Intro to me, intro to you, AAMC Axis Interprofessional Collaboration Subcommittee

I’ve been part of the Association of American Medical Colleges Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development (Axis) for over a year now (see: I said yes: AAMC Advisory Committee on Sexual Orientation, Gender Identity and Sex Development)

We’re now getting to know one another and I’m happily discovering all of the expertise across academic medicine that exists in support of LGBTQ health. It’s pretty awesome.

This month was my turn to introduce myself, who I am, where I came from, and what I hope to do with this group, in 10 minutes. My slides are below, for the record…..

At the corner of caring and equality: AAMC Axis Webinar on Transgender and Gender Nonconforming Youth

2016.05.04 AAMC Axis Webinar Nuts and Bolts of The Nuts and Bolts of Caring for and Teaching about Transgender and Gender Nonconforming Youth  04620
2016.05.04 AAMC Axis Webinar the The Nuts and Bolts of Caring for and Teaching about Transgender and Gender Nonconforming Youth 04620 (View on

This webinar, entitled The Nuts and Bolts of Caring for and Teaching about Transgender and Gender Nonconforming Youth, was the first project completed by my small subcomittee of the AAMC AXIS committee (see: I said yes: AAMC Advisory Committee on Sexual Orientation, Gender Identity and Sex Development).

During the presentation by Michelle M. Forcier, MD, MPH and Jennifer L. Rehm, MD, emcee’d by Henry Ng, MD, MPH (@TheDrHenry) and Jason Schneider, MD (@DoctorJss), I was reminded how far we have come.

There was a time, not too long ago, when I peer-reviewed a presentation about LGBTQ health that began the section on transgender person health by quoting the cost of the highest priced surgery. This demonstrated a lack of empathy for LGBTQ people as well as inaccurate knowledge of the science. See this blog post for more info about cost of care (it’s negligible): Just Read: Latest study on costs of coverage for transgender person care: still negligible.

In LGBTQ health terms that was a long time ago and now there’s a community of physician leaders who embrace science and empathy. Forcier and Rehm educated on the science and benefits of supervised medical care, backed by evidence. The response to our tweets during the session demonstrated appreciation for this perspective.

It’s great to see the medical profession changing, learning to love better, with physicians leading the way. I agree: #transtastic.

Thanks Association of American Medical Colleges (@AAMCToday), and specifically Tiffani St. Cloud, CPC (@tstcloud), and Noah Perry, for their help. More photos below, enjoy.

Slides and recording of the presentation will be posted soon. I’ll tweet them / blog them here.

Photo Friday: 7th Street, NW Rising, as taken from the beautiful LEED Gold AAMC headquarters, Washington, DC USA

7th Street NW Washington DC USA 08531
Association of American Medical Colleges Headquarters Washington DC USA 08531 (View on

This week’s photograph was taken from the roof on top of the beautiful, LEED Gold-certified Association of American Medical Colleges (@AAMCtoday) headquarters, situated in historic Mt. Vernon Square, in Washington, DC.

The view itself is a brand new vantage point (since 2014) of a historic street, destroyed once in 1968 following the assassination of Martin Luther King, Jr., and devastated again in the late 1980’s and 1990’s by an uncontrolled drug and murder epidemic, just 1 mile from the White House.

I’ve posted photos of 7th Street and the 1968 damage here: Photo Friday: Progression Place, Washington, DC.

This book, by Ruben Castaneda (@RCastanedaWP) tells the story of 7th Street in the Marion Barry era (see: Just Read: S Street Rising: Crack, Murder, and Redemption in D.C.)

In the upper left is the 7th and O market, where 8 people were shot and 1 killed in 1994, and now houses the largest grocery store in Washington, DC. Catholic University is in the upper right. On the left is the Washington, DC, Convention Center. In the foreground is an area cleared for new development, that can only be appreciated from this vantage point.

I was at the AAMC because I am a member of the Axis Committee, (I said yes: AAMC Advisory Committee on Sexual Orientation, Gender Identity and Sex Development) whose work is getting under way, and holds great promise for a future health system that’s respectful of all.

Thanks Tiffani St. Cloud (@TStCloud) for the tour and for supporting this work. The rest of my photos are below, showing the majestic parts of the city. I always prefer the parts where people learn and grow the most, though 🙂 . Enjoy, comments always welcome, and Washington, DC never stops being beautiful.

You can read more about the headquarters and the AAMC here: AAMC Dedicates New Headquarters, Learning Center for America’s Medical Schools and Teaching Hospitals – News Releases – Newsroom – AAMC

Just Read: From Patients to Providers: Changing the Culture in Medicine Toward Sexual and Gender Minorities

This is a perspective piece accompanying the study that I wrote about yesterday.

In some areas, like academic medicine, the medical profession continues to change at a pace slower than the world around it:

we posit that SGM* trainees and health professionals face discrimination in medicine and that these environments are ultimately connected to the inequities that our patients encounter when accessing care.

