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 Flickr.com)

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 Flickr.com)

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.

And:

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

I said yes: AAMC Advisory Committee on Sexual Orientation, Gender Identity and Sex Development

The Interprofessional Education Ad Hoc Committee, to be exact
The Interprofessional Education Ad Hoc Committee, to be exact

I don’t work in academic medicine and I am not in the medical education system. However, I am one of its products, and the people I serve are its beneficiaries. Sometimes with fantastic results, other times, in the case of people who are transgender or gender non-conforming, results that are underwhelming.

Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development (Axis)(@AAMCToday)

Axis serves as a nationally and internationally recognized resource to support the efforts of academic medicine and the biomedical sciences at the local, regional, national, and international levels to promote the health of people who are lesbian, gay, bisexual, transgender (LGBT), gender nonconforming (GNC), and/or born with differences in sex development (DSD).

Our profession needs to change to keep up with the world that it exists around it. In many of my interactions, it’s not keeping up. I’ve encountered this before, when I was in training (▶ The Embrace of Failure TED EYTAN and REGINA HOLLIDAY TEDxAlvaPark 2012 – YouTube). This time we don’t have to stand idly by.

Luckily I’m not the only person and not the only part of health care that recognizes this:

Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born with DSD: A Resource for Medical Educators

I’m saying yes because of these priorities for the Axis Committee:

Improve the Ability of Practicing Physicians to Care for LGBT, GNC, and DSD Patient Populations

and

Forge Partnerships to Advance the Health of LGBT, GNC, and DSD Patient Populations

Where I work (@KPTotalHealth @KPShare), we do have expertise in these areas, my colleagues are changing the profession, and we want to share and learn with people across the biomedical sciences who are doing fantastic work also. And why shouldn’t we, it’s what our patients expect.

I think:

Just a few little things … and a ton of allies 🙂

Community Clinician Roundtable - Care of Transgender Patients 50258

MedEdPortal – Call for Submissions – to improve LGBT / DSD curricula in Medical Schools

When I was at the AAMC Joint Meeting of the … (see: Dialogue about #hcsm at the 2013 #AAMCJtMtg – Academic Medicine and Social Media | Ted Eytan, MD), I was of course talking about the future, and that includes a more inclusive medical school curriculum around issues related to people who are LGBT (including, not excluding, T) and Disorders of Sex-Development-affected.

I learned there about the Lesbian, Gay, Bisexual, Transgender and/or Disorders of Sex Development-affected Patient Care Project, which is being hosted at Association of American Medical Colleges’ MedEdPortal (@MedEdPortal) , which I also learned about:

MedEdPORTAL Publications promotes educational scholarship and collaboration by facilitating the open exchange of peer-reviewed health education teaching and assessment resources.

The project, which states the obvious, in the most polite, understated way:

Strong evidence demonstrates that LGBT people and people who are affected by DSD are disadvantaged by our current healthcare system.

Is announcing a call for submissions to improve upon this situation, starting with medical schools:

The Association of American Medical Colleges announces a call for submissions for competency-based educational and assessment resources, as well as effective (or best) practices, policies and guidelines, that address the health of lesbian, gay, bisexual, and/or transgender (LGBT) individuals, gender nonconforming and/or discordant children and adolescents, and those affected by disorders of sex development (DSD).

The are some resources/educational programs on the portal already. On the positive, it’s nice to be able to have a look into what medical schools might be teaching students in this field.  Also on the positive, there are some resources already on the portal, and some of them are inclusive of trans and gender identity issues. On the not-as-positive side, there isn’t that much for this population, some of it is focused on LGB only. That’s why the call for submissions is timely and filling an important need. Here’s a video of the presentation made about the call for submissions.

I’m not a medical school educator, or a trans person, however I think both should be involved in improving the knowledge of our doctors-to-be about listening, and being there for all of the patients/communities/societies they will serve in their lifetime.

I’m thinking back to the LGBT curriculum I experienced in medical school – it was mixed. The actual teaching about taking sexual histories was modern for its time. The actual real-life discussion of sexual minorities was a disaster (which I later fixed when I was a lecturer at University of Washington – if you don’t like the news, go out and make your own). There was no discussion whatsoever about transgender health issues or DSD-affected people. The thing is that these experiences, good or bad, can affect a physician for their entire career, not to mention the reinforcement that may unintentionally happen on hospital wards / in the medical offices where they rotate (see a description of my wards experience in this writeup).

