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Decolonising: Queering the curriculum

Why is your medical curriculum straight? It’s a legacy of colonisation. Here Amy Wilson and Professor Bridgette Bewick explore the impact of the ‘straightness’ of medical education on students and patients. They identify opportunities to change and challenge us to ‘queer the curriculum’ to improve health inequalities and student outcomes.

Queering the curriculum: transforming medical education to tackle health inequalities and support student success

There are over one and a half million LGBTQIA+ people in the United Kingdom (House of Commons 2023). Yet, medical students feel underprepared to treat LGBTQIA+ patients (Barber et al., 2023). We need health professionals who understand LGBTQIA+ people to stop healthcare’s widespread discrimination of the LGBTQIA+ community (Stonewall 2016).

LGBTQIA+ patients’ lack of trust in healthcare systems is rooted in systemic injustices that contribute to poorer health outcomes for the community (Morrison et al., 2024).  Health professionals’ clinical understanding of LGBTQIA+ people comes from negative portrayals and stereotypical representation in healthcare education (BMA 2024). Many LGBTQIA+ patients decide not to access care. Where people do access treatment they often find their voices ignored and face lengthy delays. These challenges are exacerbated for transgender people and queer people of colour.

How can we address these challenges? How do we move towards equitable representation for LGBTQIA+ people in the medical curriculum? How do we move away from stereotypical presentations of LGBTQIA+ people and train health professionals to support better health outcomes for queer people? How can we develop a medical curriculum that includes authentic and joyful representation of the LGBTQIA+ community?

Tokenistic and sporadic representation of LGBTQIA+ people in the medical curriculum must end. Providing LGBTQIA+ curriculum content as an optional add on perpetuates the harmful notion that addressing the health needs of the LGBTQIA+ community is optional. To provide equitable healthcare for LGBTQIA+ people, doctors must know about the community and their health needs.

So what might this look like in practice? Queering the curriculum requires educators to look beyond the stereotypical portrayals. Consider sexual health teaching that relies on stereotyped men who have sex with men without any consideration of the health needs of queer women. Do we teach about LGBTQI+ sex workers and transgender people who are subjected to increased risk of sexual violence with compassion? Is our teaching cognisant of the social injustices faced by these highly stigmatised groups?

Where are the spaces for students to engage critically with discourses around sex and gender and the impact these have on patient outcomes? Do we allow students opportunity to consider the historical injustices on which health inequalities are built. Is the relatively poor mental health of the LGBTQIA+ community contextualised within the historical mistreatment of queer people within psychiatry? Does teaching on families and reproductive health include diverse family structures? Do we teach about “non-traditional” pregnancy and birth? Does our geriatrics content acknowledge LGBTQIA+  elderly? How is the LGTQIA+ community represented in end-of-life teaching?

So why does this matter? At best current representation of LGBTQIA+ people means many medical students are underprepared to meet the needs of LGBTQIA+ patients. At worst students graduate with further intrenched prejudicial views of the LGBTQIA+ community and contribute to a healthcare environment that is toxic for LGBTQIA+ staff and patients.

We need an integrated and comprehensive approach. Critical examination of curriculum content is needed to create space for authentic and diverse representation of the LGBTQIA+ community. We need an intersectional approach that acknowledges the multiplicity of advantages and disadvantages impacting on people’s health. This includes consideration of LGBTQIA+ people’s gender, ethnicity or race, disability, age, and financial status. The medical curriculum should enable students to learn from gender diverse and LGBTQIA+ patients. Collaborating with queer people facilitates authenticity across the curriculum. Centering the voices of queer patients’ voices through first-hand accounts or simulated patients improves cultural competence and give students practical understanding. It ensures representation is competency-based and not purely theoretical.  It is important that medical students have opportunity to develop their communication skills and history taking with LGBTQIA+ patients. Assessing these skills ensures students are competent and confident.

Queering a medical curriculum that has historically marginalized the experiences of LGBTQIA+ people takes effort and requires faculty staff to work collaboratively with students, clinicians and patients being careful not to overburden those who are also members of the LGBTQIA+ community. Better representation of LGBTQIA+ people in the medical curriculum can make a difference to students and to patients. Culturally competent doctors can reverse inequalities faced by LGBTQIA+ people. All clinical educators share responsibility for developing cultural competence teaching, diversifying the medical curriculum  and thereby creating more equitable outcomes for medical students and for the patients they go on to serve.

About the authors

Amy Wilson (she/they) is a fourth-year medical student at the University of Leeds. She undertook a Student Research Experience Placement over the summer of 2024 that aimed to create resources to support medical educators in queering the curriculum.

Professor Bridgette Bewick (she/her) is a British and Aotearoa New Zealand citizen. From a working-class background, she was the first in her family to achieve the New Zealand equivalent of GCSE and study at university. She’s an LGTBQIA+ role model at the University of Leeds and is passionate about increasing bivisiblity in higher education. Bridgette holds a portfolio of scholarship and research dedicated to advancing our understanding of developing and implementing compassionate pedagogies, facilitating belonging, supporting wellbeing and reducing mental distress and injustice within higher education.

About the project

This Student Research Experience Placement supports the School of Medicine to deliver on their commitment to the GLADD Charter which requires schools of medicine to include more joyful representation of LGBTQIA+ in the medical curriculum. This blog is informed by the two scoping reviews Amy undertook as part of her placement.  The project aims to identify important avenues for future research, to publish recommendations for designing LGBTQIA+ representation into the medical curriculum, and curates resources for clinical education.  Please contact Bridgette (b.m.bewick@leeds.ac.uk) if you would like to learn more about how Amy’s placement is supporting the School of Medicine at the University of Leeds in queering the medical curriculum.

References

  1. House of Commons Library (2023). “2021 Census: What do we know about the LGBT+ Population?” UK Parliament Website. [Online]. [Accessed 01/08/2024]. Available from: https://commonslibrary.parliament.uk/2021-census-what-do-we-know-about-the-lgbt-population
  2. Barber, A., Flach, A., Bonnington, J., & Pattinson, E. M. (2023). “LGBTQ+ Healthcare Teaching in UK Medical Schools:  An Investigation into Medical Students’ Understanding and Preparedness for Practice”. Journal of Medical Education and Curricular Development 10
  3. Morrison, T., et al. (2023). "Exploring the intersectionality of racism and sexual/gender minority health: A call to action for health-system pharmacists." American Journal of Health-System Pharmacy 81(8): 326-333.
  4. BMA (2024). “LGBTQ+ equality in medicine”. BMA Website. [Online]. [Accessed 20/06/2024]. Available from: https://www.bma.org.uk/advice-and-support/equality-and-diversity-guidance/lgbtplus-equality-in-medicine/lgbtqplus-equality-in-medicine.
  5. Stonewall (2016). “LGBTQ+ Facts and Figures”. Stonewall Website. [Online]. [Accessed 20/06/2024]. Available from: https://www.stonewall.org.uk/lgbtq-facts-and-figures.