LGBTQ+ curriculum content and delivery in PT education: A mixed-methods study

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Cabelka, Samantha Mohn-Johnsen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8723512/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Introduction: Lesbian, gay, bisexual, transgender, questioning or queer, intersex, asexual, + all inclusive (LGBTQ+) populations have known health disparities. Even where disparities are not known, it is clear that the population has unique health concerns that require a specific approach to appropriate examination and care. Previous studies examining LGBTQ+ curricula within health professions programs have found variability in content, delivery methods, and the number of hours devoted to its study. This variability has the potential to result in differences in student knowledge, competency, and confidence in working with patients from this population. The aim of this mixed-methods research was to describe the current state of LGBTQ+ curricula in PT education. Subjects: Faculty in CAPTE-accredited and developing PT and PTA programs who teach or are developing LGBTQ+ content. Methods: This study used an exploratory sequential mixed-methods design. Phase I included focus groups followed by in vivo coding for thematic identification. Using the results from Phase I, a quantitative survey was developed and distributed for Phase II. Quantitative data analysis was performed using descriptive statistics. Results : Phase I results indicated faculty strongly feel LGBTQ+ content is critical for clinical development. They also feel the current curriculum is not adequately preparing student clinicians. Phase II results indicated wide variety in breadth and depth of content and confirmed minimal opportunity for clinical skill development. Additionally, few participants reported development of specific learning objectives and assessment. Discussion and Conclusio n: With wide variety in the instructional methods used and LGBTQ+ content provided; students may be missing critical knowledge necessary to provide competent care. To improve the quality of LGBTQ+ curricula PT educators need to begin connecting skills acquisition to the content provided through explicit learning outcomes and assessment. Figures Figure 1 Figure 2 Introduction Physical therapists have a duty, as healthcare providers, to help prevent chronic conditions and disability, improve the overall health of society, and limit avoidable healthcare costs (APTA, 2019 ). To fulfill this duty, physical therapists need to be armed with the knowledge and skills necessary to promote health in all populations. Population health has been described as focusing on interrelated conditions and factors that influence the health of populations over the life course, systematic variations in their patterns of occurrence, and the resulting knowledge to develop and implement policies and actions to improve the health and well-being of populations (Frank, 1995 ). The mission of the American Physical Therapy Association (APTA), “Building a community that advances the profession of physical therapy to improve the health of society”, highlights the importance of providing training in population health so that future clinicians are equipped to meet population health needs (APTA, 2018 ). Similar to medical education, physical therapy education is challenged to incorporate population health content into already full curricula (Dunleavy et al., 2024 ). Armstrong et al. defined population health in the context of health sciences education as “the health and well-being of the individual/patient in context to the population they are a constituent of”. In support of this definition, a conceptual framework was developed for including population health concepts within health sciences curricula (Armstrong et al., 2022 ). The components include human development, social and economic environment, physical environment, health systems and healthcare, and nation, state and global health. These concepts are likely embedded into curricula across the health sciences to meet related accreditation standards (Accreditation Council for Occupational Therapy Education, 2023 ; Council on Academic Accreditation; Audiology, 2023 ; Standards and Required Elements for Accreditation of Physical Therapist Education Programs, 2025 ) that provide the foundation for understanding the minimum expectations for health providers. Because the model components are already present in curricula, integrating these concepts for a better understanding of patient health within the context of a population provides an opportunity to leverage existing content rather than introducing a new curriculum. Rethorn et al surveyed DPT programs and found that nearly all programs reported teaching prevention, health promotion, and wellness, but only 78% reported teaching population health (Rethorn et al., 2021 ). In the programs where population health was taught, only 15% of the topics were reported to be covered in depth. The concept of population health is built on the principle that understanding the specific needs of a population results in improved, targeted healthcare to meet those needs (Kindig & Stoddart, 2003 ). Providers should possess a deep understanding of population norms, values, and needs to tailor healthcare strategies that promote equitable and effective health outcomes. Survey reports indicate that a higher number of hours devoted to a population-specific curriculum results in an improved understanding of specific population needs and preferences (Nowaskie et al., 2020 ; Nowaskie & Patel, 2020 ). Utilizing sample populations that experience significant health disparities is one method to address all identified population health components to help students contextualize the individual patient within their constituent population. One sample group that easily integrates these concepts is the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) population. Consisting of a wide range of individuals across all demographics, including ethnicity, race, socioeconomic status, religion, and age, this sample represents patients all health science students are likely to encounter (The Williams Institute, 2019 ). Additionally, the Office of Disease Prevention and Health Promotion has identified improving the health and well-being of LGBT populations as a national priority (Office of Disease Prevention and Health Promotion, n.d.) due to long-standing, disproportionate health disparities relative to the general population (Gonzales et al., 2016 ; Janes et al., 2016 ; Nair et al., 2021 ). Students from several healthcare disciplines report a lack of training related to LGBTQ+ healthcare needs(Braun et al., 2017 ; Morton et al., 2021 ). Further, a survey of Doctor of Physical Therapy (DPT) program directors indicated wide variation in curricular hours devoted to LGBTQ+ topics, ranging from zero to greater than five hours (Adamson et al., 2022 ). This suggests differences in preparation among healthcare students to meet the needs of diverse populations. Health disparities within the LGBTQ+ population provide examples of the framework components of human development, social and economic environment, and physical environment. Commonly reported health disparities for the LGBTQ+ population include increased rates of mental health disorders, such as depression, anxiety (Borgogna et al., 2019 ), and substance use disorders (Mereish et al., 2015 ; Quinn et al., 2015 ), increased rates of homelessness, increased risky behaviors including experiences of bullying (Garaigordobil & Larrain, 2020 ) and violence (Flores et al., 2022 ),and increased risky sexual behavior (Gonzales & Henning-Smith, 2017 ). Additionally, the LGBTQ+ population experiences disproportionate rates of cancer and cardiovascular disease (Sirufo et al., 2023 ). Health providers are likely to encounter secondary impairments as a sequela of health disparities. The National Center for Transgender Equity reports that 39% of respondents to a national survey identified as transgender and that they had one or more disabilities where disability was defined as having “serious difficulty in the performance of major life activities such as hearing, seeing, or walking” (Gonzales & Henning-Smith, 2017 ). This statistic reinforces that it is clear that healthcare provider are likely to interact with the community to address and support the functional independence of individual patients. Notably, three primary health-specific barriers have been identified for individuals who are transgender with disabilities, including (1) higher levels of discrimination relative to transgender individuals who do not have disabilities, (2) increased discrimination when attempting to access mental health and other crisis support centers, and (3) an increased incidence of cost of care barriers (Jette, 2020 ). Barriers to care may be contextualized within the health systems and healthcare and nation, state and global health components of the framework. A common barrier for the LGBTQ+ population includes previous negative healthcare experiences resulting in delayed access to health providers, decreased health outcomes, and care that does not meet the standards of best practice (Ross & Setchell, 2019 ). Reported discrimination of sexual minority women by healthcare providers was associated with higher physical and emotional impairment and delayed care (Scott et al., 2023 ). A review of qualitative studies investigating the health impact of stigma, discrimination, prejudice, and bias experienced by transgender people found that when these negative experiences are internalized, it leads to decreased health outcomes due to healthcare avoidance, reduced healthcare utilization, decreased screenings, and delayed treatment (Drabish & Theeke, 2022 ). As a result of known disparities and lack of LGBTQ+ provider competence, patients, students, and researchers have called for increased LGBTQ+-specific instruction in health sciences education (Morton et al., 2021 ; Nowaskie et al., 2020 ; Parameshwaran et al., 2017 ). Charles et al published a clinical commentary highlighting the lack of LGBTQ+ cultural competency in PT education (Charles et al., 2022 ). The authors highlighted the need for greater inclusion of LGBTQ+ population-specific content in PT education while recognizing a distinct lack of research and guidance around pedagogical principles and specific curriculum recommendations (Charles et al., 2022 ). The aim of this mixed-methods research was to describe the current state of LGBTQ+ curriculum in PT education as a first step in developing entry-level curricular guidelines. Specific objectives were to: 1) evaluate faculty attitudes and beliefs regarding LGBTQ+ curriculum and 2) thoroughly describe the content highlighted in PT education. It was hypothesized that faculty believe LGBTQ+ content is important, and there would be a wide variation in curricular content, delivery, and instructional method. Methods Study Design This study used an exploratory sequential mixed-methods design (Fig. 1 ) and was approved by the IRB at the College of St. Scholastica. IRB #1844021-5 for Phase I, #1998630-1 for Phase II. The first phase of the study was grounded in an interpretivist research paradigm using a phenomenological qualitative approach. The first step in understanding the research question is to observe and describe what is happening, making a phenomenological approach the most appropriate choice for this study. Utilizing an interpretivist paradigm (Alharahsheh & Pius, 2020 ) allowed an in-depth exploration of PT educators' subjective experiences, attitudes, and beliefs about the inclusion of LGBTQ+ content within PT education. The first and last authors collectively have 17 years in PT education and expertise in inclusion of LGBTQ+ topics within PT curricula. In the fall of 2021, interview questions were created using themes identified in previous medicine and nursing literature. These a priori themes included specific content, course location, instructional methods, topic importance, personal experience, and barriers or facilitators. A mock interview was conducted to assess question clarity and determine the initial question order. A semi-structured interview design was established to allow for clarifying, qualifying, or follow-up questions. All focus group sessions were conducted and recorded via Zoom to allow for nationwide participation. Initial recruitment was conducted between January and March 2022. Focus group sessions occurred between February 2022 and March 2022. Phase 1 analysis was conducted from April 2022 through October 2022. The second phase of the study was conducted via a quantitative survey. Survey questions were developed using data from phase 1 from November 2022 - December 2022 and distributed from December 2022 - February 2023. Survey development used common themes around content and course delivery obtained from the focus groups. Additionally, literature related to LGBTQ+ content in health professions was explored to determine more specific content areas and instructional methods. The survey consisted of up to 43 questions in the following domains: 1) demographic information, 2) population health, 3) unique population language and terminology, 4) unique population health needs, 5) clinical skills, and 6) instructional design. Question types included multiple-choice, multiple-select, and blank text. Participants Focus group participants were recruited from CAPTE-accredited DPT and PTA programs. An email describing the study was sent to all CAPTE-accredited DPT and PTA program directors, requesting they forward the study email to the appropriate faculty. Included in the email was a link to a brief screening survey consisting of demographic questions and study consent. To maximize reach, snowball sampling was encouraged. By completing and signing the screening survey, participants consented to be enrolled in the study. Inclusion criteria required study participants to be at least 18 years of age, currently teach LGBTQ+ content, or have created or delivered LGBTQ+ content within the past 5 years. Exclusion criteria included individuals who were exclusively clinical instructors or don’t teach LGBTQ+ content, and faculty teaching exclusively in transitional DPT, bridge, or non-CAPTE accredited programs. Survey participants were recruited in the same manner as the focus groups. Additionally, participants were recruited through emails from the following organizations: American Council of Academic Physical Therapy (ACAPT), Academy of PT Research, PT Proud, Academy of Pelvic Health Physical Therapy, and OutCare. Inclusion criteria required study participants to be DPT or PTA faculty from CAPTE-accredited and developing programs. Faculty definition included core faculty, adjunct, clinical, and guest speakers. All participants needed to be over the age of 18 years. Exclusion criteria included individuals teaching exclusively in transitional DPT, bridge, or non-CAPTE accredited programs. All participants completed an informed consent prior to participation in the survey. Qualitative Data Analysis Zoom (Version 5.17.11; Zoom Video Communications, Inc.) was used to conduct and record the focus group sessions. NVivo Version 13 (2020, R1; Lumivero) was used for transcription and coding. Hand transcription was also performed for correction. Inductive in-vivo coding was conducted independently by the first and last authors. The agreed-upon codes were deductively applied to all