After more than a decade abroad, Kyle Wilby recently relocated to Canada for a big task: to lead a curriculum overhaul at Dalhousie University’s college of pharmacy. Dr. Wilby’s work focuses on how pharmacy can better serve the LGBTQ+ population. Before arriving in Halifax, he developed a curriculum in New Zealand – one of the few places where Dr. Wilby said pharmacy education is shifting to better address LGBTQ+ care.
While there’s been a push in recent years to train nurses or physicians on inclusive care, “there’s very little in the pharmacy space,” Dr. Wilby said. He sees this as a missed opportunity, since pharmacists are usually embedded within the communities they serve and thus tend to be more accessible. But there has been some activity within the field, offering injections of hormone treatment for transgender patients, for example, or point-of-care rapid HIV testing.
The LGBTQ+ population still experiences barriers to care, including stigma, discrimination and past traumatic experience in health-care settings, Dr. Wilby said. For example, patients who are not “out,” or who are uncomfortable discussing their sexuality with their doctor, can have poorer health outcomes as their care needs may not be fully addressed. Such barriers have been widely documented in medical research, including the need for medical professionals to be more sensitive to them. This past April, researchers at the University of Toronto published a study arguing for standards in LGBTQ+ medical education. (The school’s medical residency program made shifts in this area in 2020, incorporating LGBTQ+ health-specific courses into the curriculum and training).
Dr. Wilby said pharmacy needs to be part of that conversation. “We can offer that primary care resource, where someone can come in and discuss an issue before having to go to a health-care centre which might be more triggering.” It’s also one of the main reasons why pharmacy schools need to foster connections to local LGBTQ+ organizations, so that more practicing pharmacists will be aware of services their patients might need.
Education is the starting point, especially since regulations governing what pharmacists can do varies from province to province (unlike physicians). That means pharmacy schools are where new standards can be set, Dr. Wilby explained. Integrating LGBTQ+ health into the whole curriculum would be a step forward (rather than in an elective course or one-off lecture). “The people who sign up for those [elective] courses are probably more inclusive anyway,” he said. “It’s the pharmacists who don’t have interest in taking that elective that need it.”
Rethinking core beliefs
A similar shift is taking place at the University of Toronto’s school of pharmacy, where Jamie Kellar agrees that integration is the goal. Dr. Kellar is overseeing that school’s curriculum overhaul, which will include more course content on LGBTQ+ health and closer partnerships with community groups that serve the population. She said her field hasn’t been at the forefront on the issue compared to other health professions because of core beliefs about accessibility.
“There’s been a common understanding that providing and educating on medications would be similar across the board regardless of who you’re doing that for, and that’s actually not the case,” she said. “When you’re providing medication education, you’re tailoring that to the individual and their experience with taking medications or how they view medications.”
There’s physical space to consider as well. Dr. Wilby said even though pharmacies can be easy to access, a lack of LGBTQ+-inclusive signage or adequate privacy can detract from that.
‘An obligation to get it right’
Dr. Kellar also believes that pharmacy schools are an important part of driving change, which includes standardizing competency requirements. “Our education outcomes for Canadian pharmacists are the same across all of our schools,” she said. “So adding competencies that are specific to different groups would ensure that all pharmacists entering the workforce are competent to provide care, in all sorts of areas.”
Much of the time, training is centered on communicating with patients from all walks of life. While that’s important, Dr. Wilby said the curriculum needs to ensure students understand the root cause of the issues their patients face. “It always comes back to that factor of health-care settings being potentially triggering, and needing to look at inclusivity as a whole,” Dr. Wilby said. “Sometimes students don’t necessarily know what they need to know.”
The pandemic highlighted the pharmacy discipline in an unprecedented way, especially the accessibility component. When people couldn’t get in to see their family practitioner, Dr. Kellar pointed out, their pharmacist was still there to help. “It’s been great from the perspective of the profession, but I also think it comes with a requirement for us as educators to recognize the role we can play, positively but also negatively,” she said. “We have an obligation to get it right.”