Clinical competence of Polish paramedics in caring for LGBT patients: A national cross-sectional study

BACKGROUND: Systemic preparation for the care of lesbian, gay, bisexual, and transgender (LGBT) patients in Poland remains limited, despite the increasing visibility of sexual and gender minorities in clinical settings. Emergency medical services, often the first and sometimes the only point of contact with healthcare, operate without structured guidance on inclusive practice. For paramedics, this gap translates into uncertainty at the bedside and inconsistent quality of care. However, the clinical competence of Polish paramedics in responding to the needs of LGBT patients has never been empirically examined. OBJECTIVES: This study aimed to assess the clinical preparedness, attitudinal awareness, and basic knowledge of Polish paramedics regarding LGBT patients. MATERIAL AND METHODS: In a national cross-sectional survey (n = 465), 289 participants completed the LGBT-Development of Clinical Skills Scale (LGBT-DOCSS) scale. Data were analyzed using beta-inflated generalized additive model for location, scale, and shape (GAMLSS) regression with least absolute shrinkage and selection operator (LASSO)-based predictor selection. RESULTS: Clinical preparedness was low (predicted μ = 2.32/7), particularly among those without prior LGBT-specific training or exposure. Attitudinal awareness was high (μ = 5.82), while basic knowledge scores were moderate (μ = 4.06). Recent LGBT-related training was associated with higher clinical preparedness (β = 0.779, p < 0.001), and prior informal experience also showed a positive association (β = 0.553, p < 0.001). Male sex (β = 0.369, p < 0.001) was associated with higher clinical preparedness, while homosexual orientation (β = 0.349, p = 0.001) was associated with higher overall clinical competence. Lower attitudinal awareness was observed among men (β = -0.545, p < 0.001) and those without LGBT contact (β = -0.688, p < 0.001). Recent training had no significant effect on basic knowledge (β = 0.280, p = 0.295). CONCLUSIONS: Polish paramedics express attitudinal awareness but lack clinical readiness, with a low baseline clinical preparedness score (μ = 2.32/7). Given the frontline role of emergency medical services, these findings highlight an urgent need for structured, practice-oriented LGBT training within paramedic education and continuing professional development.