Lesbian, Gay, Bisexual, and Transgender Health: Obstetrician-Gynecologists' Training, Attitudes, Knowledge, and Practice

Background: Deficits in provider training may contribute to disparities impacting lesbian, gay, bisexual, transgender, and gender nonconforming (LGB-TGNC) individuals.

Methods: We sent an anonymous online survey to randomly selected members of the American Congress of Obstetricians and Gynecologists and stratified responses by the history of training. We used logistic regression to predict impact of previous training on provider comfort with LGB-TGNC patients, and secondary outcomes, including provider practices, knowledge, and attitudes.

Results: Two hundred twenty-eight of 428 (53.3%) surveys were completed. Of the 169 providers currently practicing gynecology, 72 respondents (42.6%) reported previous training in LGB-TGNC health. Those who self-identified or had a close contact identifying as LGB-TGNC were more likely to report previous training (68.1% vs. 49.5%, p = 0.02). When adjusting for demographic differences, providers reporting previous training were not more likely to be comfortable taking care of transgender/gender-nonconforming patients (aOR 1.8, 95% CI 0.95-3.40). They were more likely to report practice changes such as eliciting sexual orientation (aOR 2.15, 95% CI 1.08-4.28) and gender identity (aOR 3.02, 95% CI 1.07-8.52). Training was not independently associated with differences in provider knowledge (aOR 1.33, 95% CI 0.68-2.58) or likelihood of providing independent medical or surgical care for gender affirmation (aOR 1.64, 95% CI 0.78-3.45).

Conclusions: Less than half of board-certified obstetrician-gynecologists reported training in LGB-TGNC health, with evidence of a familiarity effect in who seeks training and provides care that accounts for differences in attitudes, knowledge, and practices. Training efforts to advance LGB-TGNC health must address bias and comfort in addition to clinical competencies.