An unmet need for paediatric LGBTQ training

Background: Lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) youth have increased health risks, exacerbated by discrimination and lack of provider training. Currently, no graduate medical education requirements address the need for LGBTQ health training, particularly for paediatric providers. We aimed to perform a needs assessment of provider knowledge, comfort and awareness of community resources regarding LGBTQ youth. Methods: We administered two anonymous surveys from May to October 2017. The first survey of 73 residents assessed awareness of community resources and comfort providing referrals. A second survey of 110 trainees and faculty assessed comfort and knowledge regarding paediatric LGBTQ health. Results: In the first survey of residents regarding community resources (n = 30, 41% response rate), most did not know where to refer LGBTQ patients for mental health care (67%), transgender care (73%), support groups (87%), emergency shelters (86%) or family resources (87%). Ninety-seven per cent would refer to the social worker. In the second survey of trainees and faculty (n = 78, 71% response rate), most had little or no knowledge regarding pre-exposure prophylaxis (60%), post-exposure prophylaxis (54%), strategies for coming out (68%), homelessness/environmental risks (59%), gender dysphoria (63%), puberty blockade (77%), hormonal (78%) and surgical (81%) transitioning, domestic violence (58%), EMR logistics (89%) and community resources (80%). Only 33% felt very comfortable eliciting a history about sexual orientation, 13% about gender identity and 14% about sexual practices. Conclusion: There is a clear need and desire for dedicated paediatric LGBTQ health training in graduate medical education. Residents and faculty need resources and training to better care for LGBTQ youth.