focus groups while simultaneously continuing an inductive analysis to identify new emergent codes. Focus groups were completed until saturation of data was evident. Data saturation was determined by repetition of previous observations with no new themes identified. Triangulation of findings occurred through participant findings, previous literature, and researcher experiences. Trustworthiness was ensured with the first and last authors maintaining a reflexive approach: sharing potential assumptions and relying on each other to identify and address potential biases and assumptions throughout the study phases. The remaining authors served as peer reviewers throughout the process. Qualtrics (Qualtrics, Provo, UT) was used to gather sample descriptives and scheduling availability. Quantitative Data Analysis Qualtrics (Qualtrics, Provo, UT) was used to collect data from the phase II quantitative survey. Microsoft Excel (Version 16.79; Microsoft) software was used to calculate descriptive statistics. Results Qualitative Focus Group Demographics Thirteen educators from across the United States (Pacific = 1, West-North Central = 4; East-South Central = 2; East-North Central = 1; Mountain = 2; Mid-Atlantic = 1; South Atlantic = 2) participated in focus groups or individual interviews. Seven were faculty in a DPT program, five were faculty in a PTA program, and one was faculty in both DPT and PTA programs. Qualitative Focus Group Results Theme 1: Instructional methods and design Participants were asked about the specific methods used to deliver LGBTQ+ curriculum within their programs. The most frequently reported methods were lecture and exam, discussion, case studies, reflection, and including evidence. Active learning methods were frequently used. We generally do that (scaffolding) through case studies, where they (the students) are provided a case study, and maybe they’re only working on one part of the case. They learn some information in lecture and then they’re let loose to answer some critical thinking, or create interventions… I think the case studies and the projects that the students do are far more powerful. Participants frequently reported using lived experience as a teaching tool in discussions, case studies, and reflection. Lived experience was introduced most often through guest speakers or panels consisting of LGBTQ+ persons. Student and faculty lived experiences were also referenced as teaching tools. ...we had a transgender male and his wife come and talk to us about their lived experience. Having students who are brave enough to share their own personal perspective helps us a lot. In addition to the explicit teaching of content, participants also rely on implicit learning, the use of modeling, and the building of relationships. ...if they see faculty saying that this is important and modeling the type of welcoming behaviors we expect within the healthcare environment… The fact is I’m not overtly teaching them something, but I’m working with them and I am open with, you know, I have a partner and all of these things. The importance of creating an emotional connection was identified as a sub-theme within the different instructional methods. So, putting a human face or a story or something that makes it memorable. “But if you give them some type of emotional reaction, whether it’s positive or even if it’s discomfort, it’s still an emotional reaction, it’s still going to stick with them”. Theme 2: Outcomes When asked to describe how the education their students received adequately prepares graduates to interact with the LGBTQ+ population, the resounding response was “we’re not”. Yeah, and I’m not going to have a very good answer because I’m going to say that we don’t prepare them for this, right? We don’t. Well, we’re not doing an adequate job. I would suggest that we’re not adequately preparing them yet. I think what we’re doing is a drop in the bucket. Despite these initial reactions, participants went on to say that they hope the current education will eventually lead to change. I hope we scratched the surface of their awareness so that they can be a little more perceptive, a little more open, and have the groundwork, just the foundation for understanding how to create a safe space. And so I think that students walk away with a bigger appreciation of why they do need to take in the whole 360. “But generally, it’s how we are educating the entry-level practitioner to be able to be adaptable to the situation. Based on the presentation of the patient and also the society and community of wherever they end up at.” Theme 3: Specific Content Participants were explicitly asked what topics related to LGBTQ+ healthcare were covered in their programs. Five main areas of content were identified: 1) Language, 2) Unique population needs, 3) Social determinants of health, 4) Access to care, and 5) Health disparities (Fig. 2 ). While not frequently mentioned the topics of trauma-informed care, misinformation, and bias were also included in some curricula. Content around language ranged from including basic descriptions and definitions of preferred name, pronouns, what it means to be non-binary versus lesbian, gay, bisexual, etc., to more applied use of how to perform inclusive interviewing. Unique population needs included coverage of healthcare concerns and needs of transgender individuals and identifying barriers to care for LGBTQ+ patients and clients. Social determinants of health including the impact of chronic stress, stigma and societal bias, intersectionality, and cultural competence were included. Quantitative Survey Demographics Seventy-eight complete surveys were recorded. The descriptive characteristics of the respondents are presented in Table 1 . The majority reported teaching in a DPT program (78.2%), followed by a PTA program (17.9%), and both (3.85%). Core faculty positions were the most represented (65.4%), followed by adjunct faculty (12.8%) and guest speakers (11.5%). When asked about their relationship to the LGBTQ+ community, the majority have worked professionally with a member of the community (33.0%) or know someone who is part of the community (29.0%). Respondents were geographically diverse, with the largest response rate from the South Atlantic (23.1%), followed by Mid-Atlantic (15.4%), East-North Central (15.4%), and West-North Central regions (14.1%). The duration of time respondents have been teaching LGBTQ+ content fell mostly within the 2–4 year range (32.5%) with the next largest group indicating they have developed but not yet taught content (22.1%). The most frequently reported LGBTQ+-specific continuing education and/or training topics were cultural competency training (17.0%), bias training (14.9%), and education on social determinants of health (11.0%). Table 1 Demographic information of quantitative survey respondents. Type of Program (n = 78) n (%) DPT 61 (78.2%) PTA 14 (17.9%) Both 3 (3.85%) Faculty Role (n = 78) Core faculty 51 (65.4%) Adjunct faculty 10 (12.8%) Guest speaker 9 (11.5%) Clinical Instructor 2 (2.56%) Department Chair 4 (5.13%) Other 2 (2.56%) Relationship to LGBTQ+ Community (Select all that apply) (n = 176) I am a member of the LGBTQ+ community 19 (10.8%) I have a close family member/friend who is part of the LGBTQ+ community 45 (25.6%) I know someone who is a part of the LGBTQ+ community 51 (29.0%) I have worked professionally with a member of the LGBTQ+ community 58 (33.0%) I choose to limit my interactions with the LGBTQ+ community 1 (0.57%) I actively avoid interactions with the LGBTQ+ community 0 (0%) No relationship to the LGBTQ+ community 1 (0.57%) Prefer not to state 1 (0.57%) Geographic Region (n = 78) New England (ME, VT, NH, MA, RI, CT) 3 (3.85%) Mid-Atlantic (DE, NY, NJ, MD, PA) 12 (15.4%) South Atlantic (VA, NC, SC, GA, FL, Puerto Rico) 18 (23.1%) East-North Central (WI, MI, IL, OH, IN) 12 (15.4%) East-South Central (KY, TN, MS, AL, WV) 3 (3.85%) West-North Central (MN, ND, SD, MO, NE, KS, IA) 11 (14.1%) West-South Central (TX, OK, LA, AK) 4 (5.13%) Mountain (NM, AZ, CO, NV, UT, ID, MT, WY) 7 (8.97%) Pacific (WA, OR, CA, AK, HI) 8 (10.3%) Duration of Teaching LGBTQ+ Content (n = 77) Content developed but not yet taught 17 (22.1%) 1 year 13 (16.9%) 2–4 years 25 (32.5%) 5–7 years 10 (13.0%) 8–10 years 7 (9.09%) More than 10 years 5 (6.49%) Continuing Education and/or Training Specific to the LGBTQ+ Population (Select all that apply) (n = 382) Bias training 57 (14.9%) Cultural competency training 65 (17.0%) Population specific health needs 38 (9.95%) Social determinants of health 42 (11.0%) Sexual history taking 25 (6.54%) Ally training 25 (6.54%) Trauma informed care 35 (9.16%) Competency for working with LGBTQ+ students 0 (0%) Ethical and legal training 28 (7.33%) Advocacy training 20 (5.24%) Evidence based practice for clinical care 36 (9.42%) Other 7 (1.83%) I have no specific education/training 4 (1.05%) n = Total number of times the response was selected. Some numbers add to more than the total number of surveys due to the option to select more than one response. Population Health, Social Determinants of Health, and Health Literacy Eighty-eight percent of respondents report including population health topics into curricula (Table 2 ). Of those who responded yes, understanding the unique health needs of specific populations (30.5%) and recognizing health disparity as a preventable health difference among populations (30.5%) were the most included population health topics (Table 2 ). Women (22.1%), LGBTQ+ (21.2%), and Black American (19.5%) populations were used the most when teaching population health concepts (Table 2 ). The majority of respondents include content related to social determinants of health. (92.0%; Table 2 ). Seventy-nine percent of respondents include health literacy in their curriculum. Of those responding yes, information about health literacy as a concept (22.2%), use of reading levels for patient education materials (19.6%), and importance of the use of common language (19.1%) were the most frequently included topics (Table 2 ). Table 2 Frequency of specific population health, social determinants of health and health literacy topics included in PT education. Population Health n (%) Population Health is Included in Curriculum (n = 77) Yes 68 (88.3%) No 9 (11.7%) Specific Population Health Topics When Including Population Health (Select All That Apply) (n = 190) Triple/Quadruple/Quintuple Aim 18 (9.47%) Understanding unique health needs of specific populations 58 (30.5%) Recognizing health disparity as preventable health differences among populations 58 (30.5%) Difference in access to care among populations 55 (28.9%) Other 1 (0.53%) Sample Populations Used When Including Population Health (Select All That Apply) (n = 226) Women 50 (22.1%) LGBTQ+ 48 (21.2%) Black American 44 (19.5%) Native American 29 (12.8%) Veterans 23 (10.2%) Refugees 10 (4.42%) Migrant workers 12 (5.31%) Other (disabilities, sex workers, transgender and non-binary, older adults, generational poverty, unhoused/rural population, Hispanic/Latino, and incarcerated or formerly incarcerated persons) 10 (4.42%) Social Determinants of Health Social Determinants of Health are Included in Curriculum (n = 75) Yes 69 (92.0%) No 6 (8.0%) Health Literacy Health Literacy is Included in Curriculum (n = 72) Yes 57 (79.2%) No 15 (20.8%) Specific Health Literacy Topics When Including Health Literacy (Select All That Apply) (n = 225) Information about health literacy as a concept 50 (22.2%) Risk factors for low health literacy 39 (17.3%) Tools used to measure health literacy 21 (9.33%) Strategies to improve health literacy 27 (12.0%) Importance of use of common language 43 (19.1%) Use of reading levels for patient education materials 44 (19.6%) Other (Effects of low health literacy) 1 (0.44%) n = Total number of times the response was selected. Some numbers add to more than the total number of surveys due to the option to select more than one response. Unique Population Language and Terminology The most frequently included topics related to unique LGBTQ+ population language and terminology include the use of legal and preferred names (93.0%), inappropriate or offensive language (88.2%), the use of neutral or non-gendered language (77.9%), and best practices related to documentation (e.g. use of inclusive intake forms, patient preferred and/or legal name, etc.) (71.9%; Online Resource 1). Less than half of responses indicated that the topics of deadnaming (36.6%), teaching about intersex (47.8%), community ownership of language (41.2%), and use of patient-preferred anatomy language (47.1%) were included in curricula (Online Resource 1). When asked about specific topics related to pronoun use, the most frequently included topics were use of inclusive practices related to forms and electronic medical records (19.0%) and sharing of personal pronouns (19.0%; Table 3 ). Man (14.6%), woman (13.7%), and non-binary (13.7%) were the most frequently reported gender identities, followed closely by transgender man (13.5%) and transgender woman (13.7%; Table 3 ). Sexual identities most commonly reported were heterosexual/straight (16.0%), lesbian (16.0%), gay (15.7%), and bisexual (14.6%; Table 3 ). Table 3 Specific LGBTQ+ population language, terminology, and population health needs included in PT education. Unique Population Language and Terminology n (%) What Topics Do You Include Related to Pronoun Use (Select All That Apply) (n = 274) Why it matters 47 (17.5%) Inclusive practices for forms and electronic medical records 52 (19.0%) Patient disclosures/documentation concerns 32 (11.7%) Sharing personal pronouns 52 (19.0%) Pronoun use with patients 51 (18.6%) Practice of apologizing 30 (10.9%) Do not teach about pronouns 10 (3.65%) When you teach about gender identity which identities do you include? (Select All That Apply) (n = 417) Agender 26 (6.24%) Androgyne 5 (1.20%) Demigender 4 (0.96%) Gender queer/Gender fluid 44 (10.6%) Man 61 (14.6%) Non-binary 57 (13.7%) Questioning or unsure 31 (7.43%) Transgender man 56 (13.5%) Transgender woman 56 (13.5%) Two-spirit 17 (4.10%) Woman 57 (13.7%) Other (metagender, intersex, do not include) 3 (0.72%) Which identities do you include related to sexual identity? (Select All That Apply) (n = 343) Asexual 32 (9.33%) Bisexual 50 (14.6%) Gay 54 (15.7%) Heterosexual/Straight 55 (16.0%) Lesbian 55 (16.0%) Pansexual 26 (7.58%) Queer 35 (10.2%) Questioning 26 (7.58%) Other (demisexual) 2 (0.58%) Do not include 8 (2.33%) Unique Population Health Needs Which of the following health disparities in the LGBTQ+ population do you include (Select all that apply) (n = 163) Mental health (e.g. suicide, depression, etc) 44 (27.0%) Substance use/abuse 33 (20.2%) Prevention of health disparities 34 (20.9%) Health risks related to gender identity (e.g. screening for prostate cancer in trans-female patients) 38 (23.3%) I do not cover any specific LGBTQ+ health disparities 14 (8.59%) What specific information about non-surgical practices do you include? (Select all that apply) (n = 52) Information that patients may be participating in these practices 21 (40.4%) Potential risks and/or side effects of these practices 16 (30.8%) Techniques to minimize risk and/or manage side effects of these practices 14 (29.9%) Other (Include handouts for clinicians related to these practices) 1 (1.92%) Which of the following gender confirmation surgeries do you cover? (Select all that apply) (n = 123) Top Surgery – Mastectomy 13 (10.6%) Top Surgery – Breast augmentation 10 (8.13%) Bottom Surgery – Vaginoplasty 13 (10.6%) Bottom Surgery – Phalloplasty 12 (9.76%) Bottom Surgery – Metoidoplasty 8 (6.50%) Top Surgery – General concepts 21 (17.1%) Bottom Surgery – General concepts 22 (17.9%) Postoperative considerations and management 22 (17.9%) Other (Double incision or chest wall reduction (not mastectomy)) 2 (1.63%) Please indicate which of the following team members you include as part of management of LGBT patients. (Select all that apply) (n = 149) Speech Therapist 17 (11.4%) Occupational Therapist 16 (10.7%) Physician – Primary care 38 (25.5%) Surgeon 32 (21.5%) Mental Health Professional 37 (24.8%) Other (Dietician, Physical Therapist, Pelvic Health PT, Social Work, front desk staff, RNs, Aides) 9 (6.04%) n = Total number of times the response was selected. Some numbers add to more than the total number of surveys due to the option to select more than one response. Unique Population Health Needs Less than half of respondents (43.9%) indicate including LGBTQ+ health needs across the lifespan (Online Resource 1). Specific LGBTQ+ health disparities covered are included in Table 2 . Just over half of respondents (52.3%) report including content related to policies that include/exclude or otherwise limit access to healthcare, participation in sports, and quality of life (Online Resource 1). Less than half of the responses indicate that nonsurgical practices and gender-affirming surgeries are covered (31.8% and 40%, respectively; Online Resource 1). Of those who include nonsurgical practices, the most frequently included topics are general information that patients may be participating in these practices (40%) and potential risks of these practices (30.8%; Table 3 ). Of those including gender-affirming surgeries, general top (17.1%) and bottom (17.9%) surgery along with postoperative considerations/management (17.9%) are covered most frequently (Table 3 ). When asked about who should be included on care teams for LGBTQ+ patients, primary care physician (25.5%) and mental health professional (24.8%) were selected most often, followed by surgeons (21.5%), speech therapist (11.4%) and occupational therapist (10.7%; Table 3 ). Clinical Skills Only 36.4% of responses indicated that education on sexual interviewing was provided (Table 4 ). Of those including sexual interviewing education, just over half (58.3%) provide opportunities to practice sexual interviewing (Table 4 ). Less than half of responses (36.9%) indicate topics related to LGBTQ+ specific screening (e.g., prostate cancer screening for transgender women, etc.) are included (Table 4 ). Sixty-eight percent of responses indicate trauma-informed care education is provided (Table 4 ) with consent (19.5%), continued consent (17.7%), trauma-informed draping/modesty (15.9%), and trauma-informed palpation (13.3%) as the most frequently included trauma-informed practices (Table 4 ). Table 4 Clinical skills and learning outcomes related to LGBTQ+ content in PT education. Clinical Skills n (%) Do you provide education on how to perform a sexual interview? (n = 66) Yes 24 (36.4%) No 42 (63.6%) Do you provide opportunities for students to practice a sexual interview? (n = 24) Yes 14 (58.3%) No 10 (41.7%) Do you provide education regarding trauma-informed care? (n = 66) Yes 45 (68.2%) No 21 (31.8%) What trauma-informed care concepts are included in your education? (n = 226) Trauma informed palpation 30 (13.3%) Trauma informed draping/modesty 36 (15.9%) Consent 44 (19.5%) Continued consent 40 (17.7%) Recognition of dissociation 23 (10.2%) Tools to manage dissociation 12 (5.31%) Recognition of sympathetic dysregulation 22 (9.73%) Tools to manage sympathetic dysregulation 16 (7.08%) Other 3 (1.33%) Do you include education regarding specific screening questions for the LGBTQ+ population? (n = 65) Yes 24 (36.9%) No 41 (63.1%) Outcomes Do you have course or unit learning objectives related to LGBTQ+ health topics? (n = 64) Yes 28 (43.8%) No 36 (56.3%) How are learning outcomes related to LGBTQ+ health topics assessed in your program? (Select all that apply) (n = 126) Multiple choice exam 20 (15.9%) Quizzes 13 (10.3%) In class quizzing software 7 (5.56%) Self-reflection 31 (24.6%) Peer reflection/assessment 10 (7.94%) Learning not assessed 14 (11.1%) Engagement/participation 26 (20.6%) Other (case studies, student presentations) 5 (3.97%) What's the primary Bloom's level for learning outcomes related to LGBTQ+ health topics? (n = 63) Remember 2 (3.17%) Understand 21 (33.3%) Apply 18 (28.6%) Analyze 4 (6.35%) Evaluate 3 (4.76%) Create 0 (0%) Not applicable 15 (23.8%) Which of the following domains of learning are represented in your curriculum related to LGBTQ+ health topics? (Select all that apply) (n = 105) Cognitive 55 (52.4%) Psychomotor 10 (9.52%) Affective 40 (38.1%) n = Total number of times the response was selected. Some numbers add to more than the total number of surveys due to the option to select more than one response. Curriculum Design and Outcomes The most frequently reported curriculum design elements related to where LGBTQ+ content is included in the curriculum, as well as specific delivery and instructional methods can be found in Online Resource 2. The most frequently reported instructional methods are similar to those identified in the qualitative data analysis. Less than half of participants (43.8%) report including course or unit learning objectives related to LGBTQ+ topics (Table 4 ). The primary Bloom’s level for learning outcomes related to LGBTQ+ topics were most frequently Understand (33.3%), Apply (28.6%), or Not applicable (23.8%) (Table 4 ). The most frequent tools for assessing learning outcomes related to LGBTQ+ health topics were self-reflection (24.6%), engagement/participation (20.6%), multiple-choice exam (15.9%) or learning was not assessed (11.1%) (Table 4 ). Cognitive (52.4%) and affective (38.1%) domains of learning related to LGBTQ+ content were more frequently represented than psychomotor (9.52%) (Table 4 ). Discussion/Conclusion To date, this is the first study of its kind to use both qualitative and quantitative methods to describe the current state of LGBTQ+ curriculum in PT education. Overall, the study results confirm the hypothesis that there is wide variation in curricular content, delivery, and instructional methods. The qualitative findings overwhelmingly suggest that faculty who participated felt strongly that the inclusion of LGBTQ+ specific content was important for physical therapy professionals. Participants who reported including this content in curricula used a wide variety of instructional methods, and there were substantial differences in the type and depth of content covered. Interestingly, participants indicated the specific content was not robust enough to adequately prepare students to work with the LGBTQ+ population. The quantitative analysis revealed that the majority of faculty who responded were delivering didactic content. Not surprisingly, the most frequently included content topics related to language included differentiation between sex and gender and definitions of various sexual and gender identities. While the majority of participant responses indicate population health topics are included, it is important to note that only 48 programs reported including LGBTQ+-specific content. Forty-eight out of over 300 PT and PTA programs is significantly low, indicating that many students are not provided education specific to the LGBTQ+ population. A survey of program directors conducted by Glick et al reported that LGBTQ+ education was conceptualized within general cultural competence (Glick et al., 2020 ). The discrepancy in how faculty and program directors categorize where LGBTQ+ health curriculum should be placed highlights the wide variation in physical therapy education and content. Using lived experience as an instructional method has been identified as a powerful teaching strategy for supporting the development of skills, knowledge, and attitudes for health professionals (Parnell et al., 2023 ). Participants frequently reported using this instructional method through the lived experiences of faculty, students, and guests. An individual patient case or sample population allows instructors to introduce the unique experiences of one individual to facilitate learning not only content but also skills like empathy, communication, and critical thinking. Respondents highlighted the importance of creating an emotional connection between students and the content. Including these teaching methods may challenge students to consider personal biases, familiar stereotypes, stigma, and fear, while balancing the needs of an individual. Health professions education relies on the integration of knowledge, clinical skills, and affective behaviors. While knowledge acquisition is a key component to gaining competency in health professions, it cannot be relied upon as the sole method of teaching and learning. Learners require applied practice to gain proficiency in clinical skills. Nursing literature suggests that skill competency is a slow process requiring practice, and providing deliberate skills practice is one method to help students increase their competence (Liou et al., 2013 ). While programs are providing some LGBTQ+ population-specific instruction, the education appears to be focused primarily on content knowledge. Slightly more than one-third (n = 24) of responding programs reported providing education on how to perform a sexual interview, and just over half of those (n = 14) reported providing opportunities to practice or further develop this clinical skill. To move students towards competency, it is critical for programs to incorporate practice opportunities related to sexual interviewing, health-specific screening, and trauma-informed care practices. Further supporting the idea that the focus is knowledge acquisition rather than application are the findings that learning outcomes were reported at primarily the “understand” level of Bloom’s taxonomy. This may not be surprising due to suggested competency standards being written at the “remember” and “understand” levels (Tatta & Dillon, 2024 ). Ultimately, less than half of programs (n = 28) reported any specific outcomes related to LGBTQ+ content. While the results of the current study indicate lower levels of learning outcomes, recommended competencies in population health, prevention, health promotion, and wellness span all levels of learning (Magnusson et al., 2020 ). This finding reflects the need to increase the depth of learning to adequately prepare clinicians to transfer their content knowledge into new and different patient situations rather than just repeating what they’ve memorized previously. Phase I limitations include the possibility that critical information was missed due to participant self-selection. It is possible that those who strongly feel this content is not relevant to clinical care did not participate. Because of the semi-structured nature of the focus groups, it is possible that information was missed and therefore not further explored in Phase II. Phase II limitations include participant self-selection and potential lack of participation from programs that do not include or teach LGBTQ+ content. Skilled physical therapy requires decision-making that incorporates patient-specific factors that may impact the delivery of care, potential barriers to care, and expected outcomes. While physical therapy professionals are well-positioned to provide care to all patient populations, the noted variation in LGBTQ+ education may limit providers from considering the patient as an individual with unique needs and experiences. Collectively, these findings indicate a significant lack of standardized education and assessment related to LGBTQ+ curricula in PT education. To equip physical therapy professionals with adequate skills to provide competent LGBTQ+ care, educators need to transition from providing basic knowledge instruction to offering opportunities for skill acquisition and practice. Connecting the education provided to explicit learning outcomes will allow future research to focus on assessing how professional education impacts health outcomes for the LGBTQ+ population. Declarations Funding Declaration No funding was received to assist with the preparation of this manuscript. Human Ethics Declaration This study was conducted in accordance with the ethical standards of the Declaration of Helsinki. The research protocol was reviewed and approved by the College of St. Scholastica Internal Review Board at College of St. Scholastica, Inc. The IRB approval number for this study is 1844021-1. Consent to Participate Declaration Informed consent was obtained from all individual participants included in the study. References Accreditation Council for Occupational Therapy Education. (2023). 2023 Accreditation Council for Occupational Therapy Education (ACOTE) Standards and Interpretive Guide . Adamson, T., Lett, E., Glick, J., Garrison-Desany, H. M., Restar, A., & Adamson, M. T. (2022). Experiences of violence and discrimination among LGBTQ+ individuals during the COVID-19 pandemic: a global cross-sectional analysis. 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Bullying and cyberbullying in LGBT adolescents: Prevalence and effects on mental health. Comunicar , 28 (62), 79–90. https://doi.org/10.3916/C62-2020-07 Glick, J. C., Leamy, C., Hewlett Molsberry, A., & Kerfeld, C. I. (2020). Moving Toward Equitable Health Care for Lesbian, Gay, Bisexual, Transgender, and Queer Patients: Education and Training in Physical Therapy Education. Journal of Physical Therapy Education , 34 (3), 192–197. https://doi.org/10.1097/JTE.0000000000000140 Gonzales, G., & Henning-Smith, C. (2017). Health Disparities by Sexual Orientation: Results and Implications from the Behavioral Risk Factor Surveillance System. Journal of Community Health , 42 (6), 1163–1172. https://doi.org/10.1007/s10900-017-0366-z Gonzales, G., Przedworski, J., & Henning-Smith, C. (2016). Comparison of health and health risk factors between lesbian, gay, and bisexual adults and heterosexual adults in the United States. JAMA Internal Medicine , 176 (9), 1344. https://doi.org/10.1001/jamainternmed.2016.3432 Janes, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The report of the 2015 U.S. transgender survey . Jette, A. M. (2020). The Importance of Collecting Data on Sexual Orientation and Gender Identity (SOGI) in Rehabilitation Research. Physical Therapy , 100 (8), 1235–1236. https://doi.org/10.1093/ptj/pzaa104 Kindig, D., & Stoddart, G. (2003). What Is Population Health? American Journal of Public Health , 93 (3), 380–383. https://doi.org/10.2105/AJPH.93.3.380 Liou, S.-R., Chang, C.-H., Tsai, H.-M., & Cheng, C.