A Day in the Life of a Fourth Year Medical Student: A focus on LGBT-inclusive Education

uvmmedicine blogger Nicholas Bonenfant '17
uvmmedicine blogger Nicholas Bonenfant ’17

A Day in the Life of a Fourth Year Medical Student: A focus on LGBT-inclusive Education
All fourth year students at the UVM Larner College of Medicine are required to complete either a teaching month or a scholarly project, both to reinforce foundational sciences and to encourage the development of students as physician-scholars. For this scholarly project, Nicholas Bonenfant ’17 has been working with Michael Upton, M.D., assistant professor of psychiatry, to develop a series of educational eModules and presentations on topics related to LGBTQ health issues. This started with an eModule and presentation targeted at increasing primary care providers’ knowledge of and comfort with prescribing pre-exposure prophylaxis (PrEP) for HIV prevention; since then, he has developed modules focused on transgender health and the unique barriers that face LGBTQ youth of color. Bonenfant, a native of Concord, NH, plans to match into pediatrics.

Can you describe the project? What were the main goals?
Initially, this project started off with addressing a finding discovered by a group of third year Larner College of Medicine students for their public health project. They found that one of the largest barriers to prescribing PrEP in Vermont is a lack of knowledge and training around this medication. PrEP is a medication taken daily by individuals who are HIV-negative but at high risk of acquiring this infection, to reduce their overall risk. According to the CDC, when taken consistently, PrEP has been shown to reduce the risk of HIV acquisition by up to 92 percent. The module, which has been presented to various groups of providers and students, covers everything from indications, clinical monitoring, to cost/insurance coverage in Vermont. Post-intervention questionnaire data has demonstrated that it’s a useful tool for educating and making primary care physicians more comfortable with prescribing PrEP and identifying high-risk patients.

Under the leadership of Dr. Upton and his recent Frymoyer grant, though, the scope of the project has morphed into something much bigger: the development of a series of educational modules on LGBTQ health. The two most recent modules I developed discuss and address the profound health disparities and difficulties that transgender children/adolescents and LGBTQ youth of color face. These modules also offer a wide array of other information, such as locally/national-based resources and the multitude of ways that pediatricians can advocate for their transgender and sexual minority patients.

The major goal is for this series of modules to be incorporated into medical school and resident curriculum here at the University of Vermont and beyond; we are excited to be presenting this process at the Improving OUTcomes national conference in Sacramento, Calif., at the end of March 2017.

What was your motivation for pursuing this project?

Nicholas Bonenfant '17 presents results of his scholarly project to residents at UVM Medical Center.
Nicholas Bonenfant ’17 presents results of his scholarly project to residents at UVM Medical Center.

The real drive behind this entire project was to, in a way, give back to the LGBT community, particularly here at UVM and in greater Vermont, which has welcomed me with open arms. I expressed this interest to Martha Seagrave, assistant professor of family medicine, about wanting to focus my family medicine clerkship community project on a topic related LGBT health care and serendipitously, she had recently had a conversation about the need to better educate providers about PrEP with Dr. Upton – and the story unfolds from there!

Additionally, during the course of fourth year, I had the unique opportunity to spend time at a “safe zone” drop-in space for LGBTQ youth of color during an extramural rotation in adolescent medicine in Boston, Mass. It was during this experience that the health disparities and difficulties that these adolescents face became so very clear to me and yet so unfamiliar to many. I saw the development of these teaching modules as a way to begin to advocate for these patients.

What have you learned from this project overall?
I’ve learned the importance and significance of focusing energy and enthusiasm that’s derived from a passion towards a greater purpose. The conversations and stories I’ve heard from LGBT patients, particularly the adolescents in Boston, really had a transformative impact on me not only as a person but as a future pediatrician. I hope that the current and future modules that we create will help to better the physician-patient interactions and motivate and inspire others to fight for children who face unique and significant challenges related to their gender identity.

Read more about Bonenfant and several of his classmates in a photo essay on the fourth year of medical school, coming out in the fall 2017 issue of Vermont Medicine.

What are your thoughts about this topic?