An education intervention in gastrointestinal healthcare workers improves knowledge of sexual and gender minority digestive health

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While literature exists in remedying SGM-related knowledge deficits in primary care, none exists for gastroenterology specialists. Aims We detail a two-site experience with a focused education intervention for gastrointestinal healthcare workers on SGM digestive health. Methods Gastroenterology and hepatology physicians, nurses, trainees, and staff at two academic medical centers participated. A 10- question pre-test and Likert scale questions on competence in caring for sexual and gender minority patients was given. Participants then attended a lecture about SGM digestive health. After, they completed a post-test and 6-month follow-up assessment. Pre- and post-test averages of correct answers were compared to assess objective knowledge acquisition and identify gaps in knowledge. Results Of 368 eligible participants, 143 (39.0%) completed the pre-test, 79 completed the post-test, and 93 completed 6-month follow-up. Pre-test average correct responses was 61%, while post-test correct responses increased to 70% (p < 0.001). At 6-month follow-up, average percent correct was 66% (p = 0.027 compared to pre-test). Competence caring for SGM patients improved from 3.62 to 3.99. (1 = strongly disagree, 5 = strongly agree; p = .033). This persisted at 6 months (average 4.07, p = .007). Conclusions A lecture-based intervention results in significant and sustained improvement in competence and knowledge surrounding digestive healthcare in SGM patients. This can be used as a starting point for curricular development at all medical education levels. Doing so may allow for more culturally inclusive care to be provided to SGM communities and foster cultural humility. LGBTQIA+ sexual and gender minority continuing medical education healthcare disparities Figures Figure 1 Figure 2 Introduction Sexual and gender minority (SGM) communities comprise over 25 million adults in the United States (US, 7.6% of the population). 1 These individuals experience numerous barriers in accessing and engaging with healthcare communities. 2 Patients are fearful of being discriminated against or, through adverse distribution of social determinants of health secondary to systematic societal discrimination, are unable to access care equitably. The needs of SGM communities are not emphasized in healthcare professionals’ (HCP) curricula, resulting in knowledge deficits even among those motivated to provide competent and culturally inclusive care for SGM people. With an increasingly hostile societal and political landscape for SGM communities in the US over the course of the 2020s (transgender bathroom laws, legalization of discrimination by small businesses), sustained efforts are needed to improve health-related disparities that exist between SGM communities and other groups. 2 – 7 These disparities are centered on social determinants of health resulting in inequity, rather than inherent characteristics among SGM people and include increased rates of substance use disorder, obesity, depression and anxiety, and anorectal cancer (all of which directly or indirectly impact digestive health). 3 , 8 Efforts to educate healthcare professionals on best practices for engaging with SGM communities have been increasingly implemented over the past decade, particularly at the undergraduate and graduate medical education levels (UME and GME) when compared to prior to 2015. 9 – 12 There are few studies that examine educational content regarding SGM communities in healthcare in continuing medical education (CME) and none in gastroenterology, hepatology, and nutrition. 13 Prior studies have largely described the subjective experiences of single institutions. 12 , 14 – 15 Work that has examined knowledge acquisition has generally only done so immediately after the intervention, with few examining longitudinal knowledge retention. 16 – 18 Prior educational interventions have targeted one population of providers or staff, though more recent literature has begun to include mixed learner groups with physicians, advanced practice providers, trainees, and administrative staff. 18 We report our experience with a lecture-based educational intervention targeting gastroenterologists and HCPs on digestive health and general care of SGM communities. We hypothesized that a lecture-based intervention would lead to immediate and long-term improvements in knowledge in this subject area. Additionally, we analyzed how subjective attitudes and confidence in caring for SGM patients changed after this intervention. Methods Subjects HCPs were recruited at two academic medical centers in the Northeast, United States. Participants included faculty physicians and advanced practice providers (APPs), gastroenterology and hepatology trainees, nursing, technician, and administrative staff in endoscopy, the operating room, and clinic nursing staff and administrative staff. The study was approved by the IRBs at both institutions that participated in the study. Intervention A lecture on the digestive care of patients that identify as members of SGM communities was created by one of the authors (SP), specifically for physicians and APPs (Fig. 1 ). This was subsequently adapted for nursing and administrative staff. Physicians and APPs attended this lecture at a divisional grand rounds educational activity. Nursing and administrative staff received the lecture intervention at a weekly meeting where the largest percentage of staff could attend (given grand rounds were routinely not attended by non-physicians at both institutions). Content was administered separately at both institutions and were given by two of the authors (AG and SP). Assessment Prior to the intervention, all participants completed a pre-test on the survey software Qualtrics (Qualtrics, Provo, UT). This included a 10-question knowledge assessment about the SGM community and their interaction with healthcare. The assessment was created by two of the authors (AG, CV) based on the prior literature in the topic of SGM healthcare education interventions and SGM digestive health, as well as the lecture content to ensure all questions were relevant. 3 , 19 The final assessment was approved by all authors. The nursing, administrative and procedural staff knowledge assessment included 7 of the 10 questions (three medical knowledge questions were not included as it was out of scope of practice) (Supplemental Fig. 1). 1 , 3 , 20 – 26 Additionally, all participants were asked five questions regarding their agreement with statements regarding confidence and attitudes towards caring for the SGM community (Likert scale 1–5 with 1 = strongly disagree, 5 = strongly agree). Demographic information collected included role in the medical center, years’ post-training completion, gender identity, sexual orientation, and if the subject identifies as transgender (Supplemental Fig. 1). To reduce the risk of revealing participants’ identities, race and ethnicity data purposefully were not collected. It was felt that this identifier would be of lower yield, as attitudes towards SGM people likely do not consistently stratify along race/ethnicity self-identification. Immediately following the lecture, participants were asked to complete a post-test that included the same questions as the pre-test. To assess the durability of response to the intervention, all participants who completed the pre-test (regardless of whether they attended the lecture) were asked to complete a follow-up assessment 6 months after the intervention. Note was made during the analysis of those who did or did not attend the lecture. The inclusion of those who did not attend the lecture in 6 month follow up was to ensure that any improvement seen was the result of the intervention and not repeat testing. Primary Outcome The primary outcome was improvement in overall knowledge at immediate and 6-month follow-up as measured by the percentage of knowledge questions answered correctly. Secondary Outcomes Secondary outcomes included improvement in confidence and attitudes toward caring for the SGM community, as measured by changes in Likert scale average for each statement (total of 5). Data Collection and Power Calculation All data was collected in the Qualtrics system and anonymous. At the time of analysis, all data was transitioned and converted to SPSS 29.0 (IBM Corp., Armonk, NY). A power calculation was performed. To detect an improvement of 5% in the immediate