Transgender individuals experience a number of barriers to access to care including lack of availability of competent healthcare providers and stigma in healthcare settings. This is especially true in rural South Central Appalachia, where access to care for the general population is already limited. However, to date, little research has been done assessing the extent to which and reasons for lack of physical and mental healthcare access for transgender and other gender minority populations in this region. In this mixed-methods study we surveyed 155 healthcare providers and conducted focus groups and interviews with 18 patients in order to gain a better understanding of the obstacles to care that local gender minority patients experience. Results indicate that providers have a lack of training and a general lack of knowledge about these populations and their health needs and that many patients have difficulty identifying friendly and competent providers, have experienced stigma in healthcare settings, and often find themselves educating their own providers about their basic health needs. There is a clear need for training of currently-practicing primary care providers in South Central Appalachia on basic gender minority health needs and a need to train providers-in-training about the needs of LGBT patients.

One-third of transgender individuals report having at least one negative health care experience related to being transgender and nearly a quarter report that they have delayed seeking health care due to fear of being mistreated. Objective: To assess medical providers’ experiences with, attitudes towards, and knowledge of transgender health care in the Northeast Tennessee region. Study Design: Cross-sectional survey. Setting: Academic and community health care clinics in Northeast Tennessee. Participants: Physicians, nurse practitioners, and physician assistants practicing emergency medicine, family medicine, internal medicine, obstetrics & gynecology, or pediatrics (n=154). Main and Secondary Outcome Measures: Descriptive statistics and multiple regression models were used to determine relationships between provider characteristics and three sets of dependent variables (practices, attitudes, and knowledge). Results: The majority of providers (65%) had not received training in transgender healthcare. Over 90% perceived they had treated fewer than five trans-identified patients in the last year. The majority of respondents (69.3%) felt comfortable providing health care to transgender patients, yet only 38% felt competent treating this population. Providers indicated it was important to know their patients’ sexual practices, gender identity and sexual orientation; however, the majority of providers never or rarely asked patients their gender identity (75.4%), sexuality (57.2%), or desired pronouns (84.4%). Having formal training in transgender health was the only significant predictor of knowledge, sexual orientation and gender history taking, and competence/comfort with transgender patient care. Conclusions: Results demonstrate a contradiction between ideology and practice. Most participants responded they felt comfortable providing care to the transgender population, yet their responses indicated a lack of training and absence of inclusivity in their health care practices. As formal training was the only significant predictor of outcomes, this suggests that additional medical education and training is needed on transgender health care.

East Tennessee State University implemented quality improvement (QI) training for second-year family medicine residents in 2009. Results in 2011 indicated training increased scores in QI skill assessments as well as self-efficacy in QI. With residents who completed the training now in practice, does the increase in knowledge and skill translate to increased QI in practice? A survey of graduates compares frequency of QI cycles and self-assessment of QI skills among graduating classes, those receiving QI training and those graduating before training began. Residents that completed the QI curriculum rated their training higher; however residents that did not receive training were more involved in QI in practice. We suggest that this is due to QI involvement increasing with practice. Results will guide curriculum improvements to strengthen future resident training.

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Despite advances in online research methods, there are still significant challenges in sampling certain populations. These challenges include the concealed nature of stigmatized identities, lack of access to the internet, or living in rural or remote geographic locations. In this interactive discussion, we will focus on research with hard-to-reach populations, and successes and challenges encountered while using online methods to recruit participants and gather data. Each of the presenters will briefly talk about different experiences recruiting sexual and gender minority participants in rural areas using online methods. We welcome researchers who have worked with other hard-to reach population, those who are interested in doing so, and those who have used other methods of sampling and data collection using new technology to share their experiences. We will also break into small groups to discuss how recruitment and data collection are made more complex when targeting multiple intersecting marginalized identity statuses that, combined, make them particularly vulnerable to being understudied. Finally, we will collaboratively construct a list of strategies and resources to share with session attendees at the conclusion of the session.

In 2016, Tennessee Governor Bill Haslam signed into law the “Counseling Discrimination Bill,” which allows a licensed counselor in a private practice to use personal (i.e., religious) beliefs as an reason to terminate care or refer away LGBT+ clients, as long as they refer the client to another counselor. In that same year, the state legislature and governor defunded the University of Tennessee, Knoxville’s Office for Diversity and Inclusion, which had spearheaded a number of LGBT+ activities and initiatives around campus. In this interactive discussion, scholars from different Tennessee institutions (and/ or who were raised and educated in Tennessee) will discuss how their scholarship and activism has been shaped by, and is helping to inform, LGBT+ policy in Tennessee, and how these lessons might be applied in other state/local contexts. The panelists will speak to a number of questions, including: How can my scholarship inform LGBT+ policy in my state? How do I connect with policymakers, practitioners, and organizations that could benefit from my expertise? How can I contribute to local advocacy efforts, and what might be my appropriate role in those efforts? How do I get involved in this arena at different stages of my career? and How can I help interested students get involved?

Sexual minority women experience a number of physical and mental health disparities compared to their heterosexual peers. One factor contributing to this disparity is access to care, of which sexual minority women also report having less than heterosexual women. In this study I examine predictors of sexual minority women's access to care in three ecological contexts: structural, community, and interpersonal. Eighty-eight sexual minority women 22 and older from Davidson County, TN responded to an online survey that gathered information about demographic factors and various aspects access to care including accessing healthcare systems, gaining access within the system, and patient/provider relationships. Multiple regression analysis was used to determine whether demographic factors were significant predictors of access to care. Age, education, and degree to which participants were open with others about their sexual orientation were significant predictors of access. Results point to significant differences in access to care within this population that has multiple marginalized identity statuses, indicating a need for attention to within-population access needs. Sexual minority women who are younger, less educated, and less out to others about their sexual orientation may be at increased risk to face barriers to care. Implications for practice and policy include a need for increased cultural competence of healthcare providers, and changes in policies that will close the insurance gap between heterosexual and sexual minority adults in the U.S.

In this hands-on preconference workshop, we will introduce dermoscopy, a proven adjunctive tool that increases sensitivity and specificity of melanoma detection and improves diagnostic accuracy for basal and squamous cell carcinomas. Participants will learn how to use a dermatoscope in clinical practice and learn the two-step algorithm to diagnose unknown skin lesions and determine the need for biopsy. Biopsy techniques will be taught with a handson evidence-based approach that can be applied at one’s home institution. Participants will leave with fundamental competence in the use of dermoscopy for early skin cancer detection, improved understanding of biopsy techniques, tools to train others, free apps, Dermoscopedia, online resources, and online and in-person courses.