Recommendations for Enhancing the Climate for LGBT Students and Employees in Health Professional Schools

A GLMA White Paper

Recommended citation: Snowdon, S. (2013) Recommendations for Enhancing the Climate for LGBT Students and Employees in Health Professional Schools: A GLMA White Paper. Washington, DC: GLMA.

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ii ACKNOWLEDGEMENTS GLMA extends very special appreciation to Shane Snowdon for her authorship of this paper, as well as her longstanding work addressing the needs of LGBT people in academic settings. GLMA would also like to extend appreciation to former GLMA intern Shannon O’Hern, MD, former GLMA staff member James Beaudreau, MPA, and Carl Streed, Jr., MD, for their significant contributions to the bibliography. Thanks also to Jesse Joad, MD, MS, GLMA Vice President for Education, Hector Vargas, JD, GLMA’s Executive Director, and Emily Kane-Lee, MA, GLMA’s Education & Communications Manager and project manager for this paper. GLMA also acknowledges Pat Dunn, JD, MSW, for her contributions to this project. Finally, we gratefully acknowledge Pfizer, Inc., for its generous support of GLMA’s work on health profession education reform and this resulting paper.

About GLMA GLMA: Health Professionals Advancing LGBT Equality, which was founded in 1981, is the world’s oldest and largest association of lesbian, gay, bisexual and transgender (LGBT)—and ally—healthcare professionals. GLMA’s mission is to ensure equality in healthcare for LGBT individuals and healthcare providers. GLMA achieves its goals by using healthcare expertise in professional education, public policy work, patient education and referrals and the promotion of research. GLMA represents the interests of thousands of LGBT healthcare professionals as well as millions of LGBT patients across the country.

iii FOREWORD It is with great pleasure that GLMA: The recommendations are accompanied Health Professionals Advancing LGBT by a bibliography of LGBT health resources Equality provides this unique white paper, compiled by Shannon O’Hern, former GLMA “Recommendations for Enhancing the intern, James Beaudreau, former Education Climate for LGBT Students & Employees in and Policy Director at GLMA, and Carl Streed, Health Professional Schools.” The paper is the Jr., a GLMA board member and internal culmination of a project begun in 2010 by medicine resident at Johns Hopkins Bayview GLMA, which convened an advisory group Medical Center. The bibliography includes under the leadership of Shane Snowdon, then references on a wide range of LGBT-related Director of the Center for LGBT Health & health topics, including LGBT health risks and Equity at the University of California San concerns, LGBT inclusion in health professions Francisco (UCSF). education, and issues affecting lesbians/ The initial intent of the project was to WSW, gay men/MSM, bisexuals, transgender provide resources and information to medical individuals, LGBT youth, LGBT elders and schools in response to recommendations that LGBT families. were developed by the Association of American It is important to note that equality Medical Colleges (AAMC) in 2007, but not for LGBT people is expanding rapidly widely implemented. Since the inception of nationwide—in fact, major changes occurred the project, its scope has changed to include as this document was being prepared. Be sure all health professional schools and to focus to check the footnotes provided for the latest on climate, since curriculum and healthcare information about LGBT non-discrimination recommendations are now available elsewhere, laws in your area, federal treatment of same-sex often with input from GLMA. married couples and similar topics. In addition, In this paper, primary author Shane national organizations like the AAMC will be Snowdon, with assistance from advisory providing new resources in coming months to group members, has provided comprehensive ensure equity and inclusion for LGBT students, recommendations to health professional schools staff and faculty, including surveys, model on how to improve their climate for LGBT policies, and opportunities for learning and students, faculty and staff. In her 13 years at discussion. UCSF, she was often the only person nationally We are confident that these climate visiting health professional schools, listening to recommendations, together with the issues around climate and meeting with LGBT accompanying bibliography, will be useful for all students, faculty and administrators to suggest involved in health professional education, which solutions. These recommendations distill her will play a critical role in achieving equity for expertise from 13 years of work with UCSF and LGBT patients and health professionals alike. other schools.

iv Recommendations for Enhancing the Climate for LGBT Students & Employees in Health Professional Schools

OVERVIEW from discrimination, and give particular or is well along, you should find much of value attention to the concerns of transgender people, in these recommendations. Not all can be It can be very tempting for health who have become much more visible in health implemented immediately, but each one you professional schools to focus primarily on professional schools and healthcare generally. embrace will be a gift to all of your students and curriculum in their desire to attend to LGBT The recommendations also discuss how employees. needs and concerns. This is understandable, institutional diversity initiatives can enhance since curriculum enhancement is critical if LGBT equity and inclusion, sending LGBT LGBT people are to receive equitable, inclusive, students and employees the message that they INSTITUTIONAL EQUITY knowledgeable and sensitive healthcare. It are seen and supported. is every bit as vital, however, for schools to Include “sexual orientation” and “gender These broad institutional recommendations ensure that their climate is equitable, inclusive, identity and expression” in your school’s are supplemented by detailed information supportive and welcoming for LGBT students nondiscrimination policy. about best practices in specific activity areas. and employees. Climate improvement not only LGBT protection in a non-discrimination To ensure that your school mirrors the general maximizes the success of curriculum initiatives policy is considered foundational to LGBT population, counters entry barriers to LGBT but is also tremendously important in its own equity and inclusion, and sends a powerful people in the health professions and enjoys right. positive message to LGBT students and the benefits of LGBT student and employee Needless to say, LGBT climate improvement employees. It is also strongly backed by diversity, admissions and recruitment initiatives is enormously helpful to LGBT students and the American public, about 75% of whom are described in detail. Recognizing how much employees, assuring them of fair and unbiased believe that LGBT discrimination should be targeted and inclusive programs, together treatment and enabling them to be their full, prohibited.1 with mentoring and networking initiatives, authentic selves, just like their colleagues. Your school may not be located in a state contribute to the success of students and Students and employees should never fear that that bans discrimination on the basis of sexual employees from groups that have historically if they are simply themselves, if they mention orientation (protecting lesbian, gay and bisexual faced discrimination, the recommendations the important people and events in their lives, people) and/or gender identity and expression also discuss the kinds of offerings that are most they will face bias ranging from joking and (protecting transgender and other gender- useful for LGBT campus community members. hostile comments to ostracism, harassment non-conforming people).2 You are still free, The recommendations also explain and career obstacles. And LGBT students and however, to create an institutional prohibition the importance of offering LGBT-related employees, like members of other groups that with institutional consequences, a move that information, resources and training to your have historically faced discrimination, deeply conveys a strong commitment to LGBT equity school as a whole. This vital educational work appreciate support in navigating the particular and inclusion. Schools located in states that do deepens general campus awareness of LGBT challenges they face as LGBT people. ban LGBT discrimination are strongly urged to needs and concerns, so that work toward equity But LGBT climate improvement isn’t mirror that ban in their own policies, in order and inclusion is well understood and supported. valuable only to LGBT students and employees. to affirm their concern for their LGBT students Among the many recommendations is that It benefits everyone associated with a health recognition be offered to individuals who have school, helping all become more comfortable, made significant contributions to LGBT equity 1. Since at least 2001, 75% or more of the American public, in sensitive and knowledgeable vis-à-vis LGBT and inclusion, whether or not they are LGBT major national polls, has indicated support for laws prohibiting colleagues and patients (and other LGBT people discrimination on the basis of sexual orientation. See, for themselves. in their lives). The recommendations below do example, Inside-OUT: A Report on the Experiences of Lesbians, Finally, your school is urged to consider Gays and Bisexuals in America and the Public’s Views on Issues much more than enable students and employees and Policies Related to Sexual Orientation, The Kaiser Family creating an LGBT office, designating an LGBT to steer clear of biased or discriminatory Foundation, 2001, http://kaiserfamilyfoundation.files.wordpress. point-person or appointing a high-level LGBT com/2013/01/national-surveys-on-experiences-of-lesbians-gays- behavior. They also allow students and advisory committee. By doing so, you’ll ensure and-bisexuals-and-the-public-s-views-related-to-sexual-orientation. employees to get to know LGBT people as pdf. Polling with respect to protection vis-à-vis gender identity and that these recommendations are as useful their full, authentic selves—a critical factor in expression has been more limited, but a recent national poll that as possible, since they can easily be used to found 75% support for sexual orientation protection found 73% extending full acceptance to LGBT colleagues support for gender identity/expression protection: http://www. structure and guide the work of a dedicated and providing optimal care to LGBT patients. americanprogress.org/issues/lgbt/news/2011/06/02/9716/polls- office, point-person or advisory group. They can show-huge-public-support-for-gay-and-transgender-workplace- The recommendations address the entire also be used by a diversity office or officer to protections/.) spectrum of climate issues experienced by frame LGBT work. LGBT students and employees. They discuss 2. More information about LGBT discrimination laws and policies in Whether your school is just beginning its your state is available at these websites: the cornerstones of institutional equity, which http://www.ngltf.org/reports_and_research/nondiscrimination_ journey toward LGBT equity and inclusion, protect LGBT campus community members laws http://www.hrc.org/resources/entry/maps-of-state-laws-policies