and 6-month follow-up assessment, with a baseline knowledge assessment score of 60% (0.60) and a standard deviation of 10% with a power of 80%, each group needed to include at least 63 subjects. Analysis All statistical analyses were done in SPSS 21.0. For the primary and secondary outcomes, one-way ANOVA and Tukey HSD tests were employed. Demographic information was analyzed with descriptive statistics. Results Demographics Of 368 eligible participants, 143 completed the pre-test portion of the study (response rate = 39%). This was a prerequisite for completing both the immediate and 6-month follow-up test. Of these, 141 provided demographic information (Table 1 ). Attendings represented 35.7% of participants, gastroenterology trainees 11.9% and APPs comprised 8.4% of participants. Procedural staff (endoscopy suite nurses, technicians, and OR staff) accounted for 23.8% of the study sample, while clinic-based nurses represented 12.6% and gastroenterology administrative staff 6.3%. Table 1 Participant characteristics of those who completed pre-test, immediate post-test, and 6-month follow-up after intervention. Demographic Category Number (Percentage) Pre-Test Number (Percentage) Post-Test Number (Percentage) 6-Month Follow-Up with Intervention Role Attending 51 (35.7%) 32 (40.5%) 37 (52.9%) Gastroenterology trainee 17 (11.9%) 10 (12.7%) 10 (14.3%) Advanced practice provider 12 (8.4%) 3 (3.8%) 4 (5.7%) Endoscopy nurse/technician 13 (9.1%) 8 (10.1%) 5 (7.1%) Clinic nurse/medical assistant 18 (12.6%) 7 (8.9%) 3 (4.3%) Operating room nurse/staff 21 (14.7%) 12 (15.2%) 8 (11.4%) Administrative staff 9 (6.3%) 5 (6.4%) 3 (4.3%) Years’ Experience 1–9 81 (56.6%) 47 (59.5%) 41 (58.6%) 10–19 24 (16.8%) 14 (17.7%) 10 (14.3%) 20–29 20 (14.0%) 11 (13.9%) 11 (15.7%) 30–39 10 (7.0%) 2 (2.5%) 6 (8.6%) 40+ 6 (4.2%) 3 (3.8%) 2 (2.9%) Gender Identity Man 42 (29.4%) 24 (30.4%) 24 (34.3%) Woman 93 (65.0%) 49 (62.0%) 42 (60.0%) Non-binary/non-conforming 2 (1.4%) 2 (2.6%) 1 (1.4%) Prefer not to say 4 (2.8%) 2 (2.5%) 3 (4.3%) Sexual Orientation Straight 126 (88.1%) 68 (86.1%) 63 (90.0%) Gay or lesbian 7 (4.9%) 3 (3.8%) 2 (2.9%) Bisexual 2 (1.4%) 0 (0%) 0 (0%) Queer 1 (0.7%) 2 (2.5%) 2 (2.9%) Other sexual orientation 2 (1.4%) 1 (1.3%) 1 (1.4%) Prefer not to say 3 (2.1%) 3 (3.8%) 2 (2.9%) Transgender Yes 2 (1.4%) 2 (2.5%) 1 (1.4%) No 137 (95.8%) 73 (92.4%) 65 (92.9%) Prefer not to say 2 (1.4%) 2 (2.5%) 4 (5.7%) Demographic information not obtained 2 (1.4%) 2 (2.5%) 0 (0%) Of all participants, more than half (56.6%) were in the first 10 years of practicing within the field of gastroenterology or working in procedural spaces. Regarding gender identity, 65% of participants identified as women and 29.4% identified as men. Of the cohort, 7.0% of participants identified as a member of the SGM community with two subjects (1.4%) identifying as transgender. Two participants (1.4%) identified as gender non-binary and four (2.8%) did not wish to identify their gender identity. Objective Knowledge Acquisition A total of 143 participants completed the pre-test across both sites (68 at site 1, 75 at site 2). Of those who completed the pre-test, 79 (55.2%) attended the lecture and completed the immediate post-test, and 93 (65.0%) completed the 6-month follow-up test (all participants eligible to complete 6-month follow-up assessment, 70 attended the intervention, 23 did not). The proportion of correct answers selected by participants on the pre-test was 0.61 [SD = 0.14]. A significant improvement in proportion of correct answers was noted at the time of the immediate post-test (0.70 [SD = 0.15], p < .001). This improvement remained significant at 6-month follow-up (0.66 [SD = 0.14], p = .027) (Fig. 2 ). When dividing the 6-month follow-up assessment into those who attended the intervention lecture and those who did not, those who did not attend the intervention had no difference in knowledge compared to the pre-test (Fig. 2 ). Post-hoc sub-analyses showed that participants that identified as men and women both had significant improvements in knowledge. The same was found for providers (attending physicians, trainees, and APPs), as well as nursing and administrative staff. Those with 1–9 years of healthcare experience showed significant improvements in knowledge, whereas those with 10–19 years and 20–29 years of healthcare experience showed no significant improvement in knowledge (those with 10–19 years of experience showed a trend towards significance, p = .09). Sub-analyses were not performed for groups with less than 10 participants. Subjective Improvements in Confidence and Attitudes Towards the SGM Community Participants who were present for the intervention felt significantly more confident in providing care for the SGM community both immediately and at 6-month follow-up (p = .033 and .007, respectively). Those who did not participate in the intervention did not have a significant difference in confidence. All other subjective measures regarding confidence and attitudes towards caring for the SGM community were not significantly different after the intervention (Table 2 ). Table 2 Average Likert scale score for subjective ratings about competence caring for and opinions regarding the sexual and gender minority communities. 1 = strongly disagree, 5 = strongly agree. *** Significant at p < 0.05 Statement and Group Mean Likert Score I feel competent to provide care for members of the sexual and gender minority community. Pre-test 3.62 Post-test 3.99*** 6-month follow-up (intervention) 4.07*** 6-month follow-up (no intervention) 3.87 I would be able to talk with a patient who identifies as a sexual and gender minority in a sensitive manner. Pre-test 4.19 Post-test 4.38 6-month follow-up (intervention) 4.40 6-month follow-up (no intervention) 4.39 If I see discrimination against a sexual and gender minority person or group occur, I actively work to confront it. Pre-test 4.18 Post-test 4.41 6-month follow-up (intervention) 4.36 6-month follow-up (no intervention) 4.09 I am open to learning about the experiences of sexual and gender minority people from someone who identifies as a sexual and gender minority. Pre-test 4.57 Post-test 4.64 6-month follow-up (intervention) 4.63 6-month follow-up (no intervention) 4.57 I am comfortable with knowing that, in being an ally to sexual and gender minority individuals, people may assume I am a sexual and gender minority person. Pre-test 3.99 Post-test 4.29 6-month follow-up (intervention) 4.34 6-month follow-up (no intervention) 4.09 Discussion After engaging in a single lecture-based educational intervention, we demonstrate that participants had significant increases in objective knowledge about SGM digestive care and best practices, as demonstrated by a post-intervention knowledge assessment. Moreover, this improvement in knowledge was durable over a period of 6 months, as shown by a follow-up knowledge assessment. In addition, we show that providers who participated in the intervention felt significantly more confident in caring for the SGM community. This study represents the first example of an SGM digestive health curriculum that is specifically meant for a breadth of gastroenterology and hepatology providers and ancillary staff. Participants in our intervention included attending-level gastroenterologists, as well as trainees, nurses, and administrators. Given that this study was completed at two institutions, this suggests that our intervention may be appropriate for both the totality of staff in gastroenterology divisions, and any institution that wishes to engage in this curriculum. The need for relevant curricula on the topic of SGM healthcare is clear and to this point has primarily been focused in UME. 5 However, there remain a lack of clear GME and CME requirements for SGM training initiatives. 27 While providers generally find this content area important, a commonly cited barrier to development of such curricula is lack of expertise. 28 – 31 Regardless, various specialties have now studied or enacted curricula on the topic of general SGM patient care, including nursing, peri-operative staff, pediatrics, palliative care, and emergency medicine. 11 , 13 , 32 – 34 These curricula take various forms including asynchronous online modules, single lectures, and lecture series, and the amount of time dedicated to them is variable. 