

Semelrath had found his project.

After presenting the results of the research to Dr. Arnyce Pock, associate dean for Curriculum in the School of Medicine (SoM), she asked Semelrath, an assistant professor in the SoM’s Department of Military and Emergency Medicine, to run with the curriculum project, which also received the approval of SoM dean Dr. Art Kellermann and the school’s Executive Curriculum Committee.

Beginning with the class of 2022, the new curriculum additions will take a more comprehensive approach to addressing concerns specific to the LGBT+ community.

The existing curriculum had limited coverage of LGBT+ issues to the reproduction module of the pre-clerkship year’s curriculum for students, Semelrath says. "Many of the hours were focused on sexual health practices like HIV infection and complications and sexually transmitted infections. While those are an important part of anyone's medical care, I wanted to shift the emphasis away from just focusing on things that may reinforce negative stereotypes.

“A lot of people in the military are not used to, or not comfortable interacting with, people who identify as lesbian, gay, bisexual or transgender. It’s really kind of a remnant of the “don’t ask, don’t tell policy. It’s not necessarily that military healthcare providers don’t want to provide excellent care for this population, but for a long time, we weren’t allowed to. And so that has left us with an education gap. We don’t want to add in a lot of things, because there’s already a lot in the new curriculum in such a short amount of time, but we want to realign it to have it be a more holistic view of people in the LGBT+ community,” said Semelrath.

The Uniformed Services University’s F. Edward Hebert 
School of Medicine is modifying its curriculum to include 
additions that will take a more comprehensive approach to 
addressing health care and other concerns specific 
to the LGBT+ community. (Image credit: Tatjana Plitt)

Semelrath is working to ensure the new curriculum guidelines focus on a variety of underserved areas like caring for the mental health needs of people in the LGBT+ community and approaches to preventive medicine.

“I wanted to put in those aspects while drawing out what’s already in the curriculum; shape it to be a little bit more holistic to get a better view of the population as a whole,” he said. “One of the biggest things is that lesbian, gay and bisexual individuals, especially in adolescence, who self-identify or are identified as such, have two to three times higher risk of committing suicide than a heterosexual adolescent, when adjusting for population. If they identify as transgender that goes up to four to five times.”

Also included in the new curriculum guidelines are the high risks of domestic violence, domestic assault and sexual assault that can occur in the transgender community, in particular, that aren’t often addressed by healthcare providers when speaking to patients who experience it. Semelrath is hoping to include this information as a part of the family practice and pediatric clerkships, which will give students a basis from which to start when learning how to approach patients and compassionately deal with their issues.

"In creating this curriculum, I hope to be able to expand our students' world view and their ability to care for our unique and amazing community. But ultimately, I want them to recognize that the LGBT+ community is really no different than any of their other patients, and are deserving of the excellent, compassionate care we train them to provide."