1 and employees. federal government now treats same-sex and tax burden by “grossing up” the salaries of • Make sure that the policy is readily available different-sex spouses identically in many realms, affected employees to offset the tax they pay on to students and employees online, in trafficked including taxation, immigration, financial aid, the employer share of health coverage.7 areas and in recruitment and orientation Family Medical Leave and more.4 It’s also important that schools not overlook materials; also ensure that key staff and faculty Schools are also strongly encouraged to treat dental, vision, life, accidental death and are familiar with the policy. unmarried same-sex partners identically to dismemberment and similar health-related • Make sure that all protected by the policy spouses, as described below, even in states where benefits when equalizing insurance coverage. In know how to raise a question or lodge a same-sex couples may legally marry. In order addition, schools can choose to extend COBRA complaint in connection with it. to enhance recruitment and retention, many coverage to same-sex partners on the same basis • Ensure that those who monitor and schools extend spousal benefits to domestic as spouses.8 enforce your school’s policy are well-versed in partners who can legally marry. LGBT terminology and concerns, particularly Offer health coverage to spouses and same- TIP: Make sure benefits administrators at your confidentiality. Staff and faculty charged with sex domestic partners on an equal basis. school are prepared to talk knowledgeably and handling discrimination complaints often have comfortably with LGBT students, staff and faculty not had LGBT-related training, since there is no Health professional schools are, of course, particularly aware of the critical importance about health and other benefits. If you have not federal law prohibiting LGBT discrimination. yet equalized benefits, a sensitive and sympathetic of adequate health insurance. Coverage for (See discussion of training below.) explanation of the outlook for equalization is much domestic partners (when offered to spouses) is • Review LGBT-related complaints regularly appreciated, as opposed to a terse “Only family widely viewed as a key element in recruitment, to assure that responses have been adequate, to members are eligible.” spot trends and to take preventive action. retention and morale, explaining why 62% of the Fortune 500 (and many colleges and • If your school has a “mistreatment,” Ensure that your school’s health coverage does universities) now offer partner coverage. A “civility” or similar policy in addition to a not exclude transgender care. wealth of resources is available for schools non-discrimination policy, make sure that A growing number of institutions9 are taking seeking to explore or add this coverage, it is LGBT-inclusive in its call for respectful action to ensure that their health policies cover including information about utilization and treatment of all community members. transgender care, e.g., health services provided implementation of this low-cost, high-need both in connection with gender transitions and benefit.5 in relation to a transgender person’s assigned TIP: The current legal trend is for courts and In equalizing health coverage for spouses and sex at birth. Many policies currently exclude administrative agencies to interpret prohibitions domestic partners, it’s important to note that actual and perceived transgender-related care, of “gender” or “sex” discrimination as also a school’s monetary contribution to coverage forcing covered transgender individuals to pay banning discrimination related to gender for a domestic partner (and any children of the identity or expression. (For example, in April out of pocket for--or do without--medically domestic partner who are not tax dependents 2012 the federal Equal Employment Opportunity necessary services. The AMA and other of the covered employee) is considered income Commission ruled that Title VII of the Civil Rights health organizations have called for an end to the covered employee under federal law and Act protects transgender and other non-gender- to this practice and many insurers now offer in most states.6 This means that the employer conforming employees from discrimination.3) But transgender coverage on request, utilizing the contribution to the coverage is reported on it is strongly recommended that schools spell out Standards of Care developed by the World the employee’s W-2 as regular taxable income, that discrimination related to gender identity and Professional Association for Transgender Health effectively reducing that employee’s salary and expression is forbidden, in order to send a powerful (WPATH). This coverage is extremely helpful to creating inequity: employer contributions to message that it will not be tolerated. transgender students and employees and signals coverage of a spouse and spouse’s children are a strong, proactive commitment to LGBT never federally taxed. A growing number of Ensure that your school treats married same- equity and inclusion.10 sex spouses identically to different-sex employers are choosing to offset this inequitable spouses. Your school should make no distinction 7. The HRC Foundation provides information about grossing up: 4. For detailed, up-to-date information about federal http://www.hrc.org/resources/entry/domestic-partner-benefits- between same-sex and different-sex spouses. In implementation of the DOMA ruling, see: http://www.lambdalegal. grossing-up-to-offset-imputed-income-tax particular, appropriate staff members should org/publications/after-doma 8. The Society for Human Resource Management (SHRM) be aware of the federal responses to the June 5. For example, extensive data and resources related to employee provides information about COBRA coverage for same-sex 2013 ruling by the U.S. Supreme Court that partner coverage are available from the Human Rights Campaign partners: http://www.shrm.org/TemplatesTools/hrqa/pages/ struck down a key section of the Defense of (HRC) Corporate Equality Index: http://www.hrc.org/resources/ doesfederalcobraapplytosamesexdomesticpartners.aspx entry/establishing-domestic-partner-benefits Marriage Act (DOMA). For example, the 9. For a complete list of educational institutions providing 6. Some states do not tax benefits provided to members of state- transgender health coverage, see Campus Pride: http://www. registered domestic partnerships or civil unions. On the other hand, campuspride.org/tpc/ some states that do not recognize same-sex marriages tax benefits 3. Macy v. Holder, April 2012. See the ruling and a provided to same-sex spouses even though those benefits are 10. In-depth information about transgender health coverage discussion of case by the Transgender Law Center at: http:// now exempt from federal taxation because of the Supreme Court’s is available from HRC: http://www.hrc.org/resources/entry/ transgenderlawcenter.org/archives/635. DOMA ruling. transgender-inclusive-benefits-for-employees-and-dependents

2 Allow employees to take family leave to care to them in seeking good placements for youth TRANSGENDER SERVICES & SUPPORT for seriously ill same-sex partners, just as for in need.12 In the last decade or so, transgender students care of spouses. Support for parenting should also extend to and employees have become much more Your school should have policies that employees who act as parents for a child with numerous and visible in health professional provide employees the same leave for care of a whom they may not have a legal relationship. schools.14 Some want to work in transgender seriously ill same-sex domestic partner as the This aids employees who co-parent a same- health, others choose different focus areas; some leave provided for care of a spouse.11 Likewise, sex partner’s biological or legal child, but are are out, some are not. Some identify with a sex if your school permits leave to be used to care prohibited by state law from establishing a legal or gender other than the one entered on their for ill family members, make sure that same- relationship with that child. birth certificate and have transitioned or plan sex domestic partners and their children are to transition to the sex or gender with which considered “family” for this purpose. If your school offers housing to students, staff and/or faculty, ensure that it is open to LGBT they identify; non-gender-conforming others Ensure that retirement plans treat spouses and people on the same basis as others. express their sense of their gender in ways that same-sex domestic partners equally. “Family” housing, for example, should be seem different from the gender expressions that Some institutions’ retirement plans offer available to same-sex partners on the same basis prevail in our society. survivor and/or continuation benefits to as different-sex couples. In addition, a number It is absolutely critical that schools welcome spouses on a more favorable basis than same-sex of schools have created policies to ensure that and thoughtfully prepare for transgender (and domestic partners. These plans can be changed transgender students, staff and faculty are other gender-non-conforming) students and to extend the same treatment to partners sensitively and equitably accommodated in employees. Preparation can do much to avoid as to spouses—a change that is particularly campus housing; some additionally offer LGBT- situations in which transgender people are met meaningful during the retirement years. themed and/or gender-neutral housing.13 with surprise, ignorance, bias, discrimination and even outright hostility and mockery. Extend all institutional benefits—discounts, Check the language of institutional policies Health professional schools can and should be memberships, insurance, loans, fee waivers and procedures for LGBT inclusion. places where transgender people experience an and more--to spouses and same-sex domestic One way to ensure that all benefits have been equitable, knowledgeable and warm welcome. partners on an equal basis. equalized is to search for references to “spouse” As mentioned above, adding “gender Most institutions provide benefits like these and “family” in academic personnel manuals, identity and expression” to your school’s non- to students, staff, faculty and their families. It as well as student and employee handbooks, discrimination policy is a foundational best is both a financial and emotional blow when a then add “domestic partner” and/or an LGBT- practice, as is transgender health coverage. same-sex-partnered employee’s family members inclusive definition of “family.” This ensures Much more can and should be done, however, are refused benefits because they are not that equalized benefits are spelled out in school to ensure equity and inclusion for transgender considered “family.” Schools should make sure materials and all policies and benefits offered to students, faculty and staff, bearing in mind that all benefits, large and small, extended to spouses and families are LGBT-inclusive. these two simple rules: the gender identity that “family members” are fully available to partners a person chooses should always be honored and partners’ children. TIP: It also sends a very welcoming message to and how a person expresses their sense of their acknowledge LGBT and other “non-traditional” gender never justifies discrimination. TIP: After equalizing benefits like these, be sure to families on student and employee forms. For Provide specialized transgender training to update online and print information about them and example, references to “spouse” can be changed to institutional leaders and all relevant staff. notify administering staff. All too often, staff learn “spouse/partner/significant other,” and references that they have mistakenly denied a benefit after full to “mother” and “father” can be changed to Staff who have received training around price has been paid or a deadline has been missed. “parent/guardian.” transgender concerns will be well-positioned to develop and implement services and support for Ensure that your school’s parenting policies transgender students and employees. They can and benefits acknowledge and support those also model sensitive language and behavior and who become parents through adoption, serve as resources for others, both transgender fostering and surrogacy. and not. Key training audiences include—but LGBT people are among the many students, are certainly not limited to—deans, chairs, staff and faculty who deeply appreciate registrars, admissions, police and security, broadened support for parenting. Although counselors and other advisers, student health 12. A discussion of LGBT-friendly employer adoption policies is centers, housing administrators and faculty there have been—and still exist in some areas— available from HRC: http://www.hrc.org/resources/entry/adoption- barriers for LGBT people who wish to foster or benefit-programs-lgbt-considerations-for-employers opinion leaders. For more information about agency outreach to LGBT people, see: adopt, many agencies now do special outreach http://www.hrc.org/resources/entry/all-children-all-families-about- the-initiative 14. One example is the creation of the UCSF Center of Excellence for Transgender Health, which provides a wealth of information: 11. The HRC Foundation provides information on family leave and 13. For a discussion of LGBT-themed and gender-neutral housing transhealth.ucsf.edu. See also this transgender overview from FMLA coverage: http://www.hrc.org/resources/entry/family-and- in one university system (the University of California), see: http:// Campus Pride: http://www.campuspride.org/resources/trans- medical-leave-act-fmla-equivalent-benefit-for-lgbt-workers www.uclgbtia.org/themehousing.html advocacy/