35 Our study represents the first foray into this area within the realm of digestive health. Its inclusion of administrative staff, procedural staff, and nurses is a distinct strength. It is important to note that certain medical knowledge questions were excluded from this subgroup of participants given these individuals are not making the medical decisions that were reflected in the questions excluded. For analysis, however, their percentage correct was accounted for within the appropriate questions. They were not penalized for the questions that were not included in their survey. Notably, one institution involved in the study had a single educational module on SGM patient care and cultural humility four years prior to the study. However, this did not focus on health-specific material, and likely did not impact study results. The other institution did not have education requirements for SGM inclusivity required for providers and ancillary staff. When it comes to prior studies on SGM curricula, most show that they are acceptable to learners, lead to subjective improvement in knowledge, as well as objective knowledge growth, though this is not universal. 12 , 14 – 18 , 33 Most assessments were largely self-created. Our study’s results are supported by this literature. While our assessment was also self-created, the overall lack of ceiling or floor effect suggests that there was an appropriate difficulty level. Regardless, standardized assessments in SGM health and digestive care are needed to better ensure learners are gaining knowledge in appropriate and important topic areas within this large field. The durability of objective knowledge acquisition is vital to any educational endeavor, particularly CME, where study results are mixed on whether these interventions lead to sustained effects. 36 However, particularly in educational interventions on the subject of SGM communities, there is a lack of literature, thus making our study novel, especially in the realm of gastroenterology and hepatology. 37 Our study shows that knowledge gained after the intervention was maintained at 6 months, with the caveat that there was knowledge regression (though this was not statistically significant). While learner satisfaction and modification of learner attitudes represent the lowest tiers of Kirkpatrick’s hierarchy of health professional education evaluation, they are vital to the success of an educational intervention. 38 Learner satisfaction data was not collected for our study, but the subjective improvement in learner competence supports prior literature that has shown similar improvements in measures looking at comfort and confidence caring for SGM communities. 11 – 14 Our intervention’s primary and secondary outcomes did not specifically examine improvement in bias against SGM communities. Data about this topic are mixed. Personal experience in an educational intervention is important in changing underlying attitudes towards SGM communities, though results are inconsistent amongst studies. 35 Additionally, opportunities for discussion led to improvements in this area. 35 This may explain the lack of significant improvement in other subjective measures analyzed. Active learner engagement is crucial to the effectiveness of an educational intervention. 39 Our lecture-based intervention did not include time for discussion and is an area for improvement in this educational intervention format. Additionally, participants used only a small portion of the Likert scale. Thus, a ceiling effect may have occurred. Interestingly, post-hoc sub-analysis showing less improvement in knowledge in more experienced or older participants may suggest generational challenges and implicit bias amongst older cohorts regarding the SGM community. This is one area to target in future interventions. Based on our experience, we would like to offer concrete suggestions for how to improve knowledge and competence in caring for SGM patients with digestive health disorders. First, while the Accreditation Council for Graduate Medical Education (ACGME) includes understanding social determinants of health in the common fellowship requirements as a means of reducing health disparities, we would advocate for use of clearer language delineating specific patient populations that trainees need to have adequate education in caring for. 40 This includes SGM communities. Second, as new evidence is disseminated, we advocate for recurring didactic content on SGM digestive health. This can include dedicated institutional-level lecture series, online modules, or utilizing gastroenterology society infrastructure to more broadly, on a virtual-scale, discuss these topics. Finally, we recommend interdisciplinary content and discussions with other physician groups, particularly those that serve as a first line in SGM patient care such as primary care, family medicine, pediatrics, and general surgery. Limitations While this study is the first multi-center example of a curriculum in SGM digestive healthcare, we acknowledge that both institutions are in the same metropolitan area of the same state where SGM rights are more deeply entrenched. While the content would be identical in all jurisdictions, assessment outcomes may have differed in those places where SGM rights are politically contentious. The other main limitation of our study is the lack of longitudinal didactic content (limited to just one lecture). While we are encouraged that knowledge acquisition shows sustained improvement, there appears to be some knowledge regression. Thus, it would be important to measure knowledge acquisition over a more sustained educational curriculum for gastroenterology providers and support staff, as literature and educational theory supports more integrated curricula with time for spaced repetition and interleaving (teaching on different topics during a longitudinal curriculum). 41 , 42 Finally, we do not know the impact that this intervention had on patient outcomes, though anecdotally, providers were more attuned to asking about patient sexual practices when relevant to their chief complaint and ordering appropriate diagnostic testing. We recognize that not collecting race/ethnicity data, while likely enhancing survey response by preserving anonymity, may represent a limitation. Additionally, we recognize that non-response bias may self-select for participants who are more apt to want to learn more about this topic, and thus may limit generalizability. However, our response rate is reasonable given the type of study conducted. 43 Conclusion Our study demonstrates that a single lecture-based educational intervention leads to sustained knowledge acquisition amongst gastroenterology and hepatology providers and ancillary staff on the topic of SGM digestive healthcare. It has the added benefit of improving confidence in managing SGM patients with these conditions. Ultimately, we hope that this encourages other gastroenterology and hepatology providers, as well as general healthcare practitioners to incorporate education on the care of SGM patients within their specialties. This is just one step in addressing the healthcare disparities experienced by SGM communities in an effort to improve their long-term health outcomes. Declarations Author contributions: Alexander Goldowsky was responsible for planning the study, planning and executing the educational intervention, analyzing and interpreting data, and drafting the manuscript. He has approved the final draft submitted. Jenna Clukey was responsible for analyzing and interpreting data and drafting the manuscript. She has approved the final draft submitted. Carl Streed, Jr. was responsible for planning the study and educational intervention. He has approved the final draft submitted. Sonali Paul was responsible for planning the study and educational intervention and executing the educational intervention. She has approved the final draft submitted. Christopher Vélez was responsible for planning the study, planning and executing the educational intervention, analyzing and interpreting data, and drafting the manuscript. He has approved the final draft submitted. Funding CV has received funding from the American College of Gastroenterology via the Health Equity Research Award mechanism, as well as diversity, equity, and inclusion funding from Ironwood. 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In: Craig, R.L., Ed., Training and Development Handbook: A Guide to Human Resource Development. New York. NY: McGraw Hill; 1976. Bucklin BA, Asdigian NL, Hawkins JL, et al. Making it stick: use of active learning strategies in continuing medical education. BMC Med Educ , 2021; 21 (1):44. ACGME Common Program Requirements (Fellowship). Accreditation Council for Graduate Medical Education. https://www.acgme.org/globalassets/pfassets/programrequirements/cprfellowship_2023.pdf. Phillips JL, Heneka N, Bhattarai P, Fraser C, Shaw T. Effectiveness of the spaced education pedagogy for clinicians' continuing professional development: a systematic review. Med Educ . 