By: Elke Zschaebitz, DNP, APRN, FNP-BC (she/her)
Each year, I invite storytellers to talk about their lived experiences as patients, or parents of gender-diverse patients to the medical students. It’s not a lot of time that medical school or other programs teach about the care of this marginalized population, but it’s a powerful session and they learn a lot after a couple of hours. Or they engage and become more interested in learning more. In a virtual setting for this session, they keep their cameras on. They listen intently and ask questions. And their evaluations reflect the empathy and the surprise of the stories these storytellers give of their most moving and profound experiences within the healthcare systems and broad society.
One of our storytellers, a person assigned female at birth who is a transmasculine individual talks about his healthcare experiences in context to his recurrent UTIs. During his last episode he recalled his experience traveling during a holiday and was in pain and had a high fever by the time he was seen by a provider in an urgent care facility. He was told after disclosing that he was transgender that “we don’t care for patients like you” and that he “should fly back to his home state” three hours away. By the time he flew back that day, drove two hours to his home city he was quickly admitted, he was in full sepsis and almost died.
To unpack stories that these students hear the faculty from various institutions hold virtual interprofessional sessions called VIPE and include recorded storytellers like these to discuss them in small IPE groups so that students may process and learn together after a learning session. We could give the students some case studies to include this information, however when it comes from the mouth of an authentic individual—it creates an impact on the students. They stop scrolling and multi-tasking online, half-listening. They listen and describe being impacted by the reality that the data describes.
Lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual (LGBTQIA+) individuals experience pervasive health disparities rooted in systemic bias, stigma, and discrimination. Nearly one-third of transgender respondents in a survey reported delaying or avoiding medical care due to fear of mistreatment, and a quarter reported outright refusal of care by a provider. LGBTQIA+ youth face disproportionate rates of
depression, suicidality, and homelessness, while others bear a disproportionate burden of HIV. These disparities are not inevitable—they are produced and sustained by bias within health systems, and they demand a trained, advocacy-oriented health workforce to address them.
Research confirms that discrimination in health care settings is associated with reduced trust, non-disclosure of sexual orientation and gender identity, non-adherence to treatment, and worse outcomes. Critically, bias is not confined to any single profession—physicians, nurses, pharmacists, social workers, and public health professionals can all harbor attitudes that compromise care. This reality demands an interprofessional response.
Yet LGBTQIA+ health education remains critically inadequate across health science programs. A landmark survey of U.S. and Canadian medical schools found the median instructional time devoted to LGBT content was only five hours across the entire curriculum. Where content does appear, it tends to be narrowly biomedical—focusing on HIV pharmacology or hormone therapy—while neglecting cultural humility, inclusive history-taking, trauma-informed communication, and the structural advocacy role of health professionals. These are not merely academic oversights; they translate directly into patient harm.
Focused attention on historically vulnerable patients provides the ideal framework for addressing these gaps even in short bursts of academic time. When students learn and process together, they develop a more complete understanding of how care is delivered across the continuum—and how each profession contributes to health equity or note gaps in care. The Interprofessional Education Collaborative (IPEC, 2016) identifies values and ethics as a core IPE competency; advocacy for vulnerable populations must be made explicit within that domain. Students should emerge from their training prepared to use affirming language, take inclusive sexual health histories, provide or refer for gender-affirming care, and challenge discriminatory institutional practices.
Effective sessions like these should be grounded in cultural humility—a commitment to ongoing self-reflection rather than static competence—and an intersectional lens that recognizes the compounding disadvantages faced by LGBTQIA+ individuals and other populations who navigate challenges to include other social factors such poverty, disability and include implicit and explicit bias education. Pedagogically, this means implicit bias exercises, standardized patient simulations (like LGBTQIA+ scenarios for example), and trauma-informed communication training. Institutional commitment is equally essential to establish explicit competency
standards for this content.
Our work is rooted in life and death circumstances with an opportunity to help impact potentially harmful patient encounters. We can use our privilege in our roles to help student navigate through challenges in their future practice and roles.
References
- The VIPE program: https://www.virtual-ipe.org
Gonzales, G., & Henning-Smith, C. (2017). Barriers to care among transgender and gender nonconforming adults. The Milbank Quarterly, 95(4), 726–748. - The Trevor Project. (2022). 2022 National Survey on LGBTQ Youth Mental Health. The Trevor Project.
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