Enriching & Strengthening the Curriculum via Infusion of Sexuality & LGBTI Topics

Proposal to the Academy of Medical Educators
Ellen Haller, MD
Laura Hill-Sakurai, MD
Lee Jones, MD
Linda Alperstein, MSW, LCSW

Background Information
This proposal reflects important developments, upon which our project will draw extensively. But it also arises from several promising events that have occurred within SOM in recent months. Foremost among these was a thoughtful letter addressed to a number of SOM faculty and signed by nearly forty second-year students. It expressed a number of specific concerns about the I3 block, which, they felt, portrayed "homosexuality" as the leading risk factor for HIV, presented gay men demeaningly, confused sexual orientation and sexual behaviors, and failed to provide the information necessary for physicians to communicate adequately with patients about STDs and sexuality in general. But the letter went beyond the I3 block, noting that no one block could fairly be expected to provide the range of sexuality and LGBTI information needed by students, yet not, they felt, provided by the current curriculum. The letter-writers asked that student-faculty discussion be initiated to consider how best to convey this crucial information.

The students' detailed and respectfully worded letter led to several highly productive conversations, facilitated by Dean Loeser, among faculty and students within the I3 block and beyond. As the support letters mention, these wide-ranging conversations identified "gaffes, gaps, and opportunities" in all four years of the curriculum, and included considerable brainstorming about specific additions and improvements. These meetings, accompanied by many informal faculty-student exchanges, made clear that tremendous energy, interest, and expertise are now available within SOM for curriculum enhancement around sexuality and LGBTI topics. Our project intends to capitalize on that energy, interest, and expertise to provide UCSF students with the skills and information in these areas that, all agree, our society now requires of its physicians.

Project Goals
1. Review sexuality- and LGBTI-related curriculum content at UCSF and other schools (a significant portion of this review has already been accomplished)
2. Interview faculty and students at UCSF and selected other schools to hear their thinking about what would most enrich and strengthen the SOM curriculum, regardless of whether such content is now in place at UCSF or elsewhere (a significant portion of this has already been accomplished)
3. Review the information gathered in steps 1 and 2; identify the most promising additions/revisions to the SOM curriculum; rank them by impact and feasibility; and decide whether they would best be implemented over the short, medium, or long term
4. For the highest-ranked additions/revisions, particularly those implementable in the short term, determine what specific form they should take and where they might be infused
5. Work closely with individual faculty members to ensure that all proposed additions/revisions are truly welcome, effective, and workable; to adapt them as needed; to schedule their infusion into the curriculum; and to offer resources and support during and in connection with the infusion (which we would expect to occur from Summer 2004 onward, although some innovations may be "piloted" before then)
6. Create a process for monitoring, gathering feedback about, evaluating, and documenting all such curriculum additions and revisions

In accomplishing these goals, we intend to be mindful of the multitude of factors that can make or break curriculum additions and revisions. Thus, additional goals for our project include these intentions:

· To achieve maximum buy-in and success, we will collaborate not only with those who are already interested and/or involved in sexuality and LGBTI curriculum infusion but also with those who may not be interested in or perceive a need for such infusion
· We will involve students from all four years in every phase of the project
· While Prologue, FPC, I3, and Life Cycle will be key focus areas for the project, as the support letters attest, we will not overlook any area or year of the curriculum
· We will be mindful of the fact that the curriculum is packed, to say the least, and that all additions and revisions must reflect this reality
· We will take careful note of similar and allied projects, making contact with other Innovations Grant recipients and other themes/stewardships, such as those supporting ethics and culture infusion

Measurement & Documentation of Project Efficacy & Outcome
Measurement and documentation will, needless to say, be critical to the long-term success of this project. We have already discussed a number of methods for assessing efficacy and outcome, listed below, and we will supplement these (per Goal 6 above) as the project unfolds. In seeking funding for a second year of work from external sources (see "Plan for Project Continuation"), we hope to secure support for ongoing evaluation of the project, after the AME grant ends.

Plan for Project Continuation
With the support of the collaborators mentioned above, the project team plans to continue its work for at least one year after the end of the AME grant, in the belief that a project of this scope requires ongoing, focused attention. We hope to receive funding for this ongoing work from BAPHR (which, as noted above, is already providing financial support) and from other external funders. We have already received very positive feedback about the project from two key external funders, both of which have said that they would view AME funding as an impressive sign of high-level institutional buy-in.

For further information, please contact:
Ellen Haller, MD at ellenh@lppi.ucsf.edu
Laura Hill-Sakurai, MD at hillsakl@fcm.ucsf.edu
Linda Alperstein, MSW, LCSW at lindaalp@earthlink.net