2019;53(9):886-902. Winn AS, DelSignore L, Marcus C, et al. Applying Cognitive Learning Strategies to Enhance Learning and Retention in Clinical Teaching Settings. MedEdPORTAL . 2019;15:10850. Williamson, M.K., Pirkis, J., Pfaff, J.J. et al. Recruiting and retaining GPs and patients in intervention studies: the DEPS-GP project as a case study. BMC Med Res Methodol 2007; 7 :42. Additional Declarations No competing interests reported. Supplementary Files SupplementalFigure1SGMEducationFINALDDS.docx Cite Share Download PDF Status: Published Journal Publication published 20 Feb, 2025 Read the published version in Digestive Diseases and Sciences → Version 1 posted Editorial decision: Revision requested 17 Nov, 2024 Reviews received at journal 05 Nov, 2024 Reviews received at journal 01 Nov, 2024 Reviewers agreed at journal 15 Oct, 2024 Reviewers agreed at journal 14 Oct, 2024 Reviewers agreed at journal 10 Oct, 2024 Reviewers invited by journal 09 Oct, 2024 Editor assigned by journal 07 Oct, 2024 Submission checks completed at journal 04 Oct, 2024 First submitted to journal 04 Oct, 2024 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. 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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-5204583","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":379221268,"identity":"d4ea7246-a616-4e99-9cd6-87a2257a1df2","order_by":0,"name":"Alexander Goldowsky","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIiWNgGAWjYHACxgM8QJJfgrFBAkgnQATZgPgAbj1gLZIzSNZicIOBgTgt/P2LDxx4U3HY3vh2c+OtGzUMefyzzxh+rihjkOO7kYBVi8SNZwkH55w5nLjtzsFm65xjDMUS53KMJc+cYzCWxKGF4cYZg8O8bbcTzG4ktknnNjAkNpxhS5BsbGNI3IBDizxUi73xDKiW+WfYkn8CtdTj0mJwvgeshXGDBFTLhjPMx0C2JBjg0GJ4gw3kl/+JMyB+kUjcCNRi2XBOwnDmmQdYtcidP3zwwZuKNHv+2e0Pb+fU2CTOO8PYfLOhzEae7zgO70ugiktgMDAB/wHccqNgFIyCUTAKwAAA5fBuAmj/eJ4AAAAASUVORK5CYII=","orcid":"","institution":"Beth Israel Deaconess Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Alexander","middleName":"","lastName":"Goldowsky","suffix":""},{"id":379221269,"identity":"7ffbf5eb-3e8d-4e31-9b8a-afbd258fadeb","order_by":1,"name":"Jenna Clukey","email":"","orcid":"","institution":"Massachusetts General Hospital, Massachusetts General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jenna","middleName":"","lastName":"Clukey","suffix":""},{"id":379221270,"identity":"1b94207f-0f82-42f9-be42-29a31c23597f","order_by":2,"name":"Carl Streed","email":"","orcid":"","institution":"Boston Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Carl","middleName":"","lastName":"Streed","suffix":""},{"id":379221271,"identity":"e93910ab-64f3-439a-968b-dcc7963bec8d","order_by":3,"name":"Sonali Paul","email":"","orcid":"","institution":"University of Chicago Medicine","correspondingAuthor":false,"prefix":"","firstName":"Sonali","middleName":"","lastName":"Paul","suffix":""},{"id":379221272,"identity":"1f32a29b-bcf6-4497-88f7-3357186cee8f","order_by":4,"name":"Christopher Vélez","email":"","orcid":"","institution":"Massachusetts General Hospital, Massachusetts General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Christopher","middleName":"","lastName":"Vélez","suffix":""}],"badges":[],"createdAt":"2024-10-04 14:23:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5204583/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5204583/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10620-025-08921-3","type":"published","date":"2025-02-20T15:57:11+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":70917694,"identity":"8f2755dd-38e5-417a-a707-910f118c5012","added_by":"auto","created_at":"2024-12-09 08:22:33","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":403567,"visible":true,"origin":"","legend":"\u003cp\u003eExample slides from presentation on sexual and gender minority (SGM) digestive health.\u003c/p\u003e","description":"","filename":"Figure1DDS10.4.24.png","url":"https://assets-eu.researchsquare.com/files/rs-5204583/v1/f75f42dbeb0e3b3b934c2fef.png"},{"id":70917693,"identity":"1de9ecf2-5e2d-46a5-ab5f-4fb27608fc79","added_by":"auto","created_at":"2024-12-09 08:22:33","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":219813,"visible":true,"origin":"","legend":"\u003cp\u003eMean percentage of knowledge questions answered correctly in the pre-intervention, post-intervention, and 6-month follow-up period. Pre-test n = 143, post-test n = 79, 6-month follow-up (intervention) n = 70, 6-month follow-up (no intervention) n = 23. * Significant at p \u0026lt; 0.05.\u003c/p\u003e","description":"","filename":"Figure2DDS10.4.24.png","url":"https://assets-eu.researchsquare.com/files/rs-5204583/v1/dcf2267d621cfafa83f8f9f1.png"},{"id":77052502,"identity":"8c82d645-2ac9-40a9-8b91-e8573cbb9287","added_by":"auto","created_at":"2025-02-24 16:12:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1739512,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5204583/v1/4b373185-a6d6-4ef5-ae6d-f7ef489d5965.pdf"},{"id":70917692,"identity":"4c696f87-f257-4547-bc84-682a80c953fa","added_by":"auto","created_at":"2024-12-09 08:22:33","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20980,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalFigure1SGMEducationFINALDDS.docx","url":"https://assets-eu.researchsquare.com/files/rs-5204583/v1/36f60531bc7c1afdffd85823.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"An education intervention in gastrointestinal healthcare workers improves knowledge of sexual and gender minority digestive health","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSexual and gender minority (SGM) communities comprise over 25\u0026nbsp;million adults in the United States (US, 7.6% of the population).\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e These individuals experience numerous barriers in accessing and engaging with healthcare communities.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Patients are fearful of being discriminated against or, through adverse distribution of social determinants of health secondary to systematic societal discrimination, are unable to access care equitably. The needs of SGM communities are not emphasized in healthcare professionals\u0026rsquo; (HCP) curricula, resulting in knowledge deficits even among those motivated to provide competent and culturally inclusive care for SGM people. With an increasingly hostile societal and political landscape for SGM communities in the US over the course of the 2020s (transgender bathroom laws, legalization of discrimination by small businesses), sustained efforts are needed to improve health-related disparities that exist between SGM communities and other groups.\u003csup\u003e\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e These disparities are centered on social determinants of health resulting in inequity, rather than inherent characteristics among SGM people and include increased rates of substance use disorder, obesity, depression and anxiety, and anorectal cancer (all of which directly or indirectly impact digestive health).\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEfforts to educate healthcare professionals on best practices for engaging with SGM communities have been increasingly implemented over the past decade, particularly at the undergraduate and graduate medical education levels (UME and GME) when compared to prior to 2015. \u003csup\u003e\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e There are few studies that examine educational content regarding SGM communities in healthcare in continuing medical education (CME) and none in gastroenterology, hepatology, and nutrition.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Prior studies have largely described the subjective experiences of single institutions.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Work that has examined knowledge acquisition has generally only done so immediately after the intervention, with few examining longitudinal knowledge retention.\u003csup\u003e\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Prior educational interventions have targeted one population of providers or staff, though more recent literature has begun to include mixed learner groups with physicians, advanced practice providers, trainees, and administrative staff.