This Pride Month, the American Association of Colleges of Osteopathic Medicine (AACOM) spoke with Nicole Wadsworth, DO, dean of the New York Institute of Technology College of Osteopathic Medicine (NYITCOM), about her efforts to address bias and health inequities among the LGBTQIA+ community and how colleges of osteopathic medicine can contribute to a more equitable healthcare landscape for LGBTQIA+ patients.
Dr. Wadsworth was part of the 2017-2018 graduating cohort of AACOM’s Senior Leadership Development Program, currently serves as chair for AACOM’s Society of Osteopathic Medical Educators and is the conference chair for AACOM’s Educating Leaders 2023 annual conference.
The answers below have been edited for brevity and clarity.
Q: In a recent op-ed, you wrote that COVID-19’s disproportionate impact on the LGBTQIA+ community is the result of longstanding health inequities. What role can osteopathic medical education play in addressing these inequities to advance LGBTQIA+ health?
Dr. Wadsworth: Osteopathic medical education can address these issues in three distinct ways. I’m a little biased to the first approach because it’s one we adopted at NYITCOM. It involves taking an internal look at your institution and working to identify both personal and structural biases. From there, you work on faculty and staff development, using your understanding of what's happening personally and institutionally, to help you address those biases in a meaningful way. The second approach is through curricular change. As I started to do this work personally and at NYITCOM, it became evident how steeped in white tradition medical education is, particularly if you take a deep look at textbooks and how they present illnesses and describe issues. You may need to research and order new textbooks and learning materials that cover topics in a broader way and adjust your curriculum accordingly. The third approach relates to partnerships. Many osteopathic medical schools partner with community-based hospitals. We can capitalize on these relationships to expand and support programming through resident education, research support and faculty development, bringing us full circle back to the first approach.
Q: Studies have shown most U.S. medical students are undereducated when it comes to LGBTQIA+ healthcare. To help address this, AACOM is launching a new Academic Recognition Program this summer for third-year students that will feature a module focused on LGBTQIA+ healthcare. Has NYITCOM adopted any new curricula to help future DOs better meet the needs of patients from sexual and gender minority groups?
Dr. Wadsworth: At NYITCOM, we’ve expanded our pre-clinicals to teach students in their first two years about patient assessment and how to ask questions around gender identity, sexual identity and sexual orientation. We also discuss terminology, so students can start to use language in a meaningful and productive way. Students interview standardized patients and practice using language that creates a more inclusive environment for the LGBTQIA+ population. In addition, we have lectures that cover endocrinology issues and clinical disorders around the adrenal gland, as well as transgender patient care. We also have a Center for Global Health, which offers an elective certificate and covers international issues around care for transgender, non-binary and gender diverse individuals. In addition, we offer clinical experiences and voluntary activities where students interact with the LGBTQIA+ community, both locally on our campus as well as in the Long Island region. We are also looking to add modules around surgical treatments for transgender patients and we’d like to incorporate more standardized patients who identify as LGBTQIA+ so that there's a genuineness as students interact with individuals from this community and work to treat the day-to-day illnesses we all experience.
Q: Representation is important both for fostering a diverse culture and for decreasing bias. How can colleges of osteopathic medicine attract more LGBTQIA+ students, faculty members, administrators and leaders?
Dr. Wadsworth: I certainly agree that representation is important in attracting a diverse group of students, faculty, administrators and leaders. To recruit for diversity, going back to one of the initial points I shared, it helps to first take a deep look at yourself to understand your own personal biases and the structural issues within your institution. Once you identify underlying problems, you can shift and start to create the culture you want. This must be a genuine commitment to change. If you as an institution aren't committed to diversity in a meaningful way, those who are visiting your campus will see that your efforts are just window dressing, and that you haven’t really embraced this as a commitment to who you are and who you want to be. Consciously recruiting students who are widely represented also requires a deep look at how you recruit, where you recruit from and what your advertising materials look like. If they aren’t inclusive and don’t use the right language, students may be less attracted to your school. As far as attracting faculty, leaders and administrators, some infrastructure pieces need to be in place. For example, do you offer partner benefits or other institutional benefits designed to make people from different perspectives and backgrounds feel comfortable, welcome and supported? Having your house in order and being truly committed to a diverse culture are key to helping you actively and successfully recruit individuals from diverse backgrounds.
