Training Beyond the Binary: LGBTQ Cultural Competency in Emergency Medicine Residency

LGBTQ individuals comprise ~5% of the U.S. population and experience persistent health disparities. Many avoid emergency care due to discrimination and mistrust, while EM physicians report limited training in LGBTQ health. Integrating structured LGBTQ curricula into residency may enhance clinical knowledge, awareness of systemic oppression, and ally behaviors.

Emergency medicine residents and attendings at a single academic institution voluntarily completed LGBTQ-focused ally and implicit bias training. The validated Ally Identity Measure (AIM) assessed pre- and post-intervention self-ratings in knowledge/skills, oppression awareness, and openness. Participants completed pre-testing, a Harvard Implicit Association Test, a two-hour AIM-guided educational session, and post-testing. Pre- and post-scores were compared using the Wilcoxon Signed Rank Test.

Responses from 31 participants were recorded, 29 met inclusion criteria of answering both pre and post-intervention questions. Following the intervention, the greatest improvement occurred in knowledge, followed by openness and oppression awareness. Mean signed ranks were highest for knowledge (125.31), compared with openness (34.90) and oppression (28.88). Knowledge gains were strongest in awareness of available resources for LGBTQ patients and families (175.5, p <0.01). The largest openness change reflected comfort with being perceived as LGBTQ when acting as an ally (55.5, p <0.005). Oppression awareness improved most in recognizing barriers faced by sexual minority groups (40.5, p < 0.002).

AIM-guided LGBTQ education for emergency medicine residents and attendings was associated with improved knowledge, openness, and oppression awareness, with the greatest gains in knowledge. This MedEd intervention is feasible, reproducible, and adaptable across EM programs, supporting structured LGBTQ curricula as a scalable strategy to advance inclusive.