Improving osteopathic medical training in providing health care to lesbian, gay, bisexual, and transgender patients.

instruction to osteopathic medical students in 40 locations in 28 states.3 In the 2013-2014 academic year, osteopathic medical colleges educated more than 23,000 future osteopathic physicians— more than 20% of US medical students overall.4 Lapinski et al1 invited all US osteopathic medical schools in existence at the time of the study to participate; notably, only 6 agreed to participate. It is unknown how students from nonparticipating schools would have responded, but I believe it is a safe guess that their levels of acceptance, treatment attitudes, and medical knowledge about LGBT patients would not have been more positive or better than those of students who responded from schools that agreed to participate in the study. In addition, only 41.3% of all osteopathic medical students at the participating COMs submitted their online survey results (not an uncommon response rate for physician surveys overall). Only 32.5% completed the entire survey, perhaps because of item burden or fatigue.1 Thus, the study’s findings represent a small group of osteopathic medical students who may be most positive in their acceptance and attitudes and have the highest level of medically relevant knowledge compared with their peers who either did not start or complete the survey. Nonrespondents or incomplete responders may have had even lower levels of acceptance, attitudes, and perhaps poorer medically relevant LGBT knowledge compared with those who responded because of a selection bias. The American Osteopathic Association’s code of ethics5 states,