3 TIP: Training may be available from an LGBT center those supporting them, with these and other As more and more U.S. institutions express on or near your campus (or in your community) or questions.17 strong support for LGBT equity and inclusion, from an individual trainer. In-person training is it is important that health professional schools Designate a point-person for transgender- strongly recommended, but a number of websites not remain silent, implying either that they 15 related needs. also offer helpful information. don’t perceive or don’t care about LGBT This point-person, who should be publicly concerns. It is critical that health schools include Develop key policies and procedures to identified, can provide skilled ongoing LGBT people as they work to ensure that they support transitioning students, staff and support to transgender students, staff and reflect the U.S. population and welcome groups faculty. faculty, whether they plan to transition, are who have historically faced discrimination It is essential that your school have policies transitioning or transitioned in the past. She or and who bring enriching experiences and and procedures in place to assist students, staff he can also provide assistance to staff working perspectives. and faculty who choose to transition from with transgender individuals—but it’s important the sex or gender on their birth certificate to to note that the identification of a point-person Ensure that diversity statements are inclusive another one. It is much harder to develop and should be a supplement to broad staff training, of LGBT people. implement these in the midst of a student or not a substitute for it. It means a great deal to LGBT students, employee’s transition process.16 staff and faculty to be mentioned when schools Identify single-stall restrooms restricted to one announce their commitment to diversity in • Create a process for records to show a new gender and re-sign them as unisex. gender (and new name, if any), before a legal general and specific groups in particular. All too All too often, transgender or gender-non- gender (or name) change has occurred. It is often, diversity materials leave out LGBT people conforming people experience resistance when important that transitioning students and when expressing support and concern for groups they use the bathroom. Health professional employees be addressed as the proper gender that have long faced discrimination, welcoming schools should never deny students, staff and by the proper name as soon as they wish, them to the school and indicating pride in their or faculty the right to use the bathroom of rather than being forced to wait for a legal presence. When LGBT students and employees their gender, and should provide transgender gender or name change. In particular, processes are not mentioned, they wonder—sometimes, education if there is resistance to this non- should be created for them to receive email in sadly, with reason—whether their school discriminatory stance. their new name and to receive an ID in their appreciates their presence and is aware of and Transgender groups and others recommend new name and with an appropriate photo; this concerned about the challenges they face. replacing signs limiting single-stall restrooms ensures that, as they transition to a different to only one sex with signs indicating that When creating diversity advisory groups and/ gender, their email address and ID do not “out” these restrooms may be used by anyone, as or developing diversity plans and reports, them to everyone who emails and or sees them. is increasingly common in restaurants and include the perspectives, experiences and Many schools have created a simple form for other public accommodations. This change concerns of LGBT students, staff and faculty. changes in records, email and IDs. is welcomed not only by transgender people When a school charges staff, faculty • Create flexible guidelines for supporting seeking a bathroom where they will not meet or a specially constituted group with transitions. Student affairs and human resources resistance but also by people caring for children examining institutional diversity and making staff, in particular, should receive guidance or adults of another sex and people waiting in recommendations for improvement, it’s and training in supporting transitions. While long lines for the bathroom signed for their sex, important that LGBT concerns be explicitly the needs and preferences of transitioning hesitant to use a line-free single-stall restroom included in the charge, so they’re not overlooked individuals are paramount, they often request signed for another sex. or added only as an after-thought. Likewise, in and welcome assistance in thinking about how selecting those who will prepare diversity plans (and whether) to discuss their transition with or reports, it is essential to include people who classmates, roommates, colleagues and others. DIVERSITY INITIATIVES are well-versed in LGBT perspectives, needs and There are a number of excellent resources LGBT people applaud and are often heavily resources. designed to help transitioning individuals, and engaged in institutional diversity initiatives. So Allow LGBT students and employees to self- it can be painful and disturbing, when these identify on institutional surveys and forms. 15. An online search will reveal a host of transgender trainers efforts are not LGBT-inclusive, given ongoing It sends a very welcoming message to LGBT and other training options nationwide. For a map of campus LGBT bias and discrimination based on LGBT status. centers, visit the Consortium of Higher Education LGBT Resource students and employees when surveys and forms Professionals: http://www.lgbtcampus.org/lgbt-support-services- requesting demographic data on a voluntary, map confidential basis provide options for them For a list of the 200+ LGBT community centers in the country, visit 17. For example, see the extensive resources provided by the Centerlink: http://www.lgbtcenters.org/Centers/find-a-center.aspx National Center for Transgender Equality: to self-identify as LGBT, if they wish. By http://transequality.org/Resources/ modifying the “gender” question on surveys Also, the HRC Foundation provides employee resources that are 16. A helpful overview of transition concerns is available from HRC: often useful to students: and forms to be transgender-inclusive and also http://www.hrc.org/resources/entry/workplace-gender-transition- http://www.hrc.org/resources/entry/coming-out-in-the-workplace- adding a question about sexual identity, schools guidelines as-transgender