-Y. (2013). The effects of a deliberate practice program on nursing students’ perception of clinical competence. Nurse Education Today , 33 (4), 358–363. https://doi.org/10.1016/j.nedt.2012.07.007 Magnusson, D. M., Rethorn, Z. D., Bradford, E. H., Maxwell, J., Ingman, M. S., Davenport, T. E., & Bezner, J. R. (2020). Population Health, Prevention, Health Promotion, and Wellness Competencies in Physical Therapist Professional Education: Results of a Modified Delphi Study. Physical Therapy , 100 (9), 1645–1658. https://doi.org/10.1093/ptj/pzaa056 Mereish, E. H., Lee, J. H., Gamarel, K. E., Zaller, N. D., & Operario, D. (2015). Sexual orientation disparities in psychiatric and drug use disorders among a nationally representative sample of women with alcohol use disorders. Addictive Behaviors , 47 , 80–85. https://doi.org/10.1016/j.addbeh.2015.03.023 Morton, R. C., Ge, W., Kerns, L., & Rasey, J. (2021). Addressing Lesbian, Gay, Bisexual, Transgender, and Queer Health in Physical Therapy Education. Journal of Physical Therapy Education , 35 (4), 307–314. https://doi.org/10.1097/jte.0000000000000198 Nair, J. M. C., Waad, A., Byam, S., & Maher, M. (2021). Barriers to care and root cause analysis of LGBTQ+ patients’ experiences: A qualitative study. Nursing Research , 70 (6), 417–424. https://doi.org/10.1097/NNR.0000000000000541 Nowaskie, D. Z., & Patel, A. U. (2020). How much is needed? Patient exposure and curricular education on medical students’ LGBT cultural competency. BMC Medical Education , 20 , 490. Nowaskie, D. Z., Patel, A. U., & Fang, R. C. (2020). A multicenter, multidisciplinary evaluation of 1701 healthcare professional students’ LGBT cultural competency: Comparisons between dental, medical, occupational therapy, pharmacy, physical therapy, physician assistant, and social work students. PLoS ONE , 15 (8 August). https://doi.org/10.1371/journal.pone.0237670 Office of Disease Prevention and Health Promotion. (n.d.). Healthy People 2030 . U.S. Department of Health and Human Services. Retrieved April 30, 2024, from https://health.gov/healthypeople/objectives-and-data/browse-objectives/lgbt Parameshwaran, V., Cockbain, B. C., Hillyard, M., & Price, J. R. (2017). Is the Lack of Specific Lesbian, Gay, Bisexual, Transgender and Queer/Questioning (LGBTQ) Health Care Education in Medical School a Cause for Concern? Evidence From a Survey of Knowledge and Practice Among UK Medical Students. J Homosex , 64 (3), 367–381. https://doi.org/10.1080/00918369.2016.1190218 Parnell, T., Fiske, K., Stastny, K., Sewell, S., & Nott, M. (2023). Lived experience narratives in health professional education: educators’ perspectives of a co-designed, online mental health education resource. BMC Medical Education , 23 (1), 946. https://doi.org/10.1186/s12909-023-04956-0 Quinn, G. P., Sutton, S. K., Winfield, B., Breen, S., Canales, J., Shetty, G., Sehovic, I., Green, B. L., & Schabath, M. B. (2015). Lesbian, Gay, Bisexual, Transgender, Queer/Questioning (LGBTQ) Perceptions and Health Care Experiences. J Gay Lesbian Soc Serv , 27 (2), 246–261. https://doi.org/10.1080/10538720.2015.1022273 Rethorn, Z. D., Maxwell, J. L., Bezner, J. R., Davenport, T. E., Bradford, E. H., Ingman, M. S., & Magnusson, D. M. (2021). What Are DPT Program Practices and Attitudes Related to Population Health, Prevention, Health Promotion, and Wellness? Results of a National Survey. Physical Therapy , 101 (1). https://doi.org/10.1093/ptj/pzaa178 Ross, M. H., & Setchell, J. (2019). People who identify as LGBTIQ + can experience assumptions, discomfort, some discrimination, and a lack of knowledge while attending physiotherapy: a survey. J Physiother , 65 (2), 99–105. https://doi.org/10.1016/j.jphys.2019.02.002 Scott, S. B., Knopp, K., Yang, J. P., Do, Q. A., & Gaska, K. A. (2023). Sexual Minority Women, Health Care Discrimination, and Poor Health Outcomes: A Mediation Model Through Delayed Care. LGBT Health , 10 (3), 202–210. https://doi.org/10.1089/lgbt.2021.0414 Sirufo, M. M., Magnanimi, L. M., Ginaldi, L., & De Martinis, M. (2023). Overcoming LGBTQI+ Disparities in Cardio-Oncology. JACC: CardioOncology , 5 (2), 267–270. https://doi.org/10.1016/j.jaccao.2022.11.017 Standards and Required Elements for Accreditation of Physical Therapist Education Programs, American Physial Therapy Association (2025). Tatta, J., & Dillon, F. R. (2024). Queering the Physical Therapy Curriculum: Suggested Competency Standards to Eliminate LGBTQIA+ Health Disparities. Physical Therapy , 104 (9). https://doi.org/10.1093/ptj/pzad169 The Williams Institute. (2019, January). LGBT Demographic Data Interactive . UCLA School of Law. https://williamsinstitute.law.ucla.edu/visualization/lgbt-stats/?topic=LGBT#about-the-data Additional Declarations No competing interests reported. Supplementary Files OnlineResource11.docx OnlineResource21.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 26 Mar, 2026 Reviews received at journal 19 Feb, 2026 Reviewers agreed at journal 13 Feb, 2026 Reviewers invited by journal 11 Feb, 2026 Editor assigned by journal 29 Jan, 2026 Submission checks completed at journal 29 Jan, 2026 First submitted to journal 28 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8723512","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":590899558,"identity":"ec50e774-919f-421e-9bb1-7ddbdce8276c","order_by":0,"name":"Christine A. 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The larger the segment indicates the more frequently that theme was identified.\u003c/p\u003e","description":"","filename":"Figure21.png","url":"https://assets-eu.researchsquare.com/files/rs-8723512/v1/a91c342a952ffd5788025258.png"},{"id":102759187,"identity":"8ec20f46-1746-440f-859c-0d1e206db711","added_by":"auto","created_at":"2026-02-16 10:12:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1596664,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8723512/v1/8ba6f793-6289-4e69-92ab-46a198fb216c.pdf"},{"id":102758842,"identity":"7c5abb4d-c50c-4001-b44a-f8a49168c149","added_by":"auto","created_at":"2026-02-16 10:11:55","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":22438,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineResource11.docx","url":"https://assets-eu.researchsquare.com/files/rs-8723512/v1/fe71fa8cdf3594ee94df414d.docx"},{"id":102758700,"identity":"fff8f9b1-9db1-40bc-ade8-034f627915f1","added_by":"auto","created_at":"2026-02-16 10:11:26","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":24732,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineResource21.docx","url":"https://assets-eu.researchsquare.com/files/rs-8723512/v1/8f5aa1f19caade9034403358.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"LGBTQ+ curriculum content and delivery in PT education: A mixed-methods study","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePhysical therapists have a duty, as healthcare providers, to help prevent chronic conditions and disability, improve the overall health of society, and limit avoidable healthcare costs (APTA, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). To fulfill this duty, physical therapists need to be armed with the knowledge and skills necessary to promote health in all populations. Population health has been described as focusing on interrelated conditions and factors that influence the health of populations over the life course, systematic variations in their patterns of occurrence, and the resulting knowledge to develop and implement policies and actions to improve the health and well-being of populations (Frank, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e1995\u003c/span\u003e). The mission of the American Physical Therapy Association (APTA), \u0026ldquo;Building a community that advances the profession of physical therapy to improve the health of society\u0026rdquo;, highlights the importance of providing training in population health so that future clinicians are equipped to meet population health needs (APTA, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Similar to medical education, physical therapy education is challenged to incorporate population health content into already full curricula (Dunleavy et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Armstrong et al. defined population health in the context of health sciences education as \u0026ldquo;the health and well-being of the individual/patient in context to the population they are a constituent of\u0026rdquo;. In support of this definition, a conceptual framework was developed for including population health concepts within health sciences curricula (Armstrong et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The components include human development, social and economic environment, physical environment, health systems and healthcare, and nation, state and global health. These concepts are likely embedded into curricula across the health sciences to meet related accreditation standards (Accreditation Council for Occupational Therapy Education, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Council on Academic Accreditation; Audiology, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Standards and Required Elements for Accreditation of Physical Therapist Education Programs, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) that provide the foundation for understanding the minimum expectations for health providers. Because the model components are already present in curricula, integrating these concepts for a better understanding of patient health within the context of a population provides an opportunity to leverage existing content rather than introducing a new curriculum.\u003c/p\u003e \u003cp\u003eRethorn et al surveyed DPT programs and found that nearly all programs reported teaching prevention, health promotion, and wellness, but only 78% reported teaching population health (Rethorn et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). In the programs where population health was taught, only 15% of the topics were reported to be covered in depth. The concept of population health is built on the principle that understanding the specific needs of a population results in improved, targeted healthcare to meet those needs (Kindig \u0026amp; Stoddart, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). Providers should possess a deep understanding of population norms, values, and needs to tailor healthcare strategies that promote equitable and effective health outcomes. Survey reports indicate that a higher number of hours devoted to a population-specific curriculum results in an improved understanding of specific population needs and preferences (Nowaskie et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Nowaskie \u0026amp; Patel, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Utilizing sample populations that experience significant health disparities is one method to address all identified population health components to help students contextualize the individual patient within their constituent population.\u003c/p\u003e \u003cp\u003eOne sample group that easily integrates these concepts is the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) population. Consisting of a wide range of individuals across all demographics, including ethnicity, race, socioeconomic status, religion, and age, this sample represents patients all health science students are likely to encounter (The Williams Institute, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Additionally, the Office of Disease Prevention and Health Promotion has identified improving the health and well-being of LGBT populations as a national priority (Office of Disease Prevention and Health Promotion, n.d.) due to long-standing, disproportionate health disparities relative to the general population (Gonzales et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Janes et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Nair et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Students from several healthcare disciplines report a lack of training related to LGBTQ+ healthcare needs(Braun et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Morton et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Further, a survey of Doctor of Physical Therapy (DPT) program directors indicated wide variation in curricular hours devoted to LGBTQ+ topics, ranging from zero to greater than five hours (Adamson et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This suggests differences in preparation among healthcare students to meet the needs of diverse populations.\u003c/p\u003e \u003cp\u003eHealth disparities within the LGBTQ+ population provide examples of the framework components of human development, social and economic environment, and physical environment. Commonly reported health disparities for the LGBTQ+ population include increased rates of mental health disorders, such as depression, anxiety (Borgogna et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), and substance use disorders (Mereish et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Quinn et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), increased rates of homelessness, increased risky behaviors including experiences of bullying (Garaigordobil \u0026amp; Larrain, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and violence (Flores et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e),and increased risky sexual behavior (Gonzales \u0026amp; Henning-Smith, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Additionally, the LGBTQ+ population experiences disproportionate rates of cancer and cardiovascular disease (Sirufo et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Health providers are likely to encounter secondary impairments as a sequela of health disparities. The National Center for Transgender Equity reports that 39% of respondents to a national survey identified as transgender and that they had one or more disabilities where disability was defined as having \u0026ldquo;serious difficulty in the performance of major life activities such as hearing, seeing, or walking\u0026rdquo; (Gonzales \u0026amp; Henning-Smith, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). This statistic reinforces that it is clear that healthcare provider are likely to interact with the community to address and support the functional independence of individual patients. Notably, three primary health-specific barriers have been identified for individuals who are transgender with disabilities, including (1) higher levels of discrimination relative to transgender individuals who do not have disabilities, (2) increased discrimination when attempting to access mental health and other crisis support centers, and (3) an increased incidence of cost of care barriers (Jette, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBarriers to care may be contextualized within the health systems and healthcare and nation, state and global health components of the framework. A common barrier for the LGBTQ+ population includes previous negative healthcare experiences resulting in delayed access to health providers, decreased health outcomes, and care that does not meet the standards of best practice (Ross \u0026amp; Setchell, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Reported discrimination of sexual minority women by healthcare providers was associated with higher physical and emotional impairment and delayed care (Scott et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). A review of qualitative studies investigating the health impact of stigma, discrimination, prejudice, and bias experienced by transgender people found that when these negative experiences are internalized, it leads to decreased health outcomes due to healthcare avoidance, reduced healthcare utilization, decreased screenings, and delayed treatment (Drabish \u0026amp; Theeke, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs a result of known disparities and lack of LGBTQ+ provider competence, patients, students, and researchers have called for increased LGBTQ+-specific instruction in health sciences education (Morton et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Nowaskie et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Parameshwaran et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Charles et al published a clinical commentary highlighting the lack of LGBTQ+ cultural competency in PT education (Charles et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The authors highlighted the need for greater inclusion of LGBTQ+ population-specific content in PT education while recognizing a distinct lack of research and guidance around pedagogical principles and specific curriculum recommendations (Charles et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The aim of this mixed-methods research was to describe the current state of LGBTQ+ curriculum in PT education as a first step in developing entry-level curricular guidelines. Specific objectives were to: 1) evaluate faculty attitudes and beliefs regarding LGBTQ+ curriculum and 2) thoroughly describe the content highlighted in PT education. It was hypothesized that faculty believe LGBTQ+ content is important, and there would be a wide variation in curricular content, delivery, and instructional method.