Q: Last month was Mental Health Awareness Month, and while mental health struggles disproportionately affect those in the medical profession, they also disproportionately affect LGBTQIA+ individuals. On top of this, COVID-19 is causing broad and far-reaching mental health concerns across the population at large. What advice do you have for advancing LGBTQIA+ mental health amid such a stressful landscape?
Dr. Wadsworth: I’m very proud of NYITCOM’s Center for Behavioral Health’s approach to diminishing the stigmatization that accompanies mental health. We've done that by making mental healthcare part of everyday life. At our institution, we have a culture of needing to take care of yourself. It's critically important, and it requires prioritizing your mental wellbeing. We're very intentional about how we talk about it. This has allowed LGBTQIA+ students, and all students, to feel comfortable recognizing that it's okay to have anxiety, to have depression and to have needs, and to see that we want to help them. In addition, we discuss mental health outside of the curriculum. We engage with each other informally, with faculty and administrators, and we talk about how we've all approached mental health in our own lives and what we can do to make it better. We also outwardly display that we've taken additional training or have additional expertise as it relates to the LGBTQIA+ population. This outward demonstration communicates that we are health professionals who understand and want to listen and talk through issues. We encourage our entire community to participate in a safe zone training, which gives students some comfort that they'll be accepted and cared for in a positive way.
Q: What does the osteopathic approach of whole person care mean to you, and does it play a role in how you teach students about diversity, equity and inclusion?
Dr. Wadsworth: I love this question! From my standpoint, osteopathic medicine is inclusive at its foundation. Seeing and hearing another person with the desire to understand them in their entirety underlies, in my mind, excellent healthcare. Recognizing that each person is far more than an illness and considering their multi-dimensionality allows for comprehensive care. We as osteopathic medical educators instill those values in our students, even if they're not completely aware of it. Our clinical partners will tell us, “Your students are a little bit different. They really seem to be able to engage with patients.” I'm convinced this is because osteopathic medicine’s holistic approach to healthcare is continually reinforced throughout their education. Students understand the importance of this broader perspective—that they can’t just focus on a complaint or symptoms. They need to look at the larger context of who their patients are, who they live with, where they live and all these other factors. The osteopathic approach allows for that holisticness and helps patients feel like they’re really being cared for.
Q: As we are seeing on the state and national levels, laws and their interpretations can have a huge impact on healthcare, threatening patients who seek it, their families and the health professionals who provide it. What advice would you give to osteopathic medical students or professionals who are interested in advocating for change?
Dr. Wadsworth: Advocacy is part of medicine. There has been a growing effort to include advocacy in the curriculum and to give interested students the opportunity to participate. I would encourage students and professionals to inform themselves of the specific issues and legislation affecting their communities and to reach out to their local and national representatives about their concerns. Sometimes we as a medical profession, and certainly medical students, can underestimate the power of our voice. Reach out and be very specific. I think that's something we don't emphasize enough. Sharing your concerns and providing your solutions in a very focused and concise way can be more effective when communicating with legislators. Another approach is to learn and partner with larger groups who have similar concerns to help amplify your voice. Informing yourself, being engaged and partnering when it's helpful are all great ways that you can advocate for change.
Q: There are certainly a lot of challenges and work to be done not only to advance, but also to protect, the rights of the LGBTQIA+ community. Amid all this, there is still space for hope and celebration. How are you planning to celebrate Pride Month?
Dr. Wadsworth: I'm lucky to live in an area where there's not one, but two, Pride parades, which are always a good time. I am also incredibly grateful to be a member of multiple communities. I have my NYITCOM community, the NYIT community, AACOM, the American Osteopathic Association and my local community, which all celebrate and lift up the LGBTQIA+ community. I feel very fortunate to be where I am, to be a part of what I’m a part of, to feel accepted and, like I said, to be lifted up.