For the past few years, Louisville has been knocking down barriers to equal rights for the LGBT community and finding rewards and recognition for the efforts, ranking 11th among large metropolitan cities in residents who identify as LGBT, receiving high scores in the recent Human Rights Campaign’s Municipal Equality Index and even being named a top gay travel destination.

The trend is great, but there remains a gap in what some call the biggest issue facing the LGBT community in our city, region and state—access to inclusive, affirmative and competent healthcare.

The topic of LGBT healthcare is one of great concern in the medical field with studies showing that LGBT patients “face a common set of challenges within the healthcare system. These challenges range from access to healthcare coverage and culturally competent care to state and federal policies that reinforce social stigma, marginalization, or discrimination.”

Seeking to tackle that “last frontier” in LGBT issues is the University of Louisville Medical School, which has established eQuality, a partnership program with the Association of American Medical Colleges to train future physicians in providing care for LGBT patients that’s of the same quality as the care traditionally given to other patients.    

Great Support for a Great Need

The need is great, according to Dr. Amy Holthouser, Associate Dean for Medical Education at University of Louisville School of Medicine.

“Unfortunately, if you talk to any member of the LGBT community, you’ll find that one of the things that makes healthcare outcomes worse for people in the community is physician attitudes,” says Holthouser. “It’s the last place that someone should have to expect that they will be judged, rejected, focused on inappropriately or have any kind of traumatic interactions, but it’s very frequent. Generally speaking, you cannot find a member of the LGBT community that doesn’t have some sort of horror story to share about their interactions with doctors.”

Fortunately for Holthouser and the others working on eQuality, support for the program has come from many sources.

She credits the University of Louisville for the fundamental values that really allowed the eQuality project to get off the ground.

“Our school has benefitted from the increase awareness and advocacy for the LGBT community that has occurred throughout the University as an organization,” she says, adding that the University has made great strides in recent years in becoming a national leader for inclusive education for the LGBT community. In fact, it was named one of the top 25 LGBTQ-friendly campuses across the nation by Campus Pride in 2015.

The backbone of eQuality came from above when the AAMC released a manuscript of competencies aimed at bettering the education of doctors in treating the LGBT community.

That backing turned out to be the final piece of a puzzle that UofL had already been attempting to solve on its own.

“At the same time that students, faculty and staff interest was ramping up around improving our practice and our education, we also now had a top-down direction and new information and guidance about what that would look like, what are the important things to teach and what are the best way to teach it,” says Holthouser.

In 2014 Stacie Steinbock, Director of the LGBT Center Satellite Office on the Health Sciences Campus, brokered a meeting with the AAMC to discuss how UofL could help to craft a national model of teaching based on the competencies.

From the Classroom to the Community

The result is a full-scale remodel of teaching that reaches not only the classroom, but the community as well.

Components of the teaching model are as diverse as the population they attempt to care for. Most importantly, the existing curriculum for the Medical School was updated to tackle issues specific to the LGBT community.

“There are places where we updated the curriculum just in small ways to be inclusive and affirmative, and there are places where we saw that this is a real gap and thought we do need to add an hour,” says Holthouser.

Considered the most crucial aspect of this program’s success, however, is the integration of the community-at-large in the education initiatives.

Community members are invited to take part in a series of educational lunch meetings arranged by Steinbock through the eQuality project. A transgender health forum held this summer as part of the project saw input from students as well as community members and providers. From that forum, conversations have begun to form to establish a LGBT-specific clinic at UofL Medical School.

Louisville’s embrace of this program and its goals contribute a major factor of the initial success, according to project team members.

“It’s really been so exciting to see how this project is moving forward being both by and for the community as well as UofL being an excellent partner in that,” says Steinbock.

“This effort would not be nearly as successful if Louisville had not been enthusiastic about this opportunity,” adds Holthouser.  “It goes back to the advocacy and investment that the University has made in creating UofL as a LGBT-friendly place and as an ally. That’s a big part of how and why Louisville feels so good about this.”

Infinite Outcomes

One outcome of this project is immediately clear—students who seek an inclusive learning environment or who want their education to include affirmative training see UofL Medical School rise to the top of their school wish lists.

Students like Virginia Ferguson, a first year student who chose UofL for medical school after graduating with an undergraduate degree from The Ohio State University.

“I was at Louisville for a second look, and they started talking about the eQuality Project. The way they talked about it, and the people who supported it definitely made me feel like Louisville was a place that I could be successful regardless of my sexual orientation,” says Ferguson.

Ferguson, who wants to specialize in pediatrics, believes the training she will receive in the eQuality project will position her as a leader in her field.

“Louisville puts a good emphasis on lifelong learning, and our students will be able to teach other physicians as well,” she explains. “With Louisville being the first in the nation, I can help other doctors and other physicians in the future.”

Positioning the city as a leader in LGBT healthcare and attracting new students and healthcare professionals is just the tip of an ever-growing iceberg of potential benefits to this program, say program leaders.

“It can be such a boon to our community to say we are really doing this and doing it well,” says Steinbock. “And we want to make sure that, in order to send that message, people get the training they need, which is probably one of the most important things that this project is providing at this point.”