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis study used an exploratory sequential mixed-methods design (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) and was approved by the IRB at the College of St. Scholastica. IRB #1844021-5 for Phase I, #1998630-1 for Phase II. The first phase of the study was grounded in an interpretivist research paradigm using a phenomenological qualitative approach. The first step in understanding the research question is to observe and describe what is happening, making a phenomenological approach the most appropriate choice for this study. Utilizing an interpretivist paradigm (Alharahsheh \u0026amp; Pius, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) allowed an in-depth exploration of PT educators' subjective experiences, attitudes, and beliefs about the inclusion of LGBTQ+ content within PT education. The first and last authors collectively have 17 years in PT education and expertise in inclusion of LGBTQ+ topics within PT curricula.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn the fall of 2021, interview questions were created using themes identified in previous medicine and nursing literature. These a priori themes included specific content, course location, instructional methods, topic importance, personal experience, and barriers or facilitators. A mock interview was conducted to assess question clarity and determine the initial question order. A semi-structured interview design was established to allow for clarifying, qualifying, or follow-up questions. All focus group sessions were conducted and recorded via Zoom to allow for nationwide participation. Initial recruitment was conducted between January and March 2022. Focus group sessions occurred between February 2022 and March 2022. Phase 1 analysis was conducted from April 2022 through October 2022.\u003c/p\u003e \u003cp\u003eThe second phase of the study was conducted via a quantitative survey. Survey questions were developed using data from phase 1 from November 2022 - December 2022 and distributed from December 2022 - February 2023. Survey development used common themes around content and course delivery obtained from the focus groups. Additionally, literature related to LGBTQ+ content in health professions was explored to determine more specific content areas and instructional methods. The survey consisted of up to 43 questions in the following domains: 1) demographic information, 2) population health, 3) unique population language and terminology, 4) unique population health needs, 5) clinical skills, and 6) instructional design. Question types included multiple-choice, multiple-select, and blank text.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eFocus group participants were recruited from CAPTE-accredited DPT and PTA programs. An email describing the study was sent to all CAPTE-accredited DPT and PTA program directors, requesting they forward the study email to the appropriate faculty. Included in the email was a link to a brief screening survey consisting of demographic questions and study consent. To maximize reach, snowball sampling was encouraged. By completing and signing the screening survey, participants consented to be enrolled in the study. Inclusion criteria required study participants to be at least 18 years of age, currently teach LGBTQ+ content, or have created or delivered LGBTQ+ content within the past 5 years. Exclusion criteria included individuals who were exclusively clinical instructors or don\u0026rsquo;t teach LGBTQ+ content, and faculty teaching exclusively in transitional DPT, bridge, or non-CAPTE accredited programs.\u003c/p\u003e \u003cp\u003eSurvey participants were recruited in the same manner as the focus groups. Additionally, participants were recruited through emails from the following organizations: American Council of Academic Physical Therapy (ACAPT), Academy of PT Research, PT Proud, Academy of Pelvic Health Physical Therapy, and OutCare. Inclusion criteria required study participants to be DPT or PTA faculty from CAPTE-accredited and developing programs. Faculty definition included core faculty, adjunct, clinical, and guest speakers. All participants needed to be over the age of 18 years. Exclusion criteria included individuals teaching exclusively in transitional DPT, bridge, or non-CAPTE accredited programs. All participants completed an informed consent prior to participation in the survey.\u003c/p\u003e\n\u003ch3\u003eQualitative Data Analysis\u003c/h3\u003e\n\u003cp\u003eZoom (Version 5.17.11; Zoom Video Communications, Inc.) was used to conduct and record the focus group sessions. NVivo Version 13 (2020, R1; Lumivero) was used for transcription and coding. Hand transcription was also performed for correction. Inductive in-vivo coding was conducted independently by the first and last authors. The agreed-upon codes were deductively applied to all focus groups while simultaneously continuing an inductive analysis to identify new emergent codes. Focus groups were completed until saturation of data was evident. Data saturation was determined by repetition of previous observations with no new themes identified. Triangulation of findings occurred through participant findings, previous literature, and researcher experiences. Trustworthiness was ensured with the first and last authors maintaining a reflexive approach: sharing potential assumptions and relying on each other to identify and address potential biases and assumptions throughout the study phases. The remaining authors served as peer reviewers throughout the process. Qualtrics (Qualtrics, Provo, UT) was used to gather sample descriptives and scheduling availability.\u003c/p\u003e\n\u003ch3\u003eQuantitative Data Analysis\u003c/h3\u003e\n\u003cp\u003eQualtrics (Qualtrics, Provo, UT) was used to collect data from the phase II quantitative survey. Microsoft Excel (Version 16.79; Microsoft) software was used to calculate descriptive statistics.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eQualitative Focus Group Demographics\u003c/h2\u003e \u003cp\u003e Thirteen educators from across the United States (Pacific = 1, West-North Central = 4; East-South Central = 2; East-North Central = 1; Mountain = 2; Mid-Atlantic = 1; South Atlantic = 2) participated in focus groups or individual interviews. Seven were faculty in a DPT program, five were faculty in a PTA program, and one was faculty in both DPT and PTA programs.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQualitative Focus Group Results\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1: Instructional methods and design\u003c/h2\u003e \u003cp\u003e Participants were asked about the specific methods used to deliver LGBTQ+ curriculum within their programs. The most frequently reported methods were lecture and exam, discussion, case studies, reflection, and including evidence. Active learning methods were frequently used.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWe generally do that (scaffolding) through case studies, where they (the students) are provided a case study, and maybe they’re only working on one part of the case. They learn some information in lecture and then they’re let loose to answer some critical thinking, or create interventions…\u003c/p\u003e\u003cp\u003eI think the case studies and the projects that the students do are far more powerful.\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003eParticipants frequently reported using lived experience as a teaching tool in discussions, case studies, and reflection. Lived experience was introduced most often through guest speakers or panels consisting of LGBTQ+ persons. Student and faculty lived experiences were also referenced as teaching tools.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e...we had a transgender male and his wife come and talk to us about their lived experience.\u003c/p\u003e\u003cp\u003eHaving students who are brave enough to share their own personal perspective helps us a lot.\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003eIn addition to the explicit teaching of content, participants also rely on implicit learning, the use of modeling, and the building of relationships.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e...if they see faculty saying that this is important and modeling the type of welcoming behaviors we expect within the healthcare environment…\u003c/p\u003e\u003cp\u003eThe fact is I’m not overtly teaching them something, but I’m working with them and I am open with, you know, I have a partner and all of these things.\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003eThe importance of creating an emotional connection was identified as a sub-theme within the different instructional methods.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eSo, putting a human face or a story or something that makes it memorable.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“But if you give them some type of emotional reaction, whether it’s positive or even if it’s discomfort, it’s still an emotional reaction, it’s still going to stick with them”.\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: Outcomes\u003c/h2\u003e \u003cp\u003eWhen asked to describe how the education their students received adequately prepares graduates to interact with the LGBTQ+ population, the resounding response was “we’re not”.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eYeah, and I’m not going to have a very good answer because I’m going to say that we don’t prepare them for this, right? We don’t.\u003c/p\u003e\u003cp\u003eWell, we’re not doing an adequate job.\u003c/p\u003e\u003cp\u003eI would suggest that we’re not adequately preparing them yet. I think what we’re doing is a drop in the bucket.\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003eDespite these initial reactions, participants went on to say that they hope the current education will eventually lead to change.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI hope we scratched the surface of their awareness so that they can be a little more perceptive, a little more open, and have the groundwork, just the foundation for understanding how to create a safe space.\u003c/p\u003e\u003cp\u003eAnd so I think that students walk away with a bigger appreciation of why they do need to take in the whole 360.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“But generally, it’s how we are educating the entry-level practitioner to be able to be adaptable to the situation. Based on the presentation of the patient and also the society and community of wherever they end up at.”\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: Specific Content\u003c/h2\u003e \u003cp\u003e Participants were explicitly asked what topics related to LGBTQ+ healthcare were covered in their programs. Five main areas of content were identified: 1) Language, 2) Unique population needs, 3) Social determinants of health, 4) Access to care, and 5) Health disparities (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). While not frequently mentioned the topics of trauma-informed care, misinformation, and bias were also included in some curricula. Content around language ranged from including basic descriptions and definitions of preferred name, pronouns, what it means to be non-binary versus lesbian, gay, bisexual, etc., to more applied use of how to perform inclusive interviewing. Unique population needs included coverage of healthcare concerns and needs of transgender individuals and identifying barriers to care for LGBTQ+ patients and clients. Social determinants of health including the impact of chronic stress, stigma and societal bias, intersectionality, and cultural competence were included.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative Survey Demographics\u003c/h2\u003e \u003cp\u003eSeventy-eight complete surveys were recorded. The descriptive characteristics of the respondents are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The majority reported teaching in a DPT program (78.2%), followed by a PTA program (17.9%), and both (3.85%). Core faculty positions were the most represented (65.4%), followed by adjunct faculty (12.8%) and guest speakers (11.5%). When asked about their relationship to the LGBTQ+ community, the majority have worked professionally with a member of the community (33.0%) or know someone who is part of the community (29.0%). Respondents were geographically diverse, with the largest response rate from the South Atlantic (23.1%), followed by Mid-Atlantic (15.4%), East-North Central (15.4%), and West-North Central regions (14.1%). The duration of time respondents have been teaching LGBTQ+ content fell mostly within the 2–4 year range (32.5%) with the next largest group indicating they have developed but not yet taught content (22.1%). The most frequently reported LGBTQ+-specific continuing education and/or training topics were cultural competency training (17.0%), bias training (14.9%), and education on social determinants of health (11.0%).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic information of quantitative survey respondents.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e \u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eType of Program (n = 78)\u003c/p\u003e \u003c/th\u003e\u003cth colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eDPT\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e61 (78.2%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003ePTA\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e14 (17.9%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e3 (3.85%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cb\u003eFaculty Role (n = 78)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eCore faculty\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e51 (65.4%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eAdjunct faculty\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e10 (12.8%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eGuest speaker\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e9 (11.5%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eClinical Instructor\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e2 (2.56%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eDepartment Chair\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e4 (5.13%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e2 (2.56%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cb\u003eRelationship to LGBTQ+ Community (Select all that apply) (n = 176)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eI am a member of the LGBTQ+ community\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e19 (10.8%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eI have a close family member/friend who is part of the LGBTQ+ community\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e45 (25.6%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eI know someone who is a part of the LGBTQ+ community\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e51 (29.