ࡱ>  jbjb (oo[4448-5I5q\66666777\\\\\\\_]`V\77777\866+\888766\87\88RSU/8A647TVA\0q\&TW`8W`<U8U777$ 44 :   Sample LGBT Health Curriculum Needs Assessment Survey (Fill in Name of Medical School) Date of Survey: ___________ ѿapp YOU: 1. What is your year in school? (circle one) MS I MS II MS III MS IV 2. Do you identify as LGBT? Yes No 3. Do you identify as an LGBT Ally? Yes No 4. On a scale of 1 to 5, how important do you think it is to spend time on LGBT health in the formal medical school curriculum? (1) Unimportant (2) Somewhat unimportant (3) Neutral (4) Important (5) Very important ѿapp OUR SCHOOL: 5. How well does the formal curriculum here address LGBT Health OVERALL? (1) Poorly (2) Somewhat poorly (3) Adequately (4) Well (5) Very well 6. How well do our pre-clinical classes (Years I and II) address LGBT Health OVERALL? (1) Poorly (2) Somewhat poorly (3) Adequately (4) Well (5) Very well 7. In particular, please rate these individual PRE-CLINICAL classes on how well they address LGBT health: a. History Taking & Physical Exam(0) Not Present(1) Poorly(2) Somewhat poorly(3) Adequately(4) Well(5) Very wellWhat does this class do well relating to LGBT health? What could it do better?  b. Problem-Based Learning(0) Not Present(1) Poorly(2) Somewhat poorly(3) Adequately(4) Well(5) Very wellWhat does this class do well relating to LGBT health? What could it do better? c. Infectious Disease (modify course topics to fit your curriculum)(0) Not Present(1) Poorly(2) Somewhat poorly(3) Adequately(4) Well(5) Very wellWhat does this class do well relating to LGBT health? What could it do better? d. Cardiology (modify course topics to fit your curriculum)0) Not Present(1) Poorly(2) Somewhat poorly(3) Adequately(4) Well(5) Very wellWhat does this class do well relating to LGBT health? What could it do better? e. Endocrine (modify course topics to fit your curriculum)(0) Not Present(1) Poorly(2) Somewhat poorly(3) Adequately(4) Well(5) Very wellWhat does this class do well relating to LGBT health? What could it do better?  8. How well do our clinical clerkships (Years III and IV) address LGBT Health OVERALL? (1) Poorly (2) Somewhat poorly (3) Adequately (4) Well (5) Very well 9. In particular, please rate these individual CLERKSHIPS on how well they address LGBT health: a. OB-GYN (modify clerkships to fit your institution)(0) Not Present(1) Poorly(2) Somewhat poorly(3) Adequately(4) Well(5) Very wellWhat does this clerkship do well relating to LGBT health? What could it do better? b. Psychiatry (modify clerkships to fit your institution)(0) Not Present(1) Poorly(2) Somewhat poorly(3) Adequately(4) Well(5) Very wellWhat does this clerkship do well relating to LGBT health? What could it do better? c. Internal Medicine (modify clerkships to fit your institution)(0) Not Present(1) Poorly(2) Somewhat poorly(3) Adequately(4) Well(5) Very wellWhat does this clerkship do well relating to LGBT health? What could it do better? d. Surgery(0) Not Present(1) Poorly(2) Somewhat poorly(3) Adequately(4) Well(5) Very wellWhat does this clerkship do well relating to LGBT health? What could it do better?10. Please rate these individual ELECTIVES on how well they address LGBT health: a. Adolescent Psychiatry (modify electives to fit your institution)(0) Not Present(1) Poorly(2) Somewhat poorly(3) Adequately(4) Well(5) Very wellWhat does this elective do well relating to LGBT health? What could it do better?  11. Please rate how well each of the following subject areas* is covered in our formal curriculum: a. Terminology surrounding LGBT health (introducing the words gay, MSM, etc)(0) Not Present(1) Poorly(2) Somewhat poorly(3) Adequately(4) Well(5) Very wellWhere is this topic covered in the curriculum? Where else might it be covered? b. Increased risk for breast cancer in lesbian women(0) Not Present(1) Poorly(2) Somewhat poorly(3) Adequately(4) Well(5) Very wellWhere is this topic covered in the curriculum? Where else might it be covered? c. Increased rate of HIV among young men who have sex with men(0) Not Present(1) Poorly(2) Somewhat poorly(3) Adequately(4) Well(5) Very wellWhere is this topic covered in the curriculum? Where else might it be covered? d. Office practices surrounding gender identity (sensitivity to gender variance in bathroom setup, health history forms, etc.)(0) Not Present(1) Poorly(2) Somewhat poorly(3) Adequately(4) Well(5) Very wellWhere is this topic covered in the curriculum? 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