Quick facts

• Year: 2020

  Country: United States

  Institution: University of Chicago

  Learners: First-year medical students (pre-qualifying)

  Aims: The aim of the intervention was to help students see how different parts of a person’s identity, such as race, ethnicity, sexual orientation and gender identity, come together to shape their experiences in health care.

Why was the education intervention developed?

The intervention was introduced to address a critical gap in medical education: the lack of training that helps learners understand how racialised inequities intersect with sexual orientation and gender identity to shape health outcomes. In the local curriculum only five hours are devoted to SGM health and intersectionality was largely absent, despite strong evidence that SGM people of colour experience compounded discrimination arising from racism, homophobia, and transphobia.

Prior research from the Your Voice! Your Health! project highlighted that SGM racial and ethnic minority patients encounter both racism within SGM communities and homophobia/transphobia within racial or ethnic communities, further deepening mistrust in the health system. This provided an educational and equity gap that prompted this intervention.

What was involved in the education intervention?

The intervention was a 2.5-hour teaching session for first-year medical students as part of a required course. Teaching included a 30-minute lecture on SGM health disparities, intersectionality, minority stress, and shared decision-making, followed by a 1.5-hour facilitated discussion, in which students viewed a video clip and then engaged in guided group dialogue exploring how intersecting identities affected care, communication, and trust.

The videos were developed using narratives from participants in a research project called ‘Your Voice! Your Health!’ Five sexual and gender minority (SGM) racial and ethnic minority patients participants were invited to be re-interviewed and filmed.  Participants were also then invited to participate with the students in a Q&A. Emotional safety and respectful dialogue were prioritised. Clear ground rules were established, recognising that discussions of race, gender and sexuality can be sensitive, especially for racially minoritised learners. The diverse identities and positionalities of the teaching team also helped model inclusive and reflective practice.

How was the education intervention evaluated? 

The intervention was evaluated using pre- and post-session electronic surveys.

The evaluation used questions to assess changes in students’ self-reported:

• confidence in defining key concepts (intersectionality, minority stress, sex/gender terminology)

• ability to identify barriers faced by SGM patients

• confidence communicating with SGM patients of colour (including asking about identities)

• overall satisfaction with the session

What was the impact of the education intervention?

Eighty-nine students enrolled in the required Health Care Disparities: Equity and Advocacy course. 82 completed the presurvey; 83 completed the postsurvey

The intervention had a clear and positive impact on student learning, confidence and attitudes toward caring for sexual and gender minority (SGM) patients of color.  Students showed significant increases in confidence across all measured areas including greater confidence in defining intersectionality rising from 57% (pre) to 96% (post) session.  Similar improvements were noted in understanding minority stress and in identifying ways providers can help LGBTQ patients overcome care barriers.  There was overwhelmingly positive satisfaction with the session.

Qualitative reflections suggest that students felt better prepared for future clinical interactions and more aware of how intersecting identities influence health care experiences. Learners reflected on the impact of biases, microaggressions and assumptions, and several described feeling more motivated to practise inclusive, patient-centred care.

Key learnings

• Students valued hearing directly from SGM people of colour and found that the videos made issues of racism, homophobia and transphobia more concrete and relatable.

  The facilitated, reflective discussions helped learners explore their assumptions, practise empathic listening and the presence of a near-peer student facilitator and a community member strengthened engagement and made the session feel more approachable.

Challenges

• Running the session in a large class of around 90 students made it difficult for all learners to speak or engage deeply. Discussions could have gone further, but time constraints limited the depth of exploration after each video

  Facilitating conversations about race, gender and sexuality can also be emotionally charged, requiring careful management to protect both racially minoritised and SGM learners.

Recommendations

• Future iterations could include small-group discussion, role-play, a patient panel, shorter lecture content, and more nuanced conversation around each video. Expanding to multiple sessions would allow deeper learning, practical skills development and more robust assessment