training will likely need to be done using some kind of video tool given that the people who need training are going to be dispersed, both in terms of location and time. Training methods must also take into account that three-quarters of all office visits nationally are to practices with five or fewer clinicians. And most of those practices do not have the resources to conduct extensive training programs.

Though there are important differences between collecting race and ethnicity data and sexual orientation and gender identity data, there are lessons to be learned from the experience of introducing race and ethnicity data into medical records. The first lesson is that the language provided to guide those who ask these questions must be well defined, that is, there should not be much left to the imagination of the person who is asking the question. A corollary to this lesson is that the information learned when testing questions in a research or survey context are not automatically transferrable to a clinical context, said Weinick.

A second lesson learned from collecting race and ethnicity data is that it is extremely helpful to prepare an introductory statement for the data collectors to use that explains why it is important to gather the information. That introductory statement serves the dual purpose of explaining to the patient and the staff who are going to ask these questions why the information is important to collect.

Another important lesson is that it is important to keep staff calm by identifying potential patient and staff objections in advance and build those into the training. Scripting responses so that staff can start to get comfortable with various situations is helpful, as are role-playing exercises. Another way to reassure staff is to provide them information from pilot data collection studies that show that if questions are asked in the right way, patients do not get angry. In addition, repetition is critical to making staff feel at ease. Weinick explained that the goal of training should be to drive home two points: (1) do not make assumptions about a patient based on how they look, act, or sound, and (2) patient self-identification is the only thing that matters.

Three additional factors go into successful training of the people who will be asking these questions. First, they need to understand as concretely as possible why the issue is important. Second, they need to know clearly and very specifically what they are being asked to do. And, finally, they need to have skills and scripts for addressing patient concerns.

DISCUSSION

Aaron Tax, from Services and Advocacy for GLBT Elders, asked the four speakers about their experiences in collecting sexual orientation and gender identity data for elderly persons who may be more reluctant



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