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48 QUALITY & ACCREDITATION 8 Key AAMC Considerations When Caring for LGBT Patients By Megan Wood I n 2014, the Association of American Med- ical Colleges released the first guidelines outlining how physicians should approach caring for patients who are lesbian, gay, bi- sexual, transgender, gender nonconforming or born with differences of sex development. LGBT patients sometimes face discrimina- tion and mistreatment in the healthcare environment, according to the guidelines, which help physicians excel in 30 competen- cies within eight domains. In 2015, University of Louisville (Ky.) School of Medicine launched the LGBT Health and Wellness Competency program. e medical school served as the pilot site for incorpo- rating AAMC's training competencies. e school recently awarded 102 students, faculty and staff members program certificates. Here are eight competency domains for physicians to master to enhance healthcare for patients who are LGBT, gender noncon- forming and born with differences of sex development: 1. Patient care. Collect information about a patient's history by sensitively learn- ing about the patient's "sex anatomy, sex development, sexual behavior, sexual history, sexual orientation, sexual identity and gen- der identity." Make informed decisions about diagnostic and therapeutic interventions for trans- gender patients, which gathered patient information and scientific evidence support. Relay certain healthcare needs and available options. Tailor the physical exam to the patient's unique needs and address specific health risks and challenges these individuals experi- ence. 2. Knowledge for practice. Describe differences between: • Sex and gender • Gender expression and gender identity • Gender discordance, gender noncomfor- mity and gender dysphoria • Sexual orientation, sexual identity and sexual behavior Be aware of typical sex development as well as the main causes of atypical sex develop- ment. 3. Practice-based learning and im- provement. Acknowledge shortcomings in one's knowledge, and gather scientific study evidence associated with patients' health complications. 4. Interpersonal and communication skills. Foster a comfortable environment for effective communication with patients and their families. Ensure you use current terminology and involve the patient in the decision-making process. Be aware that "unconscious bias and as- sumptions about sexuality, gender and sex anatomy may adversely affect verbal, nonver- bal, and written communication strategies" when caring for a patient. 5. Professionalism. Fully adhere to the confidentiality aspects of gender, sex and sexuality issues. Practice sensitivity and responsiveness to a diverse patient popula- tion and encourage policies that eliminate population care disparities. 6. Systems-based practice. Successful physicians will advocate for patients' high quality care, by helping them si through specific legal and policy complications. Offer your patients information about support groups or legal advocates. Also, identify how "homophobia, transpho- bia, heterosexism and sexism affect health- care inequalities, costs and outcomes." 7. Interprofessional collaboration. In- volve your whole care team to create "cultur- ally competent, patient-centered care," so all patients feel comfortable. All team members should demonstrate "mutual respect, dignity, diversity and ethical integrity" among each other and with patients. 8. Personal and professional develop- ment. You are in control of your own biases when treating patients. Work diligently to remove any unintended biases so all of your patients receive equal and quality care. n Top 25 States With the Highest & Lowest ASC Wrong-Site Surgery Rates By Mary Rechtoris C MS released the results for its 2014 Ambulatory Surgical Center Quality Re- porting Program, which cited the states with the highest rates and lowest rates for wrong site, side, patient, procedure and implant. The national average for these sentinel events was 0.028, slightly down from the 2013 average of 0.039. The states with the highest rates include: 1. Alaska: 0.158 2. Wisconsin: 0.028 3. West Virginia: 0.028 4. Wyoming: 0.028 5. Minnesota: 0.027 6. Missouri: 0.027 7. Mississippi: 0.026 8. Montana: 0.026 9. North Carolina: 0.026 10. North Dakota: 0.026 11. Washington: 0.026 12. Vermont: 0.026 13. Utah: 0.026 14. Texas: 0.026 15. Virginia: 0.026 Some of the states with the lowest rates include: 1. Arkansas: 0.013 2. Delaware: 0.016 3. California: 0.016 4. Washington, D.C.: 0.017 5. Connecticut: 0.017 6. Colorado: 0.017 7. Illinois: 0.021 8. Arizona: 0.021 9. Alabama: 0.021 10. Massachusetts: 0.022 n