4 can readily gather useful LGBT data.18 Not all excellent opportunities for schools to show their a health professions career, while only 15% of LGBT students and employees will self-identify, commitment to equity and support for LGBT LGB-identified undergraduates said they aspired even when assured of confidentiality, but students, faculty and staff include: to a health career.20 No follow-up questions important information can still be gathered. • National Coming Out Day, October 11 were posed, but possible explanations for this Allowing LGBT self-identification also signals (celebrated since 1988; also the anniversary of significant difference (which might well be even other students and employees that your school college student Matthew Shepard’s murder in more marked in other areas of the country) includes and welcomes LGBT people and Wyoming in 1998) include: familiarizes them with a best practice in patient • LGBT History Month, October • Public resistance to LGBT people in the data collection and health research. In addition, • Transgender Day of Remembrance, health professions is not uncommon. In a schools that have allowed LGBT respondents November 20 (a commemoration of 2005 Gallup poll of the general public about to self-identify and have added LGBT-related transgender people who have died in hate their “attitudes toward homosexuality,” 19% questions on climate surveys have gained crimes that has been expanded into a day or said that lesbians and gay men should not be useful insights into areas where improvement is week of transgender awareness) permitted to be physicians.21 In another survey, needed. • National LGBT Health Awareness Week, 36% of respondents indicated that they would generally last week in March not knowingly see a lesbian or gay health 22 TIP: Dr. Randall Sell of Drexel University documents • Pride Month, usually June, but July, August professional. (Neither survey asked about on gaydata.org that adding a question about sexual or other months in some areas bisexual or transgender health professionals.) orientation does not significantly lessen survey While LGBT youth are unlikely to know of participation. In fact, questions about sexual TIP: Make sure that your diversity celebration is these specific surveys, they are likely to sense orientation were added to the National Health taking place in a venue that is safe and welcoming resistance to LGBT people in general in the Interview Survey in 201319 and are increasingly for LGBT students and employees. For example, a health professions. common in surveys on health and other topics gala shouldn’t be held in a location where same-sex • Considerable resourcefulness and resilience around the country. couples are likely to be looked at askance if they are required for many LGBT youth to negotiate dance together or where transgender people are their adolescent and college years. For example, When holding celebrations of diversity or likely to be confronted if they use their gender’s the process of deciding whether, when and how planning a calendar of diversity events, be bathroom. to come out to family, friends and other adults mindful of LGBT inclusion. and peers adds a daunting layer of complexity When your school plans a general diversity to the lives of LGBT youth as they juggle event, be sure that LGBT people, achievements ADMISSIONS academics and other commitments. And they and concerns are mentioned. It’s also a good may have to negotiate additional challenges: Needless to say, it is critical that LGBT idea to review invitations to make sure they as a group, LGBT youth have been shown to students, staff and faculty be welcomed into are LGBT-inclusive--for example, that they experience extraordinarily high rates of bullying, health professional schools and protected from mention “partners” as well as “spouses.” parental abuse, homelessness, depression, bias and discrimination in admissions and 23 In addition, like other groups that have alcohol use, substance use and more. All recruitment. Your school can do much to ensure faced discrimination, LGBT people have of these challenges can threaten the degree that LGBT people experience a level playing- particular points in the year when they take of academic success needed to be a strong field and as warm an invitation as all other pride in their accomplishments, commemorate candidate for the health professions. applicants. those who have been lost and invite others to • The limited availability of role models Sadly, LGBT student applicants can face join them in working toward equality. These may also influence LGBT students’ sense of particular challenges in making their way themselves as future health professionals. They to the health professions. Although there is may even hear LGBT health professionals not yet reliable data about the number of 18. A number of institutions have chosen to modify their gender mocked: for example, googling “gay dentist” question to offer the following options, inviting respondents to LGBT people in the general population, check all that apply: female, male, transgender (sometimes divided allowing a determination of whether they are into transgender MTF/transwoman and transgender FTM/transman) 20. Unpublished data, 2010 University of California Undergraduate and other (inviting respondents to specify). Another approach underrepresented among health professional Experience Survey. Available from the Office of the President, is the two-step question recommended by the UCSF Center of students, there are certainly indications of the University of California. Excellence for Transgender Health: http://transhealth.ucsf.edu/ trans?page=lib-data-collection. A number of institutions have special difficulties they may experience. 21. Saad, Lydia, Gay Rights Attitudes a Mixed Bag, in Gallup, A. & also created a question regarding sexual identity, offering these For example, the 2010 University of Newport, F., eds., The Gallup Poll: Public Opinion 2005 (The Gallup options: bisexual, gay/lesbian, heterosexual/straight and other California Undergraduate Experience Survey Poll: 2005). (inviting respondents to specify). UCLA’s Williams Institute provides additional information at: asked UC undergraduates on all campuses about 22. Lee, Rita et al. The Dilemma of Disclosure: Patient Perspectives http://williamsinstitute.law.ucla.edu/research/census-lgbt- their career aspirations, while also allowing them on Gay and Lesbian Providers. J Gen Intern Med 23(2):142 7 demographics-studies/best-practices-for-asking-questions-about- sexual-orientation-on-surveys/ to self-identify as LGBT. Of the 61,800 students 23. Much has been written about the challenges faced and who responded, 24% of heterosexual-identified resilience shown by LGBT youth. For an overview, see Ryan, C. 19. See http://www.hhs.gov/news/press/2013pres/06/20130603a. respondents indicated they were interested in LGBT youth: Health concerns, services and care. Clinical Research html and Regulatory Affairs, 2003, 20(2): 137-158.