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWe report our experience with a lecture-based educational intervention targeting gastroenterologists and HCPs on digestive health and general care of SGM communities. We hypothesized that a lecture-based intervention would lead to immediate and long-term improvements in knowledge in this subject area. Additionally, we analyzed how subjective attitudes and confidence in caring for SGM patients changed after this intervention.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSubjects\u003c/h2\u003e \u003cp\u003eHCPs were recruited at two academic medical centers in the Northeast, United States. Participants included faculty physicians and advanced practice providers (APPs), gastroenterology and hepatology trainees, nursing, technician, and administrative staff in endoscopy, the operating room, and clinic nursing staff and administrative staff. The study was approved by the IRBs at both institutions that participated in the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eIntervention\u003c/h3\u003e\n\u003cp\u003e A lecture on the digestive care of patients that identify as members of SGM communities was created by one of the authors (SP), specifically for physicians and APPs (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This was subsequently adapted for nursing and administrative staff. Physicians and APPs attended this lecture at a divisional grand rounds educational activity. Nursing and administrative staff received the lecture intervention at a weekly meeting where the largest percentage of staff could attend (given grand rounds were routinely not attended by non-physicians at both institutions). Content was administered separately at both institutions and were given by two of the authors (AG and SP).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eAssessment\u003c/h3\u003e\n\u003cp\u003ePrior to the intervention, all participants completed a pre-test on the survey software Qualtrics (Qualtrics, Provo, UT). This included a 10-question knowledge assessment about the SGM community and their interaction with healthcare. The assessment was created by two of the authors (AG, CV) based on the prior literature in the topic of SGM healthcare education interventions and SGM digestive health, as well as the lecture content to ensure all questions were relevant.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e The final assessment was approved by all authors. The nursing, administrative and procedural staff knowledge assessment included 7 of the 10 questions (three medical knowledge questions were not included as it was out of scope of practice) (Supplemental Fig.\u0026nbsp;1).\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan additionalcitationids=\"CR21 CR22 CR23 CR24 CR25\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Additionally, all participants were asked five questions regarding their agreement with statements regarding confidence and attitudes towards caring for the SGM community (Likert scale 1\u0026ndash;5 with 1\u0026thinsp;=\u0026thinsp;strongly disagree, 5\u0026thinsp;=\u0026thinsp;strongly agree). Demographic information collected included role in the medical center, years\u0026rsquo; post-training completion, gender identity, sexual orientation, and if the subject identifies as transgender (Supplemental Fig.\u0026nbsp;1). To reduce the risk of revealing participants\u0026rsquo; identities, race and ethnicity data purposefully were not collected. It was felt that this identifier would be of lower yield, as attitudes towards SGM people likely do not consistently stratify along race/ethnicity self-identification.\u003c/p\u003e \u003cp\u003eImmediately following the lecture, participants were asked to complete a post-test that included the same questions as the pre-test. To assess the durability of response to the intervention, all participants who completed the pre-test (regardless of whether they attended the lecture) were asked to complete a follow-up assessment 6 months after the intervention. Note was made during the analysis of those who did or did not attend the lecture. The inclusion of those who did not attend the lecture in 6 month follow up was to ensure that any improvement seen was the result of the intervention and not repeat testing.\u003c/p\u003e\n\u003ch3\u003ePrimary Outcome\u003c/h3\u003e\n\u003cp\u003eThe primary outcome was improvement in overall knowledge at immediate and 6-month follow-up as measured by the percentage of knowledge questions answered correctly.\u003c/p\u003e\n\u003ch3\u003eSecondary Outcomes\u003c/h3\u003e\n\u003cp\u003eSecondary outcomes included improvement in confidence and attitudes toward caring for the SGM community, as measured by changes in Likert scale average for each statement (total of 5).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Collection and Power Calculation\u003c/h2\u003e \u003cp\u003eAll data was collected in the Qualtrics system and anonymous. At the time of analysis, all data was transitioned and converted to SPSS 29.0 (IBM Corp., Armonk, NY). A power calculation was performed. To detect an improvement of 5% in the immediate and 6-month follow-up assessment, with a baseline knowledge assessment score of 60% (0.60) and a standard deviation of 10% with a power of 80%, each group needed to include at least 63 subjects.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAnalysis\u003c/h3\u003e\n\u003cp\u003eAll statistical analyses were done in SPSS 21.0. For the primary and secondary outcomes, one-way ANOVA and Tukey HSD tests were employed. Demographic information was analyzed with descriptive statistics.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDemographics\u003c/h2\u003e \u003cp\u003eOf 368 eligible participants, 143 completed the pre-test portion of the study (response rate\u0026thinsp;=\u0026thinsp;39%). This was a prerequisite for completing both the immediate and 6-month follow-up test. Of these, 141 provided demographic information (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Attendings represented 35.7% of participants, gastroenterology trainees 11.9% and APPs comprised 8.4% of participants. Procedural staff (endoscopy suite nurses, technicians, and OR staff) accounted for 23.8% of the study sample, while clinic-based nurses represented 12.6% and gastroenterology administrative staff 6.3%.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\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\u003eParticipant characteristics of those who completed pre-test, immediate post-test, and 6-month follow-up after intervention.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber (Percentage) Pre-Test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber (Percentage) Post-Test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber (Percentage)\u003c/p\u003e \u003cp\u003e6-Month Follow-Up with Intervention\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eRole\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttending\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51 (35.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (40.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (52.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGastroenterology trainee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (11.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (12.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdvanced practice provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (8.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (5.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndoscopy nurse/technician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (10.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinic nurse/medical assistant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (12.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (8.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperating room nurse/staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (14.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (15.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdministrative staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (6.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears\u0026rsquo; Experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e81 (56.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (59.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (58.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24 (16.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (17.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (13.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (15.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (7.