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eI have worked professionally with a member of the LGBTQ+ community\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e58 (33.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eI choose to limit my interactions with the LGBTQ+ community\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e1 (0.57%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eI actively avoid interactions with the LGBTQ+ community\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eNo relationship to the LGBTQ+ community\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e1 (0.57%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003ePrefer not to state\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e1 (0.57%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cb\u003eGeographic Region (n = 78)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eNew England (ME, VT, NH, MA, RI, CT)\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e3 (3.85%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eMid-Atlantic (DE, NY, NJ, MD, PA)\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e12 (15.4%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eSouth Atlantic (VA, NC, SC, GA, FL, Puerto Rico)\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e18 (23.1%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eEast-North Central (WI, MI, IL, OH, IN)\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e12 (15.4%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eEast-South Central (KY, TN, MS, AL, WV)\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e3 (3.85%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eWest-North Central (MN, ND, SD, MO, NE, KS, IA)\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e11 (14.1%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eWest-South Central (TX, OK, LA, AK)\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e4 (5.13%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eMountain (NM, AZ, CO, NV, UT, ID, MT, WY)\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e7 (8.97%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003ePacific (WA, OR, CA, AK, HI)\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e8 (10.3%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cb\u003eDuration of Teaching LGBTQ+ Content (n = 77)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eContent developed but not yet taught\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e17 (22.1%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e1 year\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e13 (16.9%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e2–4 years\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e25 (32.5%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e5–7 years\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e10 (13.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e8–10 years\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e7 (9.09%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eMore than 10 years\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e5 (6.49%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" nameend=\"c2\" namest=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cb\u003eContinuing Education and/or Training Specific to the LGBTQ+ Population\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(Select all that apply) (n = 382)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eBias training\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e57 (14.9%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eCultural competency training\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e65 (17.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003ePopulation specific health needs\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e38 (9.95%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eSocial determinants of health\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e42 (11.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eSexual history taking\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e25 (6.54%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eAlly training\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e25 (6.54%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eTrauma informed care\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e35 (9.16%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eCompetency for working with LGBTQ+ students\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eEthical and legal training\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e28 (7.33%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eAdvocacy training\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e20 (5.24%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eEvidence based practice for clinical care\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e36 (9.42%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e7 (1.83%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eI have no specific education/training\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e4 (1.05%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003en = Total number of times the response was selected. Some numbers add to more than the total number of surveys due to the option to select more than one response.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003ePopulation Health, Social Determinants of Health, and Health Literacy\u003c/h2\u003e \u003cp\u003eEighty-eight percent of respondents report including population health topics into curricula (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Of those who responded yes, understanding the unique health needs of specific populations (30.5%) and recognizing health disparity as a preventable health difference among populations (30.5%) were the most included population health topics (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Women (22.1%), LGBTQ+ (21.2%), and Black American (19.5%) populations were used the most when teaching population health concepts (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The majority of respondents include content related to social determinants of health. (92.0%; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Seventy-nine percent of respondents include health literacy in their curriculum. Of those responding yes, information about health literacy as a concept (22.2%), use of reading levels for patient education materials (19.6%), and importance of the use of common language (19.1%) were the most frequently included topics (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency of specific population health, social determinants of health and health literacy topics included in PT education.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e \u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003ePopulation Health\u003c/p\u003e \u003c/th\u003e\u003cth colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003ePopulation Health is Included in Curriculum (n = 77)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e68 (88.3%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (11.7%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eSpecific Population Health Topics When Including Population Health (Select All That Apply) (n = 190)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eTriple/Quadruple/Quintuple Aim\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (9.47%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eUnderstanding unique health needs of specific populations\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e58 (30.5%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eRecognizing health disparity as preventable health differences among populations\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e58 (30.5%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eDifference in access to care among populations\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e55 (28.9%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.53%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eSample Populations Used When Including Population Health (Select All That Apply) (n = 226)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e50 (22.1%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eLGBTQ+\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e48 (21.2%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eBlack American\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e44 (19.5%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eNative American\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (12.8%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eVeterans\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e23 (10.2%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eRefugees\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (4.42%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eMigrant workers\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (5.31%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eOther (disabilities, sex workers, transgender and non-binary, older adults, generational poverty,\u003c/p\u003e \u003cp\u003eunhoused/rural population, Hispanic/Latino, and incarcerated or formerly incarcerated persons)\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (4.42%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cb\u003eSocial Determinants of Health\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eSocial Determinants of Health are Included in Curriculum (n = 75)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e69 (92.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (8.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cb\u003eHealth Literacy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eHealth Literacy is Included in Curriculum (n = 72)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e57 (79.2%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (20.8%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eSpecific Health Literacy Topics When Including Health Literacy (Select All That Apply) (n = 225)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eInformation about health literacy as a concept\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e50 (22.2%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eRisk factors for low health literacy\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e39 (17.3%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eTools used to measure health literacy\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (9.33%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eStrategies to improve health literacy\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (12.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eImportance of use of common language\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (19.1%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eUse of reading levels for patient education materials\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e44 (19.6%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eOther (Effects of low health literacy)\u003c/p\u003e \u003c/td\u003e\u003ctd char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.44%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003en = Total number of times the response was selected. Some numbers add to more than the total number of surveys due to the option to select more than one response.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eUnique Population Language and Terminology\u003c/h2\u003e \u003cp\u003eThe most frequently included topics related to unique LGBTQ+ population language and terminology include the use of legal and preferred names (93.0%), inappropriate or offensive language (88.2%), the use of neutral or non-gendered language (77.9%), and best practices related to documentation (e.g. use of inclusive intake forms, patient preferred and/or legal name, etc.) (71.9%; Online Resource 1). Less than half of responses indicated that the topics of deadnaming (36.6%), teaching about intersex (47.8%), community ownership of language (41.2%), and use of patient-preferred anatomy language (47.1%) were included in curricula (Online Resource 1).\u003c/p\u003e \u003cp\u003eWhen asked about specific topics related to pronoun use, the most frequently included topics were use of inclusive practices related to forms and electronic medical records (19.0%) and sharing of personal pronouns (19.0%; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Man (14.6%), woman (13.7%), and non-binary (13.7%) were the most frequently reported gender identities, followed closely by transgender man (13.5%) and transgender woman (13.7%; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Sexual identities most commonly reported were heterosexual/straight (16.0%), lesbian (16.0%), gay (15.7%), and bisexual (14.6%; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSpecific LGBTQ+ population language, terminology, and population health needs included in PT education.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e \u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eUnique Population Language and Terminology\u003c/p\u003e \u003c/th\u003e\u003cth colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd colspan=\"2\" nameend=\"c2\" namest=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eWhat Topics Do You Include Related to Pronoun Use (Select All That Apply) (n = 274)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eWhy it matters\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e47 (17.5%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eInclusive practices for forms and electronic medical records\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e52 (19.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003ePatient disclosures/documentation concerns\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e32 (11.7%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eSharing personal pronouns\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e52 (19.