5 brings up multiple mocking references to “the staffing an LGBT table. Likewise, if student To achieve these purposes, admissions tooth fairy.” Anecdotally, very few LGBT health groups representing diversity are listed, add the training should include a careful, thorough students report being acquainted with or even LGBT group at your school, if there is one. discussion of the challenges faced by LGBT knowing of an LGBT health professional— If students are quoted praising the climate for people in the health professions and beyond, beyond a handful of LGBT characters on diverse groups, add a quote about your school’s not just information about your school’s medical TV shows. (See section below on LGBT inclusiveness. climate, curriculum and resources. This mentoring.) approach educates and engages attendees who If you list online or in print individual students • Undergraduate career advisers may not be may feel hesitant about LGBT inclusion in or student groups who can be contacted for prepared to answer LGBT students’ questions the health professions or even about LGBT information about your school, include a about whether and how to mention their LGBT equity, allowing them to air their concerns and person or organization who can provide LGBT- status, LGBT-related studies and/or LGBT co- receive thoughtful responses. If training doesn’t related insights. curricular activities on graduate applications. skillfully address underlying misconceptions, If your school lacks a student volunteer or • Targeted outreach to potential LGBT stereotypes and prejudices, interviewers may group, try to identify a faculty or staff member students in print or in person is rare. In fact, merely be left with information that they are who can describe your school’s LGBT climate LGBT students looking at a health professional reluctant to deliver or that they convey with and answer questions. But be sure they are school’s website or print materials may find discomfort or disapproval. Your school should well-prepared and sensitive to confidentiality no explicit mention of LGBT people, even in respond to persistent LGBT bias among concerns—a well-meaning but ill-prepared sections on diversity. This may lead, rightly or reviewers and interviewers just as it would contact can unintentionally undo your school’s wrongly, to the conclusion that the school is not to bias in relation to other groups that have LGBT outreach! LGBT-inclusive or -supportive. historically faced discrimination. Fortunately, all of these admissions challenges Make activities for information-seekers, With training, staff and interviewers can can be addressed by health professional schools applicants and admitted-but-undecided knowledgeably and comfortably answer by using the recommendations below to send a students LGBT-inclusive. questions on key topics like same-sex partner message of equity and inclusion to actual and LGBT students often mention how health coverage, transgender health benefits, potential LGBT applicants. meaningful it is to visit a potential school and LGBT inclusion in the curriculum, LGBT hear an LGBT person on a panel about student health research, LGBT student and faculty Develop targeted LGBT outreach materials, life or a presentation about LGBT-related groups and the LGBT climate on campus including text on your admissions website faculty research or a mention of innovative and locally (which can be readily ascertained and/or a brochure or one-pager for use LGBT curriculum. These inclusion efforts can through informal and/or focus group meetings in general or LGBT-oriented recruitment with LGBT students and employees). Without activities. seem small, but make a real difference. training, they run the risk of giving LGBT These materials can highlight the ways Recruit LGBT and LGBT-knowledgeable applicants an incomplete or misleading picture in which your school extends institutional students and employees to be admissions or even having their lack of preparation equity (see above), mention LGBT group(s) reviewers and interviewers. mistaken for individual or institutional bias in or initiatives, feature an LGBT-related image If your school tries to ensure that admissions relation to LGBT people. Anecdotes abound (like a rainbow flag-draped table at a student reviewers and interviewers include people of interviewers showing embarrassment or event), include a quote from LGBT students, from groups that have historically faced changing the subject when asked about LGBT reprint your school’s LGBT-inclusive non- discrimination (and people knowledgeable topics—and, conversely, of applicants being discrimination policy and showcase a statement about the challenges faced by these groups), impressed and touched by interviewers who, from leadership welcoming LGBT applicants. consider doing similar outreach to potential while not LGBT themselves, were clearly reviewers and interviewers who are LGBT and prepared for LGBT questions. Until all staff LGBT-knowledgeable. TIP: If you develop an LGBT brochure or one-pager, and interviewers are up to speed, it is wise to be sure to include it if you send applicants and Train admissions staff and interviewers to be publicly identify a particular person who can information-seekers packets of materials geared to knowledgeable and sensitive around LGBT answer LGBT applicants’ questions fully and other groups representing diversity. Likewise, if you concerns. empathetically, although this is not a substitute offer applicants and interested others a checklist Admissions training is essential for LGBT for broad training. of informational materials they can receive, include applicants to experience equity and inclusion your LGBT brochure or one-pager. Consider allowing LGBT applicants to identify and, more generally, for the health professions as such, if they wish, in the “demographics to represent the U.S. population in all its Make outreach and admissions materials that section” of admissions forms you generate or diversity. LGBT training significantly increases highlight diversity LGBT-inclusive. control. the likelihood that LGBT applicants will be If your materials feature images of students As discussed above, in relation to institutional reviewed--and interviewed--in an unbiased, from groups that have historically faced equity, schools gather useful data and send a knowledgeable way. It also reinforces the discrimination, consider adding a photo of powerful message of equity and inclusion when message that LGBT diversity is prized along an LGBT event poster, a student wearing a they give LGBT people the opportunity to self- with other forms of diversity. rainbow sticker on her ID badge or a group identify on forms and surveys. Not all LGBT 6 people will take advantage of this opportunity, perspectives, helping create an LGBT-friendly across and learn from difference.28 As so many but it has real statistical and symbolic meaning. and -knowledgeable climate and assisting with have observed over the years, workplace equity (Specific self-identification approaches are LGBT mentoring, curriculum development, isn’t “just” the right thing to do—it’s the smart discussed above in connection with institutional health research, patient care and more.26 thing to do. equity.) LGBT-related bias or discrimination in Provide LGBT training to human resources staff Institutions that offer LGBT self- recruitment may or may not resemble bias involved in recruitment and hiring. identification options in other contexts or discrimination vis-à-vis other groups. For sometimes hesitate to provide them in example, LGBT prejudice may be expressed It’s important that HR staff involved admissions materials, concerned that this may in a comment like one all too often made with hiring, compensation and benefits be make their school’s admissions process seem about candidates from other groups that have knowledgeable not only about your school’s more LGBT-inclusive and -equitable than it historically faced discrimination: “I just don’t LGBT-related policies, benefits and resources really is, and may engender biased responses think this person is a fit for us.” Whenever this but also about general LGBT workplace to self-identifying applicants. This possibility kind of remark is made, it’s important to follow concerns, particularly bias and discrimination. underscores the importance of training up, asking about the position-related reasons for This enables them to answer candidates’ admissions staff and interviewers, as described it and assessing their validity. questions, provide information to hiring above, to respond the same way to LGBT LGBT bias is not always expressed covertly, managers and search committee chairs, and admissions bias as to any other form of bias. however. People involved in search processes identify statements or practices that may If a school feels that self-identification options may feel comfortable expressing it openly and convey bias or constitute discrimination. As would put applicants at serious risk of rejection, may even consider it justifiable. They may also in the admissions realm, it can be helpful it should embark on admissions training as soon feel, in states or at schools where there is no to identify a point-person in HR to provide as possible, since applicants may well come prohibition against LGBT discrimination, that LGBT information and training, although all out regardless of whether forms specifically there will be no consequences if they downgrade key HR staff should be up to speed on LGBT allow LGBT self-identification, in the course a candidate for being or seeming LGBT. It’s not recruitment concerns. of describing their meaningful extra-curricular uncommon for LGBT candidates to engender If your school provides materials and/or activities and /or community service. Concern comments like, “I don’t think our students trainings to strengthen recruitment practices, about the consequences of self-identification would be comfortable with someone like this,” make them LGBT-inclusive. should lead to training, rather than indefinite “I don’t want one of these people sitting at our This alerts hiring faculty and managers to postponement of self-identification front desk,” or “The other staff will be upset if your school’s LGBT-related policies, benefits opportunities. they have to work with a person like this.” and resources. LGBT inclusion in trainings is Employment equity and diversity can a particular boon to faculty and staff involved TIP: Some colleges and universities now offer LGBT never be achieved, of course, if these kinds of with recruitment, who often appreciate the self-identification options in their undergraduate comments about prospective staff and faculty opportunity to discuss how to respond to a admissions materials,24 as do some law schools.25 from groups that have historically faced biased comment about an LGBT applicant or There has also been preliminary exploration of discrimination prevent them from being hired. to a question from a candidate about partner LGBT self-identification in the common medical When qualified candidates are turned away due health coverage or other aspects of school school application. to discomfort or other bias, a school not only climate. loses their skills and experience but also misses an opportunity to deepen mutual understanding Make your school’s “equal employment and respect in the workplace. opportunity employer” notifications LGBT- STAFF & FACULTY RECRUITMENT AND inclusive. RETENTION The presence of LGBT employees, far from engendering discomfort, often promotes If your school declares via advertising, job It is important to assure LGBT people that acceptance. Research has shown that being postings, human resources webpages or other they are welcome at your school and to afford acquainted with someone LGBT is the leading materials that it does not discriminate on them unbiased treatment in the employment factor in acceptance of LGBT people27—and the basis of specific identities, characteristics process. LGBT staff and faculty bring a wealth workplaces always benefit when employees reach or experiences, add “sexual orientation” and of benefits to health professional schools, “gender identity and expression” (or “LGBT allowing them to mirror the population as a status”) to the list. You may also want to add whole, offering them diverse experiences and “LGBT individuals” to taglines indicating that certain groups “are encouraged to apply.” 26. Extensive information about recruiting and supporting LGBT faculty in schools of medicine is available on pages 25-32 of the Needless to say, LGBT people respond very 24. For an overview of undergraduate self-identification initiatives, Association of American Medical Colleges (AAMC) Group on positively when they see these assurances. see this post by Shane Windmeyer of Campus Pride: Faculty Affairs (GFA) New Members Toolkit: http://www.huffingtonpost.com/shane-l-windmeyer/college- https://www.aamc.org/download/53522/data/gfatoolkit.pdf admission-forms-sexual-orientation_b_1346593.html

25. The Law School Admission Council has created webpages to 27. See, for example, Inside-OUT: A Report on the Experiences of 28. See Degrees of Equality, Human Rights Campaign, 2009: provide information and advice to LGBT applicants: http://www. Lesbians, Gays and Bisexuals in America and the Public’s Views on http://www.hrc.org/resources/entry/degrees-of-equality lsac.org/jd/diversity/lgbt-overview.asp Issues and Policies Related to Sexual Orientation, note 1 above. 7 Consider adding LGBT groups, meetings and meet their particular needs.30 These trainings MSM), as well as referrals to LGBT-sensitive publications to your recruitment efforts. often focus on strategies for supporting LGBT local health resources.32 If your school does targeted outreach students, but their content can also be helpful • Financial aid offices should gather to groups that have historically faced in resolving workplace challenges. Participants information about the treatment of students discrimination, consider adding LGBT people in trainings like these often receive a pin, sign who have a same-sex spouse or registered to the list. There are LGBT groups in most of or sticker that allows them to make known their partner, which may differ under state and the health professions, with listservs and regular support for LGBT equity and identifies them as federal laws. meetings, and GLMA is an interprofessional resources. While audiences like these are often very organization with a well-attended annual Health professional schools may want receptive to LGBT training, health professional conference.29 In addition, most major cities to make a point of arranging training that schools sometimes worry that others—for have an LGBT publication with employment incorporates information about LGBT health example, deans, department chairs and other advertising and there are several national challenges, which can draw additional attendees senior faculty—will not make themselves LGBT publications online and in print. If your and underscore the importance of creating a available for training. This may be a realistic recruitment staffing and budget are limited, welcoming and supportive climate for LGBT fear, yet it is still important to offer them the even one posting or ad can send a welcoming students, staff and faculty. Schools may also opportunity. A number of schools have been message to potential LGBT candidates. want to add content for particular internal pleasantly surprised when very busy faculty audiences: have nonetheless made a point of attending an TIP: For information about LGBT health professional • Counseling staff may want information and LGBT training, with explanations like, “I’ve groups, contact GLMA. To learn about LGBT resources to enhance their work around coming never gotten this information before,” “I have publications locally or nationally, just do an online out, depression, anxiety and other challenges an LGBT relative,” “I’ve seen the new reports on search—or ask an out LGBT student or employee experienced by LGBT people as a group. LGBT health,” or “I wanted to let other faculty for help. • International student services should gather and staff know that this really matters.” information about the treatment of same-sex partners and spouses under federal immigration TIP: Many LGBT trainers feel that the ideal 31 STAFF & FACULTY TRAINING and citizenship laws and regulations, and training approach combines personal storysharing, about how best to support students from factual information, a “no dumb questions” As already noted in the context of admissions countries that are hostile—often openly so—to period and an opportunity for participants to and recruitment, training is a must for a school LGBT people. brainstorm solutions to common LGBT workplace to live out its policies and intentions around • Campus police should discuss strategies for and classroom challenges. But balance among LGBT equity and inclusion. Interestingly, responding sensitively to situations involving these is critical. Training that consists solely or LGBT training often receives exceptionally LGBT students, staff and faculty (such as a call primarily of a speaker panel can leave participants positive evaluations from attendees, who often about “a man using the women’s bathroom” without information about your school’s resources, feel they have received “news they can use.” after a transgender woman has used the facility and panelists who are not carefully vetted may Because LGBT visibility was so low for so long reflecting her gender identity) and for generally offer very idiosyncratic perspectives that can be and because LGBT myths and stereotypes enhancing their relationship with LGBT misleading or confusing. On the other hand, a still abound, training that provides an LGBT community members. presentation that is dry and factual can fail to overview, lets participants ask questions • Student health center staff should ensure generate interest and empathy, leaving attendees they might hesitate to raise in other settings that they have up-to-date information about bored and resistant to further diversity training. and offers advice and resources for relating key topics (including transgender health Likewise, a “no dumb questions” period, while comfortably to LGBT classmates and colleagues needs, sexual health risk assessment, HIV/STI always advisable, needs to be skillfully facilitated is often highly valued. Although more extensive screening and treatment, hepatitis among men so that it doesn’t crowd out other aspects of training is ideal, a 90-minute session covering who have sex with men (MSM), pap smears for training or revolve around a particularly persistent these basics, if done well, can leave participants MSM and women sexually active with women questioner or obscure query. Brainstorming, too, with heightened empathy for LGBT people and and pre- and post-exposure prophylaxis for calls for careful guidance, lest attendees unfamiliar a personal commitment to ensuring that they with LGBT concerns come up with ideas that would experience equity and inclusion. actually create more problems than they would 30. These trainings are often available from a campus or community Fortunately, good LGBT training is widely LGBT center, as described in note 12 above. For examples of Safe solve. available. For example, many campus LGBT Zone training provided by schools of medicine, see these materials developed by the Boston University School of Medicine and the centers, along with other LGBT groups and Feinberg School of Medicine: individual trainers, offer “Safe Zone” and http://www.bumc.bu.edu/facdev-medicine/diversity/lgbt/safe- 32. A number of student health centers offer webpages designed “Ally” trainings that health professional schools space-training/ for LGBT students. For example, see: http://www.feinberg.northwestern.edu/diversity/programs/safe- http://studentaffairs.psu.edu/health/services/clinicalServices/ have found useful, particularly if tweaked to space/ lgbtHealth.shtml http://www.health.umd.edu/healthpromotion/lgbthealth http://www.princeton.edu/uhs/healthy-living/hot-topics/lgbt-at- 31. For example, see UCSF’s webpage for LGBT students: princeton/ 29. For more information about GLMA, visit www.glma.org. http://isso.ucsf.edu/resources/lgbt-resources