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (8.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender Identity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42 (29.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (30.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (34.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWoman\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e93 (65.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (62.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-binary/non-conforming\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrefer not to say\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (2.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSexual Orientation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStraight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e126 (88.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (86.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63 (90.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGay or lesbian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (4.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBisexual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQueer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther sexual orientation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrefer not to say\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTransgender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e137 (95.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73 (92.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65 (92.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrefer not to say\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (5.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic information not obtained\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOf all participants, more than half (56.6%) were in the first 10 years of practicing within the field of gastroenterology or working in procedural spaces.\u003c/p\u003e \u003cp\u003eRegarding gender identity, 65% of participants identified as women and 29.4% identified as men. Of the cohort, 7.0% of participants identified as a member of the SGM community with two subjects (1.4%) identifying as transgender. Two participants (1.4%) identified as gender non-binary and four (2.8%) did not wish to identify their gender identity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eObjective Knowledge Acquisition\u003c/h2\u003e \u003cp\u003eA total of 143 participants completed the pre-test across both sites (68 at site 1, 75 at site 2). Of those who completed the pre-test, 79 (55.2%) attended the lecture and completed the immediate post-test, and 93 (65.0%) completed the 6-month follow-up test (all participants eligible to complete 6-month follow-up assessment, 70 attended the intervention, 23 did not). The proportion of correct answers selected by participants on the pre-test was 0.61 [SD\u0026thinsp;=\u0026thinsp;0.14]. A significant improvement in proportion of correct answers was noted at the time of the immediate post-test (0.70 [SD\u0026thinsp;=\u0026thinsp;0.15], p\u0026thinsp;\u0026lt;\u0026thinsp;.001). This improvement remained significant at 6-month follow-up (0.66 [SD\u0026thinsp;=\u0026thinsp;0.14], p\u0026thinsp;=\u0026thinsp;.027) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWhen dividing the 6-month follow-up assessment into those who attended the intervention lecture and those who did not, those who did not attend the intervention had no difference in knowledge compared to the pre-test (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePost-hoc sub-analyses showed that participants that identified as men and women both had significant improvements in knowledge. The same was found for providers (attending physicians, trainees, and APPs), as well as nursing and administrative staff. Those with 1\u0026ndash;9 years of healthcare experience showed significant improvements in knowledge, whereas those with 10\u0026ndash;19 years and 20\u0026ndash;29 years of healthcare experience showed no significant improvement in knowledge (those with 10\u0026ndash;19 years of experience showed a trend towards significance, p\u0026thinsp;=\u0026thinsp;.09). Sub-analyses were not performed for groups with less than 10 participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSubjective Improvements in Confidence and Attitudes Towards the SGM Community\u003c/h2\u003e \u003cp\u003eParticipants who were present for the intervention felt significantly more confident in providing care for the SGM community both immediately and at 6-month follow-up (p\u0026thinsp;=\u0026thinsp;.033 and .007, respectively). Those who did not participate in the intervention did not have a significant difference in confidence. All other subjective measures regarding confidence and attitudes towards caring for the SGM community were not significantly different after the intervention (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\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\u003eAverage Likert scale score for subjective ratings about competence caring for and opinions regarding the sexual and gender minority communities. 1\u0026thinsp;=\u0026thinsp;strongly disagree, 5\u0026thinsp;=\u0026thinsp;strongly agree. *** Significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatement and Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean Likert Score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eI feel competent to provide care for members of the sexual and gender minority community.\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.99***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6-month follow-up (intervention)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.07***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6-month follow-up (no intervention)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eI would be able to talk with a patient who identifies as a sexual and gender minority in a sensitive manner.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6-month follow-up (intervention)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6-month follow-up (no intervention)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIf I see discrimination against a sexual and gender minority person or group occur, I actively work to confront it.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6-month follow-up (intervention)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6-month follow-up (no intervention)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eI am open to learning about the experiences of sexual and gender minority people from someone who identifies as a sexual and gender minority.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6-month follow-up (intervention)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6-month follow-up (no intervention)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eI am comfortable with knowing that, in being an ally to sexual and gender minority individuals, people may assume I am a sexual and gender minority person.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6-month follow-up (intervention)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6-month follow-up (no intervention)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e After engaging in a single lecture-based educational intervention, we demonstrate that participants had significant increases in objective knowledge about SGM digestive care and best practices, as demonstrated by a post-intervention knowledge assessment. Moreover, this improvement in knowledge was durable over a period of 6 months, as shown by a follow-up knowledge assessment. In addition, we show that providers who participated in the intervention felt significantly more confident in caring for the SGM community.\u003c/p\u003e \u003cp\u003eThis study represents the first example of an SGM digestive health curriculum that is specifically meant for a breadth of gastroenterology and hepatology providers and ancillary staff. Participants in our intervention included attending-level gastroenterologists, as well as trainees, nurses, and administrators. Given that this study was completed at two institutions, this suggests that our intervention may be appropriate for both the totality of staff in gastroenterology divisions, and any institution that wishes to engage in this curriculum.\u003c/p\u003e \u003cp\u003eThe need for relevant curricula on the topic of SGM healthcare is clear and to this point has primarily been focused in UME.