*The term SGM is inclusive of all nonheterosexual and noncisgender individuals, including, but not limited to, those who identify as lesbian, gay, bisexual, transgender (LGBT), queer, or questioning.

In a recent survey of LGBT physicians, 10% reported being denied referrals from and 15% being harassed by heterosexual colleagues. In addition, 22% reported being socially ostracized, and 65% heard derogatory comments about LGBT individuals in the workplace.

There are really good examples given, in list form, of leading edge practices at academic institution. This list should not fit on just one page, considering the number of academic institutions that exist.

Very few academic medical centers are rated best places to work for SGM people

Very few academic medical centers and medical schools are rated in the Human Rights Campaign Corporate Equality Index.

Human Rights Campaign, Corporate Equality Index, 2015 - How to be a best place to work.
Human Rights Campaign, Corporate Equality Index, 2015 – How to be a best place to work.

For example, University of California, San Diego, which is cited in the perspective piece for having single-occupancy bathrooms, does not have a CEI ranking (you can view their lack of one here).

To see the difference of what it means to score 100%, look at Kaiser Permanente’s.

It takes a commitment to do this, one which our organization has had since the inception of the index. (see: Just Read: A perfect score for Kaiser Permanente on the Human Rights Campaign Corporate Equality Index again for 2015)

As it says in the piece:

Medicine should be at the vanguard of change and serve as a respite from societal discrimination, not as a haven for its perpetuation. Although these shortcomings likely are not universal, they remain inappropriately common.

There’s a rich opportunity for collaboration here, because there are parts of the medical profession that are leading change outside and inside of academia. Thanks again to the authors and the Academic Medicine for the reminder that the journey isn’t over.

Just Read: Sexual and Gender Minority Identity Disclosure: “In the Closet” in Medical School

Medical schools should have zero tolerance for mistreatment or discrimination against SGM* students on the basis of their identity.

*The term SGM is inclusive of all nonheterosexual and noncisgender individuals, including, but not limited to, those who identify as lesbian, gay, bisexual, transgender (LGBT), queer, or questioning

Except when it’s tolerated, even in this decade.

When I published the story of my colleague, Social Innovator: Louise “Lu” Casa, MSN, CRNP, CTTS on identity, partnership, teamwork, who came out at the beginning of her career, in 1983 (!), I cited data from 1994 about acceptance of sexual minority students (gender minorities weren’t even on the radar then). Lu noticed these articles and sent them my way.

The first is a survey of US and Canadian MD and DO students in 2009-2010 (well before the fall of “Don’t Ask, Don’t Tell” and marriage inequality in most US States) performed by researchers (medical students!) at Stanford School of Medicine (@MattMansh).

Even though the response rate is low (5.7%) it is “the largest study collecting information on sexual identity, gender identity, and identity disclosure among medical students in the United States and Canada. Respondents came from the majority of eligible medical schools, all class years, and represented a diverse set of sexual and gender identities.”

Because the goal is zero events, a description of the experience of even a subset students is going to be useful. Because the percentage of students identifying as SGM (Sexual and Gender Minority) is high (15.7%, compare to 6.9% for the general population), I assume there’s some selection bias/oversampling, which again is useful in this case.

I almost can’t believe the numbers aren’t better:

The majority (67.5%) of sexual minority respondents were “out” about their sexual identity in medical school. However, this percentage represents only a moderate increase from a previous estimate (44%) from roughly two decades ago.

The numbers are lower for gender minority students with 34.3 % reporting being out.


In interacting with residents and attendings, it is clear through general conversation and offhand comments that LGBT is unfamiliar and, at best, a joke. (26-year-old, third-year, gay, white, male, U.S. MD student)

On my surgery rotation, we saw a male- to-female transgender patient who had “do-it-yourself ” silicone breast implants which had become infected. He [sic] was treated like a freak by the residents and attendings behind closed doors, joking at his [sic] expense. (25-year-old, third-year, lesbian, white, female, U.S. MD student)

These types of environments are damaging to the profession and to our patients, and as the paper mentions, amplified in the student role, where there’s less power to challenge norms.

As recounted in my own educational experience (see: Doctors know : It Gets Better ), and more recently on stage with a patient, when I was in training all I could do is observe and remember for a future time, which I did, and that time is now 🙂 .

We shouldn’t make more people wait to be agents of change. Fortunately we don’t have to, because our generation can change is changing everything.

The importance is underscored, because since the it gets better post, the anti-LGBT comments from professional colleagues have come back, this time directed against people who are transgender, and their allies (including me). Sometimes our profession doesn’t learn from past failures.

Having a role in ending sexual and gender minority bias, without fear, is (a) as wonderful as I thought it was going to be, (b) physicians and our health professional colleagues are uniquely capable of leading the change, AND our patients and society want more leaders to experience it with me, sooner in their careers. It’s what they expect + why we came to medicine.

Don’t be afraid, be who you are. In order to be fulfilled you have to be yourself – Louse “Lu” Casa, MSN, CRNP, CTTS