EDUCATIONAL CASE REPORT Improving Communication with LGBTQ Patients: A Pilot Curriculum During the Psychiatry Clerkship Matthew C. Fadus 1 & Neal K. Peterson 2 & Celeste L. Jilich 3 & Edward M. Kantor 1 & David R. Beckert 1 & Jace M. Reed 1 & Emilio A. Valadez 1 & Timothy A. Brendle 1 Received: 26 July 2019 /Accepted: 25 November 2019 # Academic Psychiatry 2019 Although medical students gain a foundation of knowledge during their preclinical years, they are often thrust into chal- lenging situations or conversations in which they may not feel prepared during their clinical years of training. This can be particularly true for LGBTQ (lesbian, gay, bisexual, transgen- der, queer)-specific patient encounters, as LGBTQ communi- cation and education has been identified as a weakness among medical students and undergraduate medical education [1–4]. This may be reflective of limited LGBTQ-specific education that trainees may receive, as studies indicate that medical schools often offer no more than just a few hours of LGBTQ education in their entire curriculum, if any at all [4]. LGBTQ patients may avoid seeking treatment or delay their treatment due to concerns of previous encounters with clinicians or trainees that were invalidating, uncomfortable, disrespectful, or even discriminatory [5–7]. Thus, there is a need for medical schools to ensure that trainees understand how to use language that is affirming and inclusive in clinical settings, conveying a message of respect and compassion. Language that assumes partners, pronouns, gender identity, and other aspects of sexuality can be alienating and uncom- fortable to LGBTQ patients, contributing to the gender minor- ity stress that can be experienced by belonging to a stigma- tized minority group. Heteronormative assumptions (assum- ing heterosexuality as a preferred and natural sexual identity) can be a common mistake for medical students, who may not receive clinically oriented training which focuses on how to more effectively communicate with LGBTQ patients using affirming and neutral language [4]. This is particularly relevant in psychiatry given that LGBTQ patients suffer from a disparate burden of mental health conditions and have his- torically experienced a tumultuous relationship within the field of psychiatry in general [8, 9]. Compared to heterosexual and cisgender (those whose gender identity is consistent with their biological sex assigned at birth) individuals, members of the LGBTQ community are over two times more likely to attempt suicide and are twice as likely to experience depres- sion, anxiety, and illicit substance use [10, 11]. Suicide risk is especially high in gender minority (e.g., transgender and gen- der nonbinary) adolescents, as 50% of trans-males, 42% of nonbinary youth, and 30% of trans-females have reported a previous suicide attempt, compared to 14% of adolescents in general [12]. Recognizing these risks and disparities, and with the goal of improving the climate for LGBTQ individuals seeking mental healthcare, a pilot program was implemented in the psychiatry clerkship at the Medical University of South Carolina to help develop and improve upon communication skills for third-year medical students. Implementation During the core psychiatry clerkship at the Medical University of South Carolina, third-year medical students participated in a 90-min discussion-based seminar which consisted of didac- tic teaching, multiple-choice questions, clinical vignettes from the Association of American Medical Colleges [13, 14], and role-playing/problem-solving in LGBTQ clinical scenarios. The seminar took place in a small-group setting, ranging from 8 to 15 participants for a total of approximately 150 partici- pants throughout the 2018–2019 academic year. The seminar was integrated into the psychiatry clerkship curriculum and taught by senior residents and fourth year medical students with the guidance of faculty. During the week prior to each seminar, students were sent an online survey which assessed their comfort level, self- * Matthew C. Fadus fadus@musc.edu 1 Medical University of South Carolina, Charleston, SC, USA 2 Beth Israel Deaconess Medical Center, Boston, MA, USA 3 Boston University Medical Center, Boston, MA, USA Academic Psychiatry https://doi.org/10.1007/s40596-019-01157-0