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e However, there remain a lack of clear GME and CME requirements for SGM training initiatives.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e While providers generally find this content area important, a commonly cited barrier to development of such curricula is lack of expertise.\u003csup\u003e\u003cspan additionalcitationids=\"CR29 CR30\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e Regardless, various specialties have now studied or enacted curricula on the topic of general SGM patient care, including nursing, peri-operative staff, pediatrics, palliative care, and emergency medicine.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e These curricula take various forms including asynchronous online modules, single lectures, and lecture series, and the amount of time dedicated to them is variable.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e Our study represents the first foray into this area within the realm of digestive health. Its inclusion of administrative staff, procedural staff, and nurses is a distinct strength. It is important to note that certain medical knowledge questions were excluded from this subgroup of participants given these individuals are not making the medical decisions that were reflected in the questions excluded. For analysis, however, their percentage correct was accounted for within the appropriate questions. They were not penalized for the questions that were not included in their survey. Notably, one institution involved in the study had a single educational module on SGM patient care and cultural humility four years prior to the study. However, this did not focus on health-specific material, and likely did not impact study results. The other institution did not have education requirements for SGM inclusivity required for providers and ancillary staff.\u003c/p\u003e \u003cp\u003eWhen it comes to prior studies on SGM curricula, most show that they are acceptable to learners, lead to subjective improvement in knowledge, as well as objective knowledge growth, though this is not universal.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan additionalcitationids=\"CR15 CR16 CR17\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e Most assessments were largely self-created. Our study\u0026rsquo;s results are supported by this literature. While our assessment was also self-created, the overall lack of ceiling or floor effect suggests that there was an appropriate difficulty level. Regardless, standardized assessments in SGM health and digestive care are needed to better ensure learners are gaining knowledge in appropriate and important topic areas within this large field.\u003c/p\u003e \u003cp\u003eThe durability of objective knowledge acquisition is vital to any educational endeavor, particularly CME, where study results are mixed on whether these interventions lead to sustained effects.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e However, particularly in educational interventions on the subject of SGM communities, there is a lack of literature, thus making our study novel, especially in the realm of gastroenterology and hepatology.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e Our study shows that knowledge gained after the intervention was maintained at 6 months, with the caveat that there was knowledge regression (though this was not statistically significant).\u003c/p\u003e \u003cp\u003eWhile learner satisfaction and modification of learner attitudes represent the lowest tiers of Kirkpatrick\u0026rsquo;s hierarchy of health professional education evaluation, they are vital to the success of an educational intervention.\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e Learner satisfaction data was not collected for our study, but the subjective improvement in learner competence supports prior literature that has shown similar improvements in measures looking at comfort and confidence caring for SGM communities.\u003csup\u003e\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOur intervention\u0026rsquo;s primary and secondary outcomes did not specifically examine improvement in bias against SGM communities. Data about this topic are mixed. Personal experience in an educational intervention is important in changing underlying attitudes towards SGM communities, though results are inconsistent amongst studies.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e Additionally, opportunities for discussion led to improvements in this area.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e This may explain the lack of significant improvement in other subjective measures analyzed. Active learner engagement is crucial to the effectiveness of an educational intervention.\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e Our lecture-based intervention did not include time for discussion and is an area for improvement in this educational intervention format. Additionally, participants used only a small portion of the Likert scale. Thus, a ceiling effect may have occurred. Interestingly, post-hoc sub-analysis showing less improvement in knowledge in more experienced or older participants may suggest generational challenges and implicit bias amongst older cohorts regarding the SGM community. This is one area to target in future interventions.\u003c/p\u003e \u003cp\u003eBased on our experience, we would like to offer concrete suggestions for how to improve knowledge and competence in caring for SGM patients with digestive health disorders. First, while the Accreditation Council for Graduate Medical Education (ACGME) includes understanding social determinants of health in the common fellowship requirements as a means of reducing health disparities, we would advocate for use of clearer language delineating specific patient populations that trainees need to have adequate education in caring for.\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e This includes SGM communities. Second, as new evidence is disseminated, we advocate for recurring didactic content on SGM digestive health. This can include dedicated institutional-level lecture series, online modules, or utilizing gastroenterology society infrastructure to more broadly, on a virtual-scale, discuss these topics. Finally, we recommend interdisciplinary content and discussions with other physician groups, particularly those that serve as a first line in SGM patient care such as primary care, family medicine, pediatrics, and general surgery.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eWhile this study is the first multi-center example of a curriculum in SGM digestive healthcare, we acknowledge that both institutions are in the same metropolitan area of the same state where SGM rights are more deeply entrenched. While the content would be identical in all jurisdictions, assessment outcomes may have differed in those places where SGM rights are politically contentious. The other main limitation of our study is the lack of longitudinal didactic content (limited to just one lecture). While we are encouraged that knowledge acquisition shows sustained improvement, there appears to be some knowledge regression. Thus, it would be important to measure knowledge acquisition over a more sustained educational curriculum for gastroenterology providers and support staff, as literature and educational theory supports more integrated curricula with time for spaced repetition and interleaving (teaching on different topics during a longitudinal curriculum).\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e,\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e Finally, we do not know the impact that this intervention had on patient outcomes, though anecdotally, providers were more attuned to asking about patient sexual practices when relevant to their chief complaint and ordering appropriate diagnostic testing. We recognize that not collecting race/ethnicity data, while likely enhancing survey response by preserving anonymity, may represent a limitation. Additionally, we recognize that non-response bias may self-select for participants who are more apt to want to learn more about this topic, and thus may limit generalizability. However, our response rate is reasonable given the type of study conducted.