Special-"T" Training: Extended Follow-up Results from a Residency-Wide Professionalism Workshop on Transgender Health

Evaluating the effectiveness of an online curriculum on caring for transgender and nonbinary patients

BACKGROUND AND OBJECTIVES

 It is well established that provider lack of knowledge in the field of transgender and nonbinary health is as ignificant barrier to care and that training in this area is lacking. This study examined how family medicine residents' self-confidence and medical knowledge in providing gender-affirming care changed after completing a novel, online curriculum on transgender and nonbinary care.

METHODS

Thirty-nine family medicine residents were invited to complete the curriculum. Change inself-confidence was determined by the difference in scores on a Likert scale on a pre- and post-survey. Change in medical knowledge was assessed by examining the difference between pre- and post-test scores on a novel multiple-choice examination.

RESULTS

Only 7% of current residents agreed that their current training is adequate in order to provide comprehensive primary care to transgender and nonbinary people. After completion of the curriculum, 100% of participants felt at least somewhat confident providing primary care to transgender and nonbinary people, including hormone therapy. Average medical knowledge post-test scores trended higher than the pre-test results (mean (SD) at pre = 11.2 (1.4) vs post = 14.6 (2.8)).

CONCLUSIONS

An online, self-directed curriculum on caring for transgender and nonbinary patients in the primary care setting, including management of gender-affirming hormone therapy, has the potential to increase confidence and knowledge in this field, decreasing barriers to care for this population.

The power to help or harm: student perceptions of transgender health education using a qualitative approach

BACKGROUND

Lack of transgender health education among health professional education programs is a limitation to providing gender-affirming care. Educational interventions have advanced in the past decade using a variety of pedagogical approaches. Although evidence supports that educational interventions can significantly improve student knowledge, comfort levels, preparedness, and clinical skills, few studies have addressed student perceptions of or receptiveness towards transgender health education. The study purpose was to explore student perceptions of transgender health education using a qualitative approach.

METHODS

We utilized a basic qualitative design to explore student perceptions of transgender health education at a Catholic, Jesuit institution. Participants were medical students (n = 182), medical family therapy students (n = 8), speech, language and hearing sciences students (n = 44), and dietetic interns (n = 30) who participated in an Interprofessional Transgender Health Education Day (ITHED) in partnership with transgender educators and activists. Participants completed an online discussion assignment using eight discussion prompts specific to the ITHED sessions. Data were analyzed using the constant comparative method and triangulated across four medical and allied health programs.

RESULTS

A total of 263 participants provided 362 responses across eight discussion prompts. Three major themes resulted: (1) The Power to Help or Harm, (2) The Responsibility to Provide Health Care, and (3) A Posture of Humility: Listen and Learn. Each theme was supported by three to four subthemes.

CONCLUSIONS

Health professional students were highly receptive towards transgender health education delivered by transgender community members. First-person accounts from session facilitators of both positive and negative experiences in healthcare were particularly effective at illustrating the power of providers to help or harm transgender patients. Reflection and constructive dialogue offers students an opportunity to better understand the lived experiences of transgender patients and explore their identities as healthcare providers at the intersection of their religious and cultural beliefs.

A Review of Patient Experiences and Provider Education to Improve Transgender Health Inequities in the USA

Transgender individuals are an underserved, vulnerable population. They face many inequities including barriers in both accessing and receiving adequate healthcare. These inequities are proposed here to be rooted in a lack of education about transgender people and their experiences. We begin by exploring the existing transgender healthcare research carried out in the USA, examining client experiences, provider education and attitudes, and the barriers transgender people face to obtaining proper healthcare. Secondly, we look at the previous research on educational interventions implemented with medical students and practitioners in the USA to enhance knowledge about transgender people, and increase sensitivity and awareness, while also increasing the level of comfort in working with these clients. The limitations in these fields of study are discussed in order to understand how to better serve transgender clients in the USA. We will do this through a narrative review to determine evidence-based best practices for educational intervention, uncovering gaps in the literature and highlighting where to focus in future work for researchers and practitioners.

Transgender and Gender Diverse Youth in Inpatient and Other Residential Care

Inpatient and other residential care environments require special considerations for safety and unique opportunities to provide affirming care to TGD youth. Gender-positive policies, staff training, communication, placement, programming, and discharge planning are imperative; however, data and literature are limited in regard to affirming the care of TGD youth in such environments. This chapter draws from published research and best practice to support the wellness of TGD individuals in inpatient and similar settings. It offers clinical guidance for an organization's clinicians, administrators, educators, and advocates to provide safer and more effective care for TGD youth in such facilities to best support their mental and physical health.

Perioperative Care of Transgender and Gender-Diverse Patients: A Biopsychosocial Approach

Transgender and gender-diverse (TGD) people endure numerous physical and mental health disparities secondary to lifelong stigma and marginalization, which are often perpetuated in medical spaces. Despite such barriers, TGD people are seeking gender-affirming care (GAC) with increased frequency. GAC facilitates the transition from the sex assigned at birth to the affirmed gender identity and is comprised of hormone therapy (HT) and gender-affirming surgery (GAS). The anesthesia professional is uniquely poised to serve as an integral support for TGD patients within the perioperative space. To provide affirmative perioperative care to TGD patients, anesthesia professionals should understand and attend to the biological, psychological, and social dimensions of health that are relevant to this population. This review outlines the biological factors that impact the perioperative care of TGD patients, such as the management of estrogen and testosterone HT, safe use of sugammadex, interpretation of laboratory values in the context of HT, pregnancy testing, drug dosing, breast binding, altered airway and urethral anatomy after prior GAS, pain management, and other GAS considerations. Psychosocial factors are reviewed, including mental health disparities, health care provider mistrust, effective patient communication, and the interplay of these factors in the postanesthesia care unit. Finally, recommendations to improve TGD perioperative care are reviewed through an organizational approach with an emphasis on TGD-focused medical education. These factors are discussed through the lens of patient affirmation and advocacy with the intent to educate the anesthesia professional on the perioperative management of TGD patients.

