PALLA Fellow Designs Longitudinal LGBTQ+ Health Curriculum

Jenna Schiller, PA-C, MMS

My name is Jenna Schiller. I graduated from the Towson/CCBC PA program in 2017. I was accepted as a Physician Assistant Learning and Leadership Academy (PALLA) fellow in September 2020 and recently became a graduate of the fellowship in May 2021. Throughout the fellowship, we were tasked with developing an individual project that was potentially a gap in PA education or an area that we felt could be expanded or improved. When brainstorming what I wanted to do for my final project, I reflected on why I wanted to become a PA. The reason I pursued a career in medicine was to provide compassionate patient care and ensure that patients were treated fairly, justly, and with the care they deserve. 

Working in the emergency department, I was exposed to patients of all ages, races, religions, and backgrounds. I remember being a PA for only a month when I walked into a patient’s room, room 43, with the chief complaint of “vaginal bleeding.” Based off of the complaint, I expected to see a female patient. However, when I entered the room, the patient appeared male. I was immediately taken off guard and began stumbling to take a history. Instead of being straightforward and asking direct questions, I was awkward and wasn’t exactly sure what to ask or say. Luckily for me, the patient was very forgiving, kind, and open, and explained his complaint and why he came to the ER. The patient proceeded to explain to me that he was assigned female at birth but identified as male, making him my first ever transgender patient. He told me that his pronouns were he and him and asked me to address him by his chosen name. The patient also communicated to me that he had been taking testosterone for several years and has not had his menstrual cycle since he had begun the testosterone treatment. He said that he was hesitant to seek medical attention due feeling uncomfortable about his situation and poor past experiences within the medical field. 

The experience with this patient made me realize that there is a huge gap in PA education. I was not equipped to appropriately care for a patient that self-identified as LGBTQ+ that this encounter required. Therefore, I decided to design a longitudinal curriculum for PA students to better care for the patients who self-identify as LGBTQ+.

The curriculum begins prior to class time as a pre-lecture activity. Students will be asked to navigate and familiarize themselves with multiple websites and resources. The beginning of this curriculum will lay the foundation for students to be able to participate in an open forum panel, assembled of community members who self-identify as LGBTQ+. The purpose of the panel is for each member to introduce themselves and discuss their experience within their community and the medical field. Following the panel, students will have the opportunity to ask questions or provide comments in that safe place to better understand the lived experiences of the members of the panel. Once the students gain an initial understanding of the LGBTQ+ population, it was important to me to incorporate a form of art in order to have students feel and better understand the struggles and hardships that a self-identifying LGBTQ+ patient may experience. Students will be asked to watch the movie Gen Silent, a documentary following the lives of six seniors who identify as LGBTQ+ who must choose if they will hide their sexuality in order to survive in the long-term care health system. Once students’ progress through the curriculum, an OSCE will be performed with a patient who self identifies as LGBTQ+. The purpose of ending the longitudinal curriculum with a standardized patient is to have students perform a full history and physical examination, utilizing proper pronouns to assure that not only the patient feels comfortable and understood, but that the student enters their clinical year feeling comfortable and confident walking into exam room 43 in the ER, knowing they will provide the patient with compassion, understanding, and excellent patient care.