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The authors respond to Nancy Robb's account of the inadequacy of medical school curricula in addressing health care issues relevant to gay, lesbian and bisexual people (see page 765 of this issue) by proposing a framework for curriculum reform. This framework supports the development of knowledge, attitudes and skills necessary to the provision of sensitive and comprehensive care for these patient groups through four types of learning experiences: didactic instruction, small-group discussions, simulated patient encounters, and supervised encounters with real patients. Equally important is the attitudinal context in which learning takes place. Without fostering a supportive and accepting environment for education about gay, lesbian and bisexual health care issues, medical schools cannot ensure that future physicians will be equipped to provide appropriate care for all members of society.