To the Editor,


Sexual and gender minority (SGM) individuals consistently state that their health care needs are not being adequately met.1 When training future health care providers, it is important that knowledge acquisition and application occurs early in training to establish baseline familiarity through which further information can be built upon. Nevertheless, a study of North American obstetric anesthesia fellowships found that only 19% of fellowship programs have formal curricular content about caring for patients who identify as SGM.2 Our study objective was to perform a national environmental scan of anesthesia residency programs and the current curricular content focused on SGM health.

Institutional research ethics board approval was obtained on 22 May 2020. The need for written, formal consent was waived. We contacted program administrators to confirm the number of residents and approximate number of faculty involved in their residency training committee or equivalent. Based on these responses, we estimated the respective estimated maximum number of responses from each group to be 632 in the resident cohort and 269 in the faculty cohort.

We employed a modified Delphi method to create two survey instruments, one for faculty and one for residents (Electronic Supplementary Material [ESM] eAppendix 1). The expert panel consisted of twelve individuals that included physicians interested in SGM health, anesthesiologists who identify as SGM, and individuals involved in postgraduate curricular development. We created a draft survey instrument and employed a two-phase iterative process, incorporating expert feedback until consensus was reached. An additional eight people completed pilot testing of the final survey instruments.

Program administrators were asked to distribute the cover letter and survey link to potential participants via e-mail. Reminders were sent at two and seven weeks after initial survey distribution. Survey data were collected anonymously and exported via Research Electronic Data Capture (REDCap, Vanderbilt University, TN, USA). More detailed methodology is described in ESM eAppendix 2. We analyzed responses using descriptive statistics. We did not perform comparative statistics because of the low number of responses in each cell and to avoid identifying participants.

The resident response rate was 25% (159/632) and the faculty response rate was 18% (48/269). Only 4% (2/48) of faculty and 8% (13/159) of residents reported SGM curricular content in their program. Survey results are summarized in the Table and in detail in the ESM eAppendices 3–5.

Table Selected responses from faculty and resident surveys regarding presence of SGM curricular content
Full size table

Despite resident respondents stating they felt comfortable providing competent care to the SGM population, only a minority felt that their residency program prepared them to provide this care. Additionally, few faculty felt that their program adequately prepares residents to provide care for SGM patients. Top barriers to implementation of SGM curricular content identified by both faculty and resident respondents were “perceived lack of need” and “lack of staff interest.” We speculate there is an unstated belief that this topic is not a priority for curricular development during residency.

Structural and medical traumatization is more likely to affect marginalized populations, which includes SGM populations.1 Providing high-quality care to SGM populations becomes more complex when a patient has comorbidities; it is not enough to apply our current evidence without acknowledging the complex social, systemic, societal, and historical factors that affect SGM patients’ experience.1,3 It is imperative that systemic and structural changes be implemented to avoid cisheteronormativity that can significantly impact access to and delivery of high-quality health care.

Expediting SGM content into postgraduate training may not necessarily improve care for the SGM population, but is a tangible step in the right direction.4 How best to provide competent care to the SGM population before curricula is widely implemented into postgraduate training programs starts with understanding what the SGM community requires of the medical system.4,5

Limitations of this study include potential recall bias, low response rate (particularly from faculty), and inability to confirm equal representation from all programs. As a result, it was challenging to precisely determine overall SGM curricular content prevalence.

Our survey results suggest that formal curricular content explicitly addressing the needs of SGM individuals is lacking in most Canadian anesthesia residency training programs, yet most residents and faculty indicated their interest in having more SGM curricular content. Input from SGM patients is imperative to give further direction for curricular development. We advocate a call to action for development of specific entrustable professional activities and accreditation standards. Representation of such content in the Royal College of Physicians of Canada anesthesiology examinations would be an important step forward. Finally, this study has generated additional questions and directions for further research, which should be prioritized going forward.