Good morning and thank you very much for the opportunity to present our research with you virtually today. My name is Shea Buckley, I use they them pronouns and I am an OMS3 and academic medicine scholar at New York Institute of Technology's College of Osteopathic Medicine. Sexual and gender minority SGM patients experience barriers to equitable health care, in part due to a lack of adequate and inclusive education at every level of training. Recent literature illustrates that individuals who hold SGM identities are often subject to discrimination at the hands of providers with 56% of sexual minority identified patients and 70% of gender minority identified patients reporting at least one incident of health care based discrimination in their lifetime. Studies have found that many providers admit to discomfort and general lack of willingness to discuss relevant topics or perform routine screening tests on SGM patients. These barriers, discrimination and incompetencies lead to significant adverse health outcomes for this community, especially obvious in sexual health, mental health and routine cancer screenings. The prevalence of this inequity is due in part to the lack of provider knowledge about SGM identities and their specific health care needs. This knowledge deficit among the provider population is present and pervasive at all levels of experience due to lack of adequate education in SGM health care topics during undergraduate and graduate training programs. This study aims to identify current self-perceived knowledge gaps about gender identity, gender pronouns and health disparities that can be addressed by future curriculum and to assess the effectiveness of pronoun competency training as an educational tool in early undergraduate medical education. NYAT-COM introduced a mandatory student-led pronoun competency training into the 2023-24 First-Year Doctor-Patient Relations coursework to enhance didactic curriculum on SGM health needs. A pre-intervention, post-intervention survey design was used to assess student comfort, perceived knowledge and inclusive behaviors before and after watching the lecture. Five Likert-style questions were asked at the pre- and post-training time points. Questions included self-perceived understanding of using pronouns, general SGM definitions, including a specific question on cis and transgender, SGM-related barriers to care, and finally, a willingness to include pronouns in email signature. There were four open-ended free response questions asked at the post-training time point only. These included space for students to express three main learning outcomes and any remaining questions or knowledge gaps that they had after watching the training. For statistical analysis, any survey response that included at least one pair of pre- and post-training answers or at least one free response answer was analyzed. The final analysis included 481 unique survey responses. Statistical analysis was performed on JASP. A student's t-test was used to assess difference in pre-training Likert score data between the two NYTCOM campuses, and students' paired t-test was used to assess pre- to post-training change. Qualitative analysis was used to categorize key learning outcomes and knowledge gaps in questions by theme. Students were generally receptive to and grateful for the training and responded positively and professionally in the free response questions. Qualitative analysis showed the top themes identified for learning outcomes included outcomes related to concrete skill acquisition, the importance of using correct pronouns in healthcare communication, gaining a better understanding of gender concepts and SGM definitions and identities, gaining insight into the healthcare experiences of SGM community, and gaining a better understanding about how appropriate and sensitive care can address inequities, support safety, and reduce barriers to care. The most common remaining questions identified were how to provide adequate care to SGM patients and be informed about their specific healthcare needs, how to approach pronouns in the clinical setting, especially when patients who are offended or get aggravated by the topic, and how to address inequities in healthcare setting. The top knowledge gaps identified included a need for more examples and opportunities to practice, and a need for more research and statistics on the inequities present and the benefits of inclusive behaviors by physicians. Quantitative analysis showed no significant difference between any of the five pre-training Likert scores of students at the New York campus versus the Arkansas campus. Results further showed that there was significant improvement in Likert scores for all five Likert-type questions at a 0.001 significance level, as can be visualized in Figure 1. Cohen's DFX sizes for these differences ranged from negative 0.315 to negative 0.484, supporting a small to moderate effect size. A summary of these statistics can be seen in Table 1. In conclusion, we show that participating students were generally receptive to SGM education. NYTCOM's Pronoun Competency Training lecture provided an opportunity to develop concrete skills for appropriate and inclusive pronoun use, education on basic SGM definitions, and exposure to SGM experiences in healthcare. The training results resulted in improvements in self-perceived understanding of SGM topics and willingness to partake in inclusive behaviors. Future curricula should focus on evidence-based practices for providing adequate and equitable care to SGM patients, give more opportunities for practice, and develop students' professional communication skills for addressing unreceptive patients. Continued and further research is necessary to identify the long-term effects of training programs such as the Pronoun Competency Training and to identify the most efficacious learning modalities for SGM-related education. This research will continue at NYTCOM in the 2020-2024-2025 academic year to gain more insight into a larger sample of students and see how improvements to the training impact future results. My resources are available by QR code. I would like to take a moment to give a huge thank you to Dr. Scotton and Dr. Morgan for incorporating my training into the curriculum and making this research possible. Thank you.

SGM healthcare

pronoun competency

inclusive practices

medical education

evidence-based communication