There’s more background on this AAMC (@AAMCtoday) initiative below. The intent is to make sure it gets better, and gets better inclusively for trans and DSD-affected people. Even if you are not a curriculum developer, search around and feel free to add comments to any of the 3-4 pieces that are currently up there, it will help medical school faculty help save lives.

Lesbian, Gay, Bisexual, Transgender and/or Disorders of Sex Development-affected Patient Care Project – Diversity Portfolios – Diversity and Inclusion – Initiatives – AAMC

I’m glad I found this work by the AAMC. There are more and more examples of health professionals understanding the huge gap in transgender health and why it is time for a change. I’m not imagining things, and I sense that I am just scratching the surface. That’s good, there’s a lot of depth to cover :).

Dialogue about #hcsm at the 2013 #AAMCJtMtg – Academic Medicine and Social Media

Ask us about @wingofzock, or about the future in general. #hcsm breakout at the 2013 AAMC Joint Meeting, Phoenix, Arizona, USA.

Jennifer Salopek, Bryan Vartabedian, Vinny Arora, Ted Eytan, Sarah Sonies – View on Flickr

Luckily, there’s a comprehensive Storify record of the dialogue I had the opportunity to co-lead yesterday. Bryan Vartabedian, MD (@doctor_V), Vinny Arora, MD (@futuredocs), and I (@tedeytan) were at the 2013 Association of American Colleges (@AAMCtoday) joint gathering of…. essentially the leaders of our academic medicine institutions.

A few things

  • Vinny, Bryan, and I are so aligned in our drive to communicate and promote communication, even if we are not in the same environment or passionate about the same thing at the same time. That to me is a good model for the medical profession. We are part of the same community, the same society, dedicated to making lives better.
  • Really great audience and hosting by the WingofZock team (@wingofzock), specifically Jennifer Salopek (@jsalopek) and Sarah Sonies (@ssonies), and a few special guests, most notably my mother (producer of not one but two University of Arizona-trained physicians) and Anita Samarth (@anitasamarth) – it takes a community!
  • Sponsorship courtesy of Joanne Conroy, MD (@joanneconroymd), who is the Chief Health Care Officer of AAMC. Transforming an organization requires sponsorship, and it shows great foresight to bring this conversation to this group.

Like most humans, I love to learn. I enjoyed learning from these leaders.

Slides and Storify below. Thanks for following along.

@Futuredocs & @Doctor_V" target="_blank">Social Media / Academic Medicine – co-presentation with @Futuredocs & @Doctor_V from Ted Eytan

Do physicians tweet about environmental stewardship in health care?

More goodness from the MDigitalLife study courtesy of Greg Matthews (@chimoose). I asked him (very nicely) if he would take a look at the database he’s got of 3,200 verified physicians’ 2.1 million tweets for frequencies of environmental / sustainability topics, and here’s what he found.

For comparison, the same study found around 11,000+ tweets about diabetes. The hashtag I personally use to talk about this topic, #greenHC is well represented in my tweets – and I’m the only person who uses it :).

So the answer is, “not very much,” yet. This analysis was done in prep for the discussion I’m helping lead at the AAMC Joint Meeting of the… (see this blog post : Crowdsource request: Help our dialogue with leaders in academic medicine regarding social media | Ted Eytan, MD ).

Why? Because I want to show that health professionals come to social media with a mission to educate and improve health.

This is an outlet for them/us where we can advance ideas that may be far ahead of their time, kind of like a testing ground to see where the rest of our profession is.

Seeing an IV bag that’s PVC-Free and DEHP-Free for the first time may not excite you like it excites me. But it will. Someday, when you understand how they help save lives.

Simulation Training Center for Total Health 20502Thinking Green: Safer for humans of all ages

So, the data confirms I’m ahead of my time. It’s okay, @futuredocs , @Doctor_V and I are coming to the #AAMCJtMtg from the future, to share how we use this medium to participate and thrive. Don’t forget to tweet us!

Greg manually reviewed some of the terms because they are overly inclusive, for a more accurate result in this dataset. That’s dedication to helping our profession and our patients. Thank you!

To read more about the MDigitalLife study, click this link.