8 TARGETED PROGRAMS FOR LGBT coverage through their employer need to plan and depression to eating disorders and substance STUDENTS & EMPLOYEES for income tax on the employer’s contribution use. In designing these programs, it is important to the coverage. Limited legal relationship to ensure that presenters acknowledge and Programs targeted to the particular needs recognition also means that same-sex partners encompass LGBT people’s existence and of LGBT students, faculty and staff are need to make a point of preparing powers of experiences. LGBT students often report feeling tremendously helpful, both for the information attorney and advance directives and need to unseen when, for example, couples are always they provide and the supportive message they approach estate planning thoughtfully.34 In mentioned as heterosexual, parents are referred send. Not all LGBT people will have a need for addition, people planning a gender transition to only as mother-father pairs, the toll taken all programs, but all will appreciate the fact that need to do careful financial planning, given the by social stigma on emotional wellbeing is not they are offered. rarity of transgender health coverage, and need discussed and other challenges faced by LGBT LGBT people at your school can be surveyed reliable information about changing their name people are not acknowledged. formally or informally to pinpoint topics of and gender in various systems.35 And LGBT • Professional development workshops greatest interest. Topics like these typically rise people as a group need information about how and speakers. As mentioned above, targeted to the top of the list: to respond to discrimination they experience, programs to assist LGBT students with career • Navigating “outness” as a healthcare both in settings where it is prohibited and where challenges are critical. But it is also important professional. No topic is of greater interest it is not. to acknowledge LGBT concerns in general than this. One effective approach is to assemble offerings that help students decide where a panel of out faculty (and/or hospital- or to apply, craft their resumes, prepare for community-based professionals) to discuss their INCLUSIVE PROGRAMS interviews, cultivate referrals, learn managerial personal coming out process and their thoughts skills and maximize advancement opportunities. about being out to classmates/colleagues, When programs designed to help your All of these aspects of career development “authority figures,” and patients. The Q&A students negotiate particular challenges are hold particular challenges for LGBT people following is always lively and a reception or made LGBT-inclusive, they not only assist and while targeted activities allow them to meal after the panel provides opportunities for LGBT students but also acquaint other students be explored in depth, they should not be follow-up and informal discussion. with LGBT experiences. It means a lot to LGBT overlooked in broader programs. When other • Being out when applying for jobs or students when they see themselves and their students become acquainted with LGBT residencies. A workshop, dedicated speaker or concerns reflected in general programming. workplace challenges, they often report being panel on this specific outness topic is extremely Possibilities for this include: surprised by them and wanting to minimize useful. Students, in particular, appreciate • Welcome and orientation events. These them as their own careers unfold. guidance in thinking about whether, when, programs typically include a panel of students • Social activities. LGBT students sometimes where and how to come out in their professional talking about how they negotiated their first avoid (or shorten their stays at) school social journeys.33 While, of course, no one answer fits months of health professional school or a panel activities, even in this day and age. If not out, all people and all situations, it is very helpful of faculty offering advice about that critical they may worry that it will be difficult to to discuss possible approaches to being out in time. Inclusion of an out LGBT panelist navigate the event comfortably. And if out and personal essays, in responding to questions like can be very helpful in reassuring LGBT coupled, they may feel, unlike other students, “Tell us more about yourself,” in resumes/CVs newcomers that they are seen and supported. In that it would be unwise to bring their partner— and in interviews. It is important that a session addition, when orientation speakers welcome that dancing together or publicly showing like this also cover situations in which applicants specific groups—students who may have affection in any way might cause problems they are “automatically out,” for example, when they faced particular obstacles in getting to health don’t want to have to negotiate. Schools and are seeking a same-sex partner match or when professional school—it is very meaningful to student groups can ease dilemmas like these by their records are in a different name and/or LGBT students to be included and for others to holding social events in venues where same-sex gender. learn that they face some special challenges, as couples will be as comfortable as possible and • Legal and financial challenges. It’s very described above. by making publicity LGBT-inclusive both in helpful to provide information about the • Student life panels and workshops. More wording (“all partners welcomed”) and in any particular legal and financial challenges of being and more schools are offering programs to help images used. LGBT. For example, the patchwork of state students combine intensive academic work with and federal relationship recognition means that relationships and parenting duties and to help married and state-registered same-sex partners them cope with challenges ranging from anxiety face special tax filing requirements and that employees providing same-sex partner health 34. Lambda Legal has prepared a toolkit for same-sex partners: http://www.lambdalegal.org/publications/take-the-power

35. Information about gender and name changes in - and state 33. Ming Chan, MD, PhD, has authored a Guide for LGBT Medical systems is available from Lambda Legal: Students Applying for Residency which is useful across professions: http://www.lambdalegal.org/sites/default/files/publications/ http://lgbt.ucsf.edu/services_health.html#education downloads/trt_transgender_id.pdf