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003ePronoun use with patients\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e51 (18.6%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003ePractice of apologizing\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e30 (10.9%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eDo not teach about pronouns\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e10 (3.65%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" nameend=\"c2\" namest=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eWhen you teach about gender identity which identities do you include? (Select All That Apply) (n = 417)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eAgender\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e26 (6.24%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eAndrogyne\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e5 (1.20%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eDemigender\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e4 (0.96%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eGender queer/Gender fluid\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e44 (10.6%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eMan\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e61 (14.6%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eNon-binary\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e57 (13.7%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eQuestioning or unsure\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e31 (7.43%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eTransgender man\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e56 (13.5%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eTransgender woman\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e56 (13.5%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eTwo-spirit\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e17 (4.10%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eWoman\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e57 (13.7%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eOther (metagender, intersex, do not include)\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e3 (0.72%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" nameend=\"c2\" namest=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eWhich identities do you include related to sexual identity? (Select All That Apply) (n = 343)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eAsexual\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e32 (9.33%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eBisexual\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e50 (14.6%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eGay\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e54 (15.7%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eHeterosexual/Straight\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e55 (16.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eLesbian\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e55 (16.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003ePansexual\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e26 (7.58%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eQueer\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e35 (10.2%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eQuestioning\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e26 (7.58%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eOther (demisexual)\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e2 (0.58%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eDo not include\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e8 (2.33%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cb\u003eUnique Population Health Needs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" nameend=\"c2\" namest=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eWhich of the following health disparities in the LGBTQ+ population do you include (Select all that apply) (n = 163)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eMental health (e.g. suicide, depression, etc)\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e44 (27.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eSubstance use/abuse\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e33 (20.2%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003ePrevention of health disparities\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e34 (20.9%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eHealth risks related to gender identity (e.g. screening for prostate cancer in trans-female\u003c/p\u003e \u003cp\u003epatients)\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e38 (23.3%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eI do not cover any specific LGBTQ+ health disparities\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e14 (8.59%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" nameend=\"c2\" namest=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eWhat specific information about non-surgical practices do you include? (Select all that apply) (n = 52)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eInformation that patients may be participating in these practices\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e21 (40.4%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003ePotential risks and/or side effects of these practices\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e16 (30.8%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eTechniques to minimize risk and/or manage side effects of these practices\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e14 (29.9%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eOther (Include handouts for clinicians related to these practices)\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e1 (1.92%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" nameend=\"c2\" namest=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eWhich of the following gender confirmation surgeries do you cover? (Select all that apply) (n = 123)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eTop Surgery – Mastectomy\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e13 (10.6%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eTop Surgery – Breast augmentation\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e10 (8.13%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eBottom Surgery – Vaginoplasty\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e13 (10.6%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eBottom Surgery – Phalloplasty\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e12 (9.76%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eBottom Surgery – Metoidoplasty\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e8 (6.50%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eTop Surgery – General concepts\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e21 (17.1%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eBottom Surgery – General concepts\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e22 (17.9%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003ePostoperative considerations and management\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e22 (17.9%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eOther (Double incision or chest wall reduction (not mastectomy))\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e2 (1.63%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" nameend=\"c2\" namest=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003ePlease indicate which of the following team members you include as part of management of LGBT patients. (Select all that apply) (n = 149)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eSpeech Therapist\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e17 (11.4%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eOccupational Therapist\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e16 (10.7%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003ePhysician – Primary care\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e38 (25.5%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eSurgeon\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e32 (21.5%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eMental Health Professional\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e37 (24.8%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eOther (Dietician, Physical Therapist, Pelvic Health PT, Social Work, front desk staff, RNs,\u003c/p\u003e \u003cp\u003eAides)\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e9 (6.04%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003en = Total number of times the response was selected. Some numbers add to more than the total number of surveys due to the option to select more than one response.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eUnique Population Health Needs\u003c/h2\u003e \u003cp\u003eLess than half of respondents (43.9%) indicate including LGBTQ+ health needs across the lifespan (Online Resource 1). Specific LGBTQ+ health disparities covered are included in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Just over half of respondents (52.3%) report including content related to policies that include/exclude or otherwise limit access to healthcare, participation in sports, and quality of life (Online Resource 1). Less than half of the responses indicate that nonsurgical practices and gender-affirming surgeries are covered (31.8% and 40%, respectively; Online Resource 1). Of those who include nonsurgical practices, the most frequently included topics are general information that patients may be participating in these practices (40%) and potential risks of these practices (30.8%; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Of those including gender-affirming surgeries, general top (17.1%) and bottom (17.9%) surgery along with postoperative considerations/management (17.9%) are covered most frequently (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). When asked about who should be included on care teams for LGBTQ+ patients, primary care physician (25.5%) and mental health professional (24.8%) were selected most often, followed by surgeons (21.5%), speech therapist (11.4%) and occupational therapist (10.7%; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eClinical Skills\u003c/h2\u003e \u003cp\u003eOnly 36.4% of responses indicated that education on sexual interviewing was provided (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Of those including sexual interviewing education, just over half (58.3%) provide opportunities to practice sexual interviewing (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Less than half of responses (36.9%) indicate topics related to LGBTQ+ specific screening (e.g., prostate cancer screening for transgender women, etc.) are included (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Sixty-eight percent of responses indicate trauma-informed care education is provided (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) with consent (19.5%), continued consent (17.7%), trauma-informed draping/modesty (15.9%), and trauma-informed palpation (13.3%) as the most frequently included trauma-informed practices (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical skills and learning outcomes related to LGBTQ+ content in PT education.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e \u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eClinical Skills\u003c/p\u003e \u003c/th\u003e\u003cth colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd colspan=\"2\" nameend=\"c2\" namest=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eDo you provide education on how to perform a sexual interview? (n = 66)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e24 (36.4%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e42 (63.6%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" nameend=\"c2\" namest=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eDo you provide opportunities for students to practice a sexual interview? (n = 24)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e14 (58.3%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e10 (41.7%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" nameend=\"c2\" namest=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eDo you provide education regarding trauma-informed care? (n = 66)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e45 (68.2%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e21 (31.8%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" nameend=\"c2\" namest=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eWhat trauma-informed care concepts are included in your education? (n = 226)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eTrauma informed palpation\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e30 (13.3%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eTrauma informed draping/modesty\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e36 (15.9%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eConsent\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e44 (19.5%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eContinued consent\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e40 (17.7%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eRecognition of dissociation\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e23 (10.2%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eTools to manage dissociation\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e12 (5.31%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eRecognition of sympathetic dysregulation\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e22 (9.73%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eTools to manage sympathetic dysregulation\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e16 (7.08%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e3 (1.33%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" nameend=\"c2\" namest=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eDo you include education regarding specific screening questions for the LGBTQ+ population? (n = 65)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e24 (36.9%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e41 (63.1%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cb\u003eOutcomes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" nameend=\"c2\" namest=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eDo you have course or unit learning objectives related to LGBTQ+ health topics? (n = 64)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e28 (43.8%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e36 (56.3%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" nameend=\"c2\" namest=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eHow are learning outcomes related to LGBTQ+ health topics assessed in your program?\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(Select all that apply) (n = 126)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eMultiple choice exam\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e20 (15.9%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eQuizzes\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e13 (10.3%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eIn class quizzing software\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e7 (5.56%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eSelf-reflection\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e31 (24.6%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003ePeer reflection/assessment\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e10 (7.94%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eLearning not assessed\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e14 (11.1%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eEngagement/participation\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e26 (20.6%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eOther (case studies, student presentations)\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e5 (3.97%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" nameend=\"c2\" namest=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eWhat's the primary Bloom's level for learning outcomes related to LGBTQ+ health topics? (n = 63)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eRemember\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e2 (3.17%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eUnderstand\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e21 (33.3%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eApply\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e18 (28.6%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eAnalyze\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e4 (6.35%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eEvaluate\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e3 (4.76%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eCreate\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e15 (23.8%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" nameend=\"c2\" namest=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003e\u003cem\u003eWhich of the following domains of learning are represented in your curriculum related to LGBTQ+ health topics?