\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study demonstrates that a single lecture-based educational intervention leads to sustained knowledge acquisition amongst gastroenterology and hepatology providers and ancillary staff on the topic of SGM digestive healthcare. It has the added benefit of improving confidence in managing SGM patients with these conditions. Ultimately, we hope that this encourages other gastroenterology and hepatology providers, as well as general healthcare practitioners to incorporate education on the care of SGM patients within their specialties. This is just one step in addressing the healthcare disparities experienced by SGM communities in an effort to improve their long-term health outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlexander Goldowsky was responsible for planning the study, planning and executing the educational intervention, analyzing and interpreting data, and drafting the manuscript. He has approved the final draft submitted.\u003c/p\u003e\n\u003cp\u003eJenna Clukey was responsible for analyzing and interpreting data and drafting the manuscript. She has approved the final draft submitted.\u003c/p\u003e\n\u003cp\u003eCarl Streed, Jr. was responsible for planning the study and educational intervention. He has approved the final draft submitted.\u003c/p\u003e\n\u003cp\u003eSonali Paul was responsible for planning the study and educational intervention and executing the educational intervention. She has approved the final draft submitted.\u003c/p\u003e\n\u003cp\u003eChristopher V\u0026eacute;lez was responsible for planning the study, planning and executing the educational intervention, analyzing and interpreting data, and drafting the manuscript. He has approved the final draft submitted.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCV has received funding from the American College of Gastroenterology via the Health Equity Research Award mechanism, as well as diversity, equity, and inclusion funding from Ironwood.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no financial conflicts of interest to disclose as it related to this project.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJones JM. \u003cem\u003eLGBTQ+ Identification in U.S. Now at 7.6%\u003c/em\u003e. Gallup. 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In: Craig, R.L., Ed., Training and Development Handbook: A Guide to Human Resource Development. New York. NY: McGraw Hill; 1976.\u003c/li\u003e\n\u003cli\u003eBucklin BA, Asdigian NL, Hawkins JL, et al. Making it stick: use of active learning strategies in continuing medical education. \u003cem\u003eBMC Med Educ\u003c/em\u003e, 2021;\u003cem\u003e21\u003c/em\u003e(1):44.\u003c/li\u003e\n\u003cli\u003eACGME Common Program Requirements (Fellowship). Accreditation Council for Graduate Medical Education. https://www.acgme.org/globalassets/pfassets/programrequirements/cprfellowship_2023.pdf.\u003c/li\u003e\n\u003cli\u003ePhillips JL, Heneka N, Bhattarai P, Fraser C, Shaw T. Effectiveness of the spaced education pedagogy for clinicians\u0026apos; continuing professional development: a systematic review. \u003cem\u003eMed Educ\u003c/em\u003e. 2019;53(9):886-902.\u003c/li\u003e\n\u003cli\u003eWinn AS, DelSignore L, Marcus C, et al. Applying Cognitive Learning Strategies to Enhance Learning and Retention in Clinical Teaching Settings. \u003cem\u003eMedEdPORTAL\u003c/em\u003e. 2019;15:10850.\u003c/li\u003e\n\u003cli\u003eWilliamson, M.K., Pirkis, J., Pfaff, J.J. \u003cem\u003eet al.\u003c/em\u003e Recruiting and retaining GPs and patients in intervention studies: the DEPS-GP project as a case study. \u003cem\u003eBMC Med Res Methodol\u003c/em\u003e 2007;\u003cstrong\u003e7\u003c/strong\u003e:42.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"digestive-diseases-and-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ddsj","sideBox":"Learn more about [Digestive Diseases and Sciences](http://link.springer.com/journal/10620)","snPcode":"10620","submissionUrl":"https://submission.nature.com/new-submission/10620/3","title":"Digestive Diseases and Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"LGBTQIA+, sexual and gender minority, continuing medical education, healthcare disparities","lastPublishedDoi":"10.21203/rs.3.rs-5204583/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5204583/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSexual and gender minority (SGM) communities experience barriers in accessing healthcare. While literature exists in remedying SGM-related knowledge deficits in primary care, none exists for gastroenterology specialists.\u003c/p\u003e\u003ch2\u003eAims\u003c/h2\u003e \u003cp\u003eWe detail a two-site experience with a focused education intervention for gastrointestinal healthcare workers on SGM digestive health.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eGastroenterology and hepatology physicians, nurses, trainees, and staff at two academic medical centers participated. A 10- question pre-test and Likert scale questions on competence in caring for sexual and gender minority patients was given. Participants then attended a lecture about SGM digestive health. After, they completed a post-test and 6-month follow-up assessment. Pre- and post-test averages of correct answers were compared to assess objective knowledge acquisition and identify gaps in knowledge.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf 368 eligible participants, 143 (39.0%) completed the pre-test, 79 completed the post-test, and 93 completed 6-month follow-up. Pre-test average correct responses was 61%, while post-test correct responses increased to 70% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). At 6-month follow-up, average percent correct was 66% (p\u0026thinsp;=\u0026thinsp;0.027 compared to pre-test). Competence caring for SGM patients improved from 3.62 to 3.99. (1\u0026thinsp;=\u0026thinsp;strongly disagree, 5\u0026thinsp;=\u0026thinsp;strongly agree; p\u0026thinsp;=\u0026thinsp;.033). This persisted at 6 months (average 4.07, p\u0026thinsp;=\u0026thinsp;.007).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eA lecture-based intervention results in significant and sustained improvement in competence and knowledge surrounding digestive healthcare in SGM patients. This can be used as a starting point for curricular development at all medical education levels. Doing so may allow for more culturally inclusive care to be provided to SGM communities and foster cultural humility.\u003c/p\u003e","manuscriptTitle":"An education intervention in gastrointestinal healthcare workers improves knowledge of sexual and gender minority digestive health","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-09 08:22:28","doi":"10.21203/rs.3.rs-5204583/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-18T04:32:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-05T23:18:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-01T06:02:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"218199537883747099513997760852407690590","date":"2024-10-15T12:05:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"92415745557189724689417173473807634503","date":"2024-10-14T12:20:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"168623700975612921372014652063697981449","date":"2024-10-10T05:36:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-09T21:03:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-07T22:28:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-05T03:12:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"Digestive Diseases and Sciences","date":"2024-10-04T14:10:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"digestive-diseases-and-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ddsj","sideBox":"Learn more about [Digestive Diseases and Sciences](http://link.springer.com/journal/10620)","snPcode":"10620","submissionUrl":"https://submission.nature.com/new-submission/10620/3","title":"Digestive Diseases and Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"b5605b60-fc36-428a-a4aa-1e50cdbae44b","owner":[],"postedDate":"December 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-24T15:59:57+00:00","versionOfRecord":{"articleIdentity":"rs-5204583","link":"https://doi.org/10.1007/s10620-025-08921-3","journal":{"identity":"digestive-diseases-and-sciences","isVorOnly":false,"title":"Digestive Diseases and Sciences"},"publishedOn":"2025-02-20 15:57:11","publishedOnDateReadable":"February 20th, 2025"},"versionCreatedAt":"2024-12-09 08:22:28","video":"","vorDoi":"10.1007/s10620-025-08921-3","vorDoiUrl":"https://doi.org/10.1007/s10620-025-08921-3","workflowStages":[]},"version":"v1","identity":"rs-5204583","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5204583","identity":"rs-5204583","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}