9 AWARENESS-BUILDING ACTIVITIES employees interested in being LGBT allies may TIP: There is a huge variety of LGBT films available want to review the online materials provided for sale and rent. Several national film distributors In addition to targeted and inclusive by the national project Straight for Equality in (like Frameline, affiliated with San Francisco’s programs like those described above, school- Healthcare.36 annual LGBT film festival) specialize in LGBT wide activities designed to enhance LGBT releases, lists of outstanding LGBT-related films awareness and acceptance do a great deal to can be found online and some non-profits produce TIP: Staff and faculty who are LGBT (or who ensure a welcoming environment. In fact, all of movies and displays specially designed to educate are LGBT-knowledgeable, thanks to training and these efforts reinforce and amplify each other the public about LGBT people and issues.39 to warm up a school’s LGBT climate. Many experience) may want to wear or display a pin, schools have had success with campus-wide post a card or sign or add a rainbow stripe to their • Holiday commemorations. As mentioned awareness-building activities like these: ID card to indicate that they re LGBT-supportive.37 in connection with inclusion in diversity • Prominent speaker on LGBT equality. This does much on an informal level to warm up the initiatives, LGBT people have designated A well-publicized event featuring a nationally climate for LGBT students and colleagues. particular points in the year to celebrate known speaker can be a great opportunity for accomplishments, honor those who have been students, staff and faculty to come together • “LGBT Health 101” talk. Many health lost and invite others to join the movement in a show of support for LGBT equity and professional schools have drawn sizeable toward equality. While, as noted, several such inclusion. The catalogues of both general audiences for presentations that describe the holidays occur during the traditional school and LGBT-focused speakers bureaus can be health disparities and inequities experienced year, National Coming Out Day, celebrated consulted to identify speakers who would by LGBT people, together with strategies for on October 11 annually, is a particularly draw a crowd at your school. For example, you addressing them. In fact, a number of schools good opportunity for institutional awareness- may want to bring a speaker who speaks to have scheduled follow-up talks on the topics building, since it falls relatively early in the intersectionality, as someone who is both LGBT covered, such as the particular health concerns typical year and revolves around LGBT and a member of another group that has faced of transgender people and LGBT youth, elders visibility. It can be an excellent time to present historic discrimination, or a speaker who has and parents. a speaker, workshop, film or exhibit, to reaffirm achieved a notable breakthrough, like the first • Timely topic talk. When an LGBT-related your school’s commitment to LGBT equity and out legislator in your state. incident has been in the news, there may be inclusion via a public statement or to announce particular interest in awareness-building events. the extension of equal benefits or a similar For example, after gay Rutgers student Tyler TIP: Consider speakers who may not be LGBT breakthrough. Clementi committed suicide, a number of themselves but nonetheless do much to enhance • LGBT self-identification initiatives. schools invited speakers to discuss topics like understanding of LGBT people and advance LGBT Just as allies may want to publicly show their the challenges faced by LGBT youth, depression equality. One example is Judy Shepard, mother of support for LGBT colleagues and students, as among LGBT people and how to support a Matthew Shepard, the gay University of Wyoming described above, LGBT students and employees friend or family member who is coming out. student who was murdered in 1998, who says she increasingly want to self-identify, further • Films and exhibits. Movies—whether was “an average homemaker” until her son’s death warming up the school climate for LGBT dramas, comedies or documentaries—can led her to become a powerful voice against hate people. Popular options include a rainbow stripe be very powerful ways to engender greater crimes of all kinds. on ID cards and rainbow caduceus pins.40 awareness and empathy vis-a-vis LGBT people. • “LGBT 101” talk. An event like this Students and employees who might not attend provides detailed information about LGBT events like those above will often show up for identities, nomenclature, demographics and a film. Likewise, an LGBT-related exhibit in more, answering the basic questions that people a high-traffic location can move and inform who are not LGBT often want and need to ask, people who wouldn’t necessarily set other time 38 but may hesitate to raise with an LGBT peer. aside to learn more about LGBT people. 39. Schools are encouraged to explore the many LGBT-related • “Ally” or “Safe Zone” training. This films now available. Two that have been recently been shown in can be offered not only to staff and faculty, as 36. See brochure, FAQs and other resources from Straight for a number of hospitals and health professional schools and can Equality in Healthcare: be ordered online, are Transgender Tuesdays (about an early San mentioned above, but also in open sessions, http://www.straightforequality.org/Healthcare Francisco clinic serving transgender patients) and Gen Silent (about to anyone interested in being an ally to LGBT the healthcare and other challenges faced by LGBT elders); many people. These trainings typically begin by 37. Some LGBT-supportive students and employees have turned to other excellent films are now available. online vendors to design their own LGBT-supportive items (e.g., pins providing LGBT 101 information, then explore saying Straight But Not Narrow ). Straight for Equality in Healthcare 40.Many online vendors offer LGBT-themed items, including LGBT concerns in depth, often offering sells cards and other items indicating support for LGBT people in rainbow stickers the length of an ID card, or work with LGBT healthcare: students and employees to design custom items. In addition, the opportunities for problem-solving and role- http://www.pflag.org/zen/index.php?main_page=index&cPath=10 American Medical Students Association sells a rainbow caduceus playing. Attendees generally receive a sticker, pin: sign or pin that identifies them as having taken https://online.amsa.org/amsassa/ecssashop.show_product_ 38. One source of LGBT-related exhibits is the non-profit Family detail?p_product_serno=275&p_mode=detail&p_cust_id=&p_ LGBT training. As preparation for training Diversity Project: session_serno=&p_trans_ty=&p_order_serno=&p_promo_cd=&p_ or for general information, students and http://familydiv.org/host-an-exhibit/ price_cd=#

10 MENTORING & NETWORKING difficult to identify them otherwise.41 An Out Encourage formation of an LGBT student, List serves several important purposes: staff and/or faculty group and meet with its Mentoring and networking are critical for • Identifying LGBT students, staff, members or representatives regularly. LGBT students, staff and faculty to maximize faculty and alums who can be contacted for Needless to say, an LGBT group is an their success in health professional schools. information and mentoring, not only by other invaluable resource for LGBT people at health Fortunately, there is a host of ways in which LGBT people but also by staff and faculty who professional schools and for that very reason your school can facilitate the connections that may be seeking information about a particular may form on its own. At some schools, however, are so important for professional and personal LGBT topic, panelists for an event, lecturers for institutional encouragement may be helpful. support. a course or mentors for a student For example, LGBT students, staff or faculty Create (or encourage creation of) a listserv for • Allowing LGBT students, faculty, staff and can be asked whether there is an LGBT group LGBT students, staff and faculty. alums to come out publicly, if they wish—a and how the school might assist in creating one If your school offers listservs for particular process that can have great personal meaning or supporting an existing one. It is important groups, it can be very helpful to create one for • Making visible your school’s support for that LGBT groups or people considering LGBT students, staff and faculty, so that LGBT- LGBT equity and inclusion in general and forming them know that they will not face any related information is widely distributed and for LGBT individuals within the campus institutional barriers or heightened scrutiny it’s clear that LGBT concerns are an accepted community. and that they will have the same access as other part of institutional life. A listserv ensures that, An Out List is most useful in online form, groups to resources like funding and publicity as people come and go, there is an ongoing, particularly when linked to email addresses, and mechanisms. They may also need some special institutional means of information-sharing that can be hosted by a student affairs or diversity institutional assistance, especially when first is available at the same address, year in and office. It can also be published in print, with established; for example, LGBT groups at some year out. The listserv can be used for event and copies made widely available to student affairs schools may need help reserving a room which position announcements, updates about school and HR staff, although print lists are harder will offer privacy to members who may not be policies and practices, subscriber queries about to update and involve more time, labor and out. school- and LGBT health-related topics, etc. expense. Publishing an online Out List in print An LGBT group is also an invaluable source Potential subscribers can be invited via flyers, periodically, however, is very helpful in making of information for schools seeking to offer an word of mouth, and existing lists for students, the list’s existence widely known and showing LGBT-welcoming climate. Regular meetings staff and faculty. support for LGBT equity and inclusion; for with your LGBT group can ensure that your example, it can be included in the issue of a school is aware of existing and emerging Encourage use of social media for mentoring school’s newspaper or newsletter closest to needs and concerns, allowing you to be and networking. October 11, National Coming Out Day. proactive around LGBT equity and inclusion. If your school does not offer institutional Like potential listserv subscribers, potential Connections made in these meetings can also be listservs or to supplement an institutional Out List members can be reached by flyers, very helpful when problems arise.42 listserv, Facebook, Google, Yahoo and other word of mouth, and email announcements via social media can be used to ensure that LGBT existing lists and channels. No matter how big a students, staff and faculty are well-connected school’s Out List is initially or ongoingly, it is a and stay abreast of LGBT-related activities and vital source of information and a very welcome developments at your school. Is it important sign of an LGBT-inclusive climate. that LGBT-related pages, groups and lists 42. A number of health professional schools (primarily schools created by a school’s students, staff or faculty be of medicine and dentistry) have LGBT groups with websites and Facebook pages. They can be readily found online; examples treated identically to similar resources created TIP: Your school may also want to provide a list of LGBT allies for students and others seeking support. include: by campus community members vis-a-vis other http://www.dent.umich.edu/academicaffairs/dental-lesbian-gay- groups, needs and concerns, with no additional An Ally List can draw on those who have completed bisexual-transgender-alliance-lgbta an Ally or Safe Zone training or who have otherwise http://dental.tufts.edu/about/student-gateway/student- requirements or scrutiny. organizations/gay-lesbian-bisexual-transgender-and-allies-student- accumulated demonstrated knowledge of LGBT organization-glbta/ Provide an Out List of LGBT students, staff, concerns, support strategies and key resources. It’s https://www.facebook.com/PennLGBTQAlliance faculty and alumni/ae. recommended that an Ally List be separate from https://www.facebook.com/GSDAUCSF http://www.med.unc.edu/qsa/about-qsa There is no more helpful resource for LGBT an Out List, to avoid confusion and because of the https://medschool.vanderbilt.edu/gsa/ mentoring and networking than a readily significance of the coming out process for LGBT http://lgbthealth.wustl.edu/ people. http://www.bumc.bu.edu/facdev-medicine/diversity/lgbt/ available Out List of your school’s LGBT http://www.med.upenn.edu/lgbt/ students, staff, faculty and alums, since it can be http://medstation.yale.edu/gsma/www/ http://www.ucdmc.ucdavis.edu/diversity/lgbt2.html 41. At this writing, examples of online Out Lists at health https://lgbt.hms.harvard.edu/ professional schools include these (many undergraduate campuses http://lgbtpm.uchicago.edu/ also offer Out Lists): http://www.hopkinsmedicine.org/som/students/diversity/LGBT%20 http://lgbt.ucsf.edu/out_outlist.html Resources.html http://www.bumc.bu.edu/oma/out_and_ally_list/ http://weill.cornell.edu/diversity/communities/lgbt-communities/ https://lgbt.hms.harvard.edu/outlist.html http://school.med.nyu.edu/student-resources/diversity-affairs/ http://queersandalliesuic.wordpress.com/out-list/ professional-development/student-life/lesbian-gay-bisexual-and-t