\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(Select all that apply) (n = 105)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eCognitive\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e55 (52.4%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003ePsychomotor\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e10 (9.52%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colname=\"c1\" style=\"text-align: left;\"\u003e \u003cp\u003eAffective\u003c/p\u003e \u003c/td\u003e\u003ctd colname=\"c2\" style=\"text-align: left;\"\u003e \u003cp\u003e40 (38.1%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003en = Total number of times the response was selected. Some numbers add to more than the total number of surveys due to the option to select more than one response.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eCurriculum Design and Outcomes\u003c/h2\u003e \u003cp\u003eThe most frequently reported curriculum design elements related to where LGBTQ+ content is included in the curriculum, as well as specific delivery and instructional methods can be found in Online Resource 2. The most frequently reported instructional methods are similar to those identified in the qualitative data analysis.\u003c/p\u003e \u003cp\u003eLess than half of participants (43.8%) report including course or unit learning objectives related to LGBTQ+ topics (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The primary Bloom’s level for learning outcomes related to LGBTQ+ topics were most frequently Understand (33.3%), Apply (28.6%), or Not applicable (23.8%) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The most frequent tools for assessing learning outcomes related to LGBTQ+ health topics were self-reflection (24.6%), engagement/participation (20.6%), multiple-choice exam (15.9%) or learning was not assessed (11.1%) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Cognitive (52.4%) and affective (38.1%) domains of learning related to LGBTQ+ content were more frequently represented than psychomotor (9.52%) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e "},{"header":"Discussion/Conclusion","content":"\u003cp\u003eTo date, this is the first study of its kind to use both qualitative and quantitative methods to describe the current state of LGBTQ+ curriculum in PT education. Overall, the study results confirm the hypothesis that there is wide variation in curricular content, delivery, and instructional methods. The qualitative findings overwhelmingly suggest that faculty who participated felt strongly that the inclusion of LGBTQ+ specific content was important for physical therapy professionals. Participants who reported including this content in curricula used a wide variety of instructional methods, and there were substantial differences in the type and depth of content covered. Interestingly, participants indicated the specific content was not robust enough to adequately prepare students to work with the LGBTQ+ population.\u003c/p\u003e\u003cp\u003eThe quantitative analysis revealed that the majority of faculty who responded were delivering didactic content. Not surprisingly, the most frequently included content topics related to language included differentiation between sex and gender and definitions of various sexual and gender identities. While the majority of participant responses indicate population health topics are included, it is important to note that only 48 programs reported including LGBTQ+-specific content. Forty-eight out of over 300 PT and PTA programs is significantly low, indicating that many students are not provided education specific to the LGBTQ+ population. A survey of program directors conducted by Glick et al reported that LGBTQ+ education was conceptualized within general cultural competence (Glick et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The discrepancy in how faculty and program directors categorize where LGBTQ+ health curriculum should be placed highlights the wide variation in physical therapy education and content.\u003c/p\u003e\u003cp\u003eUsing lived experience as an instructional method has been identified as a powerful teaching strategy for supporting the development of skills, knowledge, and attitudes for health professionals (Parnell et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Participants frequently reported using this instructional method through the lived experiences of faculty, students, and guests. An individual patient case or sample population allows instructors to introduce the unique experiences of one individual to facilitate learning not only content but also skills like empathy, communication, and critical thinking. Respondents highlighted the importance of creating an emotional connection between students and the content. Including these teaching methods may challenge students to consider personal biases, familiar stereotypes, stigma, and fear, while balancing the needs of an individual.\u003c/p\u003e\u003cp\u003eHealth professions education relies on the integration of knowledge, clinical skills, and affective behaviors. While knowledge acquisition is a key component to gaining competency in health professions, it cannot be relied upon as the sole method of teaching and learning. Learners require applied practice to gain proficiency in clinical skills. Nursing literature suggests that skill competency is a slow process requiring practice, and providing deliberate skills practice is one method to help students increase their competence (Liou et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). While programs are providing some LGBTQ+ population-specific instruction, the education appears to be focused primarily on content knowledge. Slightly more than one-third (n = 24) of responding programs reported providing education on how to perform a sexual interview, and just over half of those (n = 14) reported providing opportunities to practice or further develop this clinical skill. To move students towards competency, it is critical for programs to incorporate practice opportunities related to sexual interviewing, health-specific screening, and trauma-informed care practices.\u003c/p\u003e\u003cp\u003eFurther supporting the idea that the focus is knowledge acquisition rather than application are the findings that learning outcomes were reported at primarily the “understand” level of Bloom’s taxonomy. This may not be surprising due to suggested competency standards being written at the “remember” and “understand” levels (Tatta \u0026amp; Dillon, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Ultimately, less than half of programs (n = 28) reported any specific outcomes related to LGBTQ+ content. While the results of the current study indicate lower levels of learning outcomes, recommended competencies in population health, prevention, health promotion, and wellness span all levels of learning (Magnusson et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This finding reflects the need to increase the depth of learning to adequately prepare clinicians to transfer their content knowledge into new and different patient situations rather than just repeating what they’ve memorized previously.\u003c/p\u003e\u003cp\u003ePhase I limitations include the possibility that critical information was missed due to participant self-selection. It is possible that those who strongly feel this content is not relevant to clinical care did not participate. Because of the semi-structured nature of the focus groups, it is possible that information was missed and therefore not further explored in Phase II. Phase II limitations include participant self-selection and potential lack of participation from programs that do not include or teach LGBTQ+ content.\u003c/p\u003e\u003cp\u003eSkilled physical therapy requires decision-making that incorporates patient-specific factors that may impact the delivery of care, potential barriers to care, and expected outcomes. While physical therapy professionals are well-positioned to provide care to all patient populations, the noted variation in LGBTQ+ education may limit providers from considering the patient as an individual with unique needs and experiences. Collectively, these findings indicate a significant lack of standardized education and assessment related to LGBTQ+ curricula in PT education. To equip physical therapy professionals with adequate skills to provide competent LGBTQ+ care, educators need to transition from providing basic knowledge instruction to offering opportunities for skill acquisition and practice. Connecting the education provided to explicit learning outcomes will allow future research to focus on assessing how professional education impacts health outcomes for the LGBTQ+ population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eFunding Declaration\u003cbr\u003e\u003c/em\u003eNo funding was received to assist with the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eHuman Ethics Declaration\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical standards of the Declaration of Helsinki. The research protocol was reviewed and approved by the College of St. Scholastica Internal Review Board at College of St. Scholastica, Inc. The IRB approval number for this study is 1844021-1.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eConsent to Participate Declaration\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAccreditation Council for Occupational Therapy Education. (2023). \u003cem\u003e2023 Accreditation Council for Occupational Therapy Education (ACOTE) Standards and Interpretive Guide\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdamson, T., Lett, E., Glick, J., Garrison-Desany, H. M., Restar, A., \u0026amp; Adamson, M. T. (2022). 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Queering the Physical Therapy Curriculum: Suggested Competency Standards to Eliminate LGBTQIA+ Health Disparities. \u003cem\u003ePhysical Therapy\u003c/em\u003e, \u003cem\u003e104\u003c/em\u003e(9). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/ptj/pzad169\u003c/span\u003e\u003cspan address=\"10.1093/ptj/pzad169\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Williams Institute. (2019, January). \u003cem\u003eLGBT Demographic Data Interactive\u003c/em\u003e. UCLA School of Law. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://williamsinstitute.law.ucla.edu/visualization/lgbt-stats/?topic=LGBT#about-the-data\u003c/span\u003e\u003cspan address=\"https://williamsinstitute.law.ucla.edu/visualization/lgbt-stats/?topic=LGBT#about-the-data\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"global-lgbtq-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Global LGBTQ+ Health](https://link.springer.com/journal/44506)","snPcode":"44506","submissionUrl":"https://submission.springernature.com/new-submission/44506/3","title":"Global LGBTQ+ Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8723512/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8723512/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Lesbian, gay, bisexual, transgender, questioning or queer, intersex, asexual, + all inclusive (LGBTQ+) populations have known health disparities. Even where disparities are not known, it is clear that the population has unique health concerns that require a specific approach to appropriate examination and care. Previous studies examining LGBTQ+ curricula within health professions programs have found variability in content, delivery methods, and the number of hours devoted to its study. This variability has the potential to result in differences in student knowledge, competency, and confidence in working with patients from this population. The aim of this mixed-methods research was to describe the current state of LGBTQ+ curricula in PT education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubjects:\u003c/strong\u003e Faculty in CAPTE-accredited and developing PT and PTA programs who teach or are developing LGBTQ+ content.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This study used an exploratory sequential mixed-methods design. Phase I included focus groups followed by in vivo coding for thematic identification. Using the results from Phase I, a quantitative survey was developed and distributed for Phase II. Quantitative data analysis was performed using descriptive statistics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Phase I results indicated faculty strongly feel LGBTQ+ content is critical for clinical development. They also feel the current curriculum is not adequately preparing student clinicians. Phase II results indicated wide variety in breadth and depth of content and confirmed minimal opportunity for clinical skill development. Additionally, few participants reported development of specific learning objectives and assessment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion and Conclusio\u003c/strong\u003en: With wide variety in the instructional methods used and LGBTQ+ content provided; students may be missing critical knowledge necessary to provide competent care. To improve the quality of LGBTQ+ curricula PT educators need to begin connecting skills acquisition to the content provided through explicit learning outcomes and assessment.\u003c/p\u003e","manuscriptTitle":"LGBTQ+ curriculum content and delivery in PT education: A mixed-methods study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-16 10:08:39","doi":"10.21203/rs.3.rs-8723512/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"46933548852949700967634320529864582221","date":"2026-03-26T15:02:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-19T18:53:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"26840221824666121677190819953200876886","date":"2026-02-13T12:50:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-11T10:59:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-30T02:46:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-30T02:44:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"Global LGBTQ+ Health","date":"2026-01-28T15:45:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"global-lgbtq-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Global LGBTQ+ Health](https://link.springer.com/journal/44506)","snPcode":"44506","submissionUrl":"https://submission.springernature.com/new-submission/44506/3","title":"Global LGBTQ+ Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ed2040aa-56fe-46b5-9873-dde7163de0ff","owner":[],"postedDate":"February 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T10:08:39+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-16 10:08:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8723512","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8723512","identity":"rs-8723512","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}