11 Hold a welcome event for LGBT campus equipped to provide good guidance or referrals Create an institutional website and/or community members and support ongoing around LGBT concerns. brochure with LGBT-related information and LGBT gatherings at your school. resources. The start of the school year, when welcome It is critical that your school provide an events abound, is an ideal time to send a strong OTHER KEY BEST PRACTICES ongoing source of LGBT information for message of LGBT equity and inclusion at your students, staff and faculty, both LGBT and not. school. LGBT students, staff and faculty can Appoint an LGBT point-person or high-level A website and/or brochure ensures, first, that be contacted to offer support for a planned LGBT advisory group. LGBT community members are fully aware of event or to request assistance in planning Your school will find it immeasurably the actions you have taken to provide equity one. Whether the gathering is held on- or off- easier to implement and maintain these and inclusion in the areas mentioned above, campus, as an institutional event or not, it is recommendations if you designate an LGBT giving them ready access to a wide range of important that information be made available point-person to help carry out your school’s information important to them. In fact, the about LGBT resources at your school; in fact, commitment to LGBT equity and inclusion. Of site or brochure can be structured around these an institutional representative may want to course, it should never fall to only one person recommendations, going over what your school request time to offer a welcome in person and to create a supportive and welcoming climate, offers in each area. review what your school offers. LGBT attendees and work to this end should never be just one Second, and equally important, a site and/or often report that this kind of event makes a big person’s job. But a point-person can do much to brochure provides very useful information to difference in their comfort level going forward. ensure that your intentions are lived out. other students, staff and faculty, filling them in Ideally, an office would be created for on your school’s LGBT-related policies, benefits, Provide funding for attendance at major events this purpose, with at least one fulltime staff training opportunities, awareness-building for LGBT health professionals and trainees. member, adequate administrative help and a initiatives and more. It is also helpful for an If your school has earmarked or discretionary programming budget. An office ensures that online or print resource to feature a “frequently funds for students (and others) to attend LGBT work at your institution is carried asked questions” section, including links to important conferences, make sure they know on, regardless of the comings and goings of information about, for example, the coming out that this support is available for them to attend staff and faculty, and shows a particularly process or specific LGBT health issues. key LGBT meetings. Individuals returning from strong institutional commitment. Every A site or brochure is not, of course, a these events have made contributions to their recommendation in this publication is best substitute for training or the designation of school’s LGBT climate and curriculum that served by the creation of an LGBT office. an office, point-person or advisory group. But would otherwise have been impossible or much- If your school’s budget or structure makes an it provides an excellent follow-up to training delayed and the mentoring and networking office impossible, however, public designation of and is usually the first project of any person they experience can be life-changing. GLMA an LGBT point-person is enormously helpful. or group formally charged with implementing holds a popular and well-attended national Again, ideally, this person would be fulltime, or recommending LGBT equity and inclusion conference annually for LGBT health although your school’s budget or structure may initiatives. Suggestions for web and brochure professionals and students, and national LGBT only allow for a part-time appointment, at least content are given above, in connection with the health student gatherings have been convened temporarily. development of an LGBT-related admissions by the University of California San Francisco, If your budget prohibits even a part-time site or brochure. the American Medical Students Association and appointment, it is extremely valuable to create others. GLMA staff can provide information an ongoing, high-level LGBT advisory group of TIP: Although websites are unsurpassed as about upcoming events, which are also students, staff and faculty to assess your LGBT information sources, your school may also want highlighted in GLMA’s periodic e-newsletters. climate, recommend improvements and help to produce a brochure to publicize your LGBT Ensure that LGBT people are included in implement approved measures. To ensure its webpage(s), to reach out to employees who existing mentoring programs. effectiveness, this group should report to and lack ready online access and to include in print If your school offers mentoring programs, regularly meet with your school’s president, orientation packets for students and employees, it is very helpful to have LGBT people among dean, diversity and inclusion dean or other unless or until your orientation materials are the mentors. LGBT mentorees will not always high-ranking official, although it will also be available only online. A brochure is also very helpful choose to work with them (or may not be working with operational staff at various levels. to have at events, during tabling, at recruitment assigned them if assignments are random), but In fact, even if your school has an LGBT office fairs and in waiting rooms. their presence in the pool adds an important or point-person, a group like this can be very resource, for mentors and mentorees alike, and helpful in ensuring that LGBT concerns are sends a welcoming message. It is also a good addressed as thoroughly and successfully as practice to provide LGBT information in any possible. preparation mentors receive, so that they are

12 Consider an award or other recognition for CONCLUSION LGBT leadership or achievement. As your school reviews and discusses If your school recognizes students, staff these recommendations, you’re sure to or faculty for leadership or achievements in develop additional ideas for supporting diversity or other areas, it is very meaningful your LGBT students, staff and faculty and to extend this recognition to LGBT-related creating an LGBT-welcoming climate at your accomplishments. People recognized may or particular campus. We hope you’ll share your may not be LGBT themselves, since the aim experiences—including the policies, programs, is simply to celebrate contributions to LGBT training and services you develop—with GLMA equity and inclusion.43 and your colleagues at other schools. These A public event celebrating those being recommendations are the first of their kind, and recognized can be a very moving occasion, additions are very welcome. bringing together both LGBT people and allies We also hope you’ll take advantage of the to reflect on all that has been accomplished. important work now underway around the The presence of campus leaders at an event country to develop LGBT-related curriculum like this sends a powerful message and for health schools. Climate and curriculum attendees often additionally appreciate hearing enhancement go hand in hand: both are critical comments from those being honored. As to creating a health workforce that is truly they share stories of overcoming obstacles knowledgeable and comfortable vis-à-vis LGBT both internal and external, all present get patients. GLMA and the AAMC, among other a sense of how rewarding it is, personally organizations, will be highlighting curriculum and institutionally, to help make equity and models and resources in coming months. inclusion possible for all. If your school is affiliated with a healthcare facility, you’ll want to know about two key resources for ensuring LGBT patient-centered care in outpatient and inpatient settings. GLMA’s Guidelines for Care of Lesbian, Gay, Bisexual and Transgender Patients (available at www.glma.org) offer guidance for individual clinicians, while the national LGBT Healthcare Equality Index (available at hrc.org/hei) provides detailed guidance to hospitals and clinics about best organizational practices for LGBT equity and inclusion. Your interest in LGBT climate, curriculum and care enhancement is deeply appreciated. It will make a real difference in the lives of your LGBT students, staff, faculty and patients—and it will make our nation’s healthcare system more equitable, diverse, inclusive and skillful. Truly, every step you take will be a gift.

43. An example of criteria and nomination processes for an LGBT award is available from the Chancellor’s Office at the University of California San Francisco: http://ucsfchancellor.ucsf.edu/award- gay-lesbian-bisexual-and-transgender-leadership

13 Selected Citations. LGBT Health Issues & LGBT Health Education

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Boston, MA: Orientation-and-Gender-Identity-Data- Transgender Health Issues and Research Massachusetts Department of Public in-Electronic-Health-Records.aspx Gaps and Opportunities; Board on the Health. Available at http://archives.lib. Health of Select Populations; Institute of AMA (American Medical Association). state.ma.us/handle/2452/112258. Medicine. The Health of Lesbian, Gay, 2010. Health care needs of the homosexual Bisexual, and Transgender People: Building Makadon HJ. Ending LGBT invisibility population. AMA policy regarding sexual a Foundation for Better Understanding. in health care: the first step in ensuring orientation. Available at http://www. Washington, DC: Institute of Medicine; equitable care. Cleve Clin J Med. ama-assn.org/ama/pub/ about-ama/ 2011. Available at http://www.nap. 2011 Apr;78(4):220-4. Review. our-people/member-groups-sections/ edu/catalog.php?record_id=13128. glbt-advisory-committee/ama-policy- Makadon, H. J. 2006. 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