Transgender Healthcare and Medical Education: An Inductive Thematic Analysis of Digital Discourse

Introduction Transgender and gender-diverse (TGD) patients face significant healthcare disparities informed by discrimination, social stigma, and socioeconomic inequality. This is further exacerbated by a paucity of transgender health content in medical education, contributing to a large proportion of providers being ill-equipped to manage TGD patients' health concerns. Method This paper uses the framework approach for an inductive thematic analysis of online discussion forums concerning transgender health and medical education. Online text from anonymous participants was chosen for their authentic accounts of healthcare experiences and to ensure responses are less restrained in discussing sensitive topics. Results Three major themes were identified from the data: desire for more knowledgeable providers, negative healthcare experiences and attitudes, and recommendations for transgender health education. Three subcategories emerged from the latter theme that further illuminated participant recommendations for inclusive healthcare. Conclusions As a result of the unique healthcare concerns faced by TGD patients, providing materials to educate students and providers is crucial to meet the needs of the TGD patient population. Participant reports align with previous literature in recommending curricular reforms in medical school, promoting career options for TGD-identifying people in healthcare, and cultivating a more inclusive clinical culture.

Educating "Helping" Professional Students to "Help" Trans People Navigate Their Health Care Needs: A Review of Recent Literature

In the 2015 United States Trans Survey, trans people overwhelmingly indicated that training health-care providers about trans health is an urgent policy priority within the US. This literature review examines the types of educational training interventions health professional schools have developed from 2015-2020 focused on trans health. This review revealed that the fields of medicine and interprofessional education have created the majority of interventions, which tend to increase students' knowledge, comfort, and confidence working with trans patients. Schools of counseling, social work, and public health are not adequately developing curriculum and interventions that prepare students in health professional schools to work with trans people. Recommendations include schools of medicine developing more faculty expertise in trans medicine, professional organizations requiring trans content on licensure exams, state licensure boards requiring continuing education in trans health, and health professional schools increasing the use of trans standardized patients and trans panels.

Assessing Comfort of Physicians to Provide Transgender-Specific Care

Purpose

Transgender individuals disproportionately face barriers to accessing and receiving health care. This study examines physician comfort in managing and caring for the unique health needs and barriers that transgender patients encounter. We predicted that increased exposure to a transgender person, prior treatment of a transgender patient, and transgender health education would increase comfort in providing care to transgender individuals.

Methods

A Qualtrics® survey link was sent through mail to actively licensed physicians within the state of Nevada. Questions related to perceived comfort level were measured on a 10-point scale (1=lowest level of comfort, 10=highest level of comfort) and dichotomized for analysis (1-5=not comfortable, 6-10=comfortable).

Results

Survey response was 62 of 1620 (4%). Comfort with providing transgender patients routine care (87%) and sex or gender-related care (68%) was high, whereas comfort with providing hormonal treatment (26%) was low. A majority (61%) of respondents either had no training or obtained their training through a nonformal avenue (e.g., self-study and literature review) regarding transgender health issues. Although there was no evidence that knowing a transgender person (p>0.165) or having more education (p>0.489) significantly improved comfortability with treatment, respondents who had previously treated a transgender patient had greater comfort providing routine (p=0.059) and sex or gender-related care (p=0.011).

Conclusion

Although the results show that a majority of physician respondents in Nevada feel comfortable providing routine care to transgender patients, they also reveal a need for education that incorporates experience with transgender patients and a need for widely available guidelines on hormonal treatment of transgender patients.

Positive patient-provider relationships among transgender and nonbinary individuals in New York City

Background: Transgender and nonbinary (TGNB) individuals have diverse health needs and may face disproportionate barriers to healthcare, including developing positive patient-provider relationships. While there is mounting evidence of gender-based stigma and discrimination in healthcare, little is known about how TGNB individuals develop positive patient-provider relationships. Aims: To examine TGNB individuals' interactions with healthcare providers and identify main characteristics of positive patient-providers relationships. Methods: We conducted semi-structured interviews with a purposive sample of 13 TGNB individuals in New York, NY. Interviews were transcribed verbatim and analyzed inductively for themes related to characteristics of positive and trusting relationships with healthcare providers. Results: Participants' mean age was 30 years (IQR = 13 years) and most participants were nonwhite (n = 12, 92%). Receiving peer referrals to specific clinics or providers helped many participants find providers perceived to be competent and created initial grounds for positive patient-provider relationships. Providers with whom participants had positive relationships commonly managed primary care and gender-affirming care and relied on a network of interdisciplinary providers for other specialized care. Providers who were positively evaluated were perceived to possess in-depth clinical knowledge on the issues they were responsible for managing, including gender-affirming interventions, particularly for TGNB patients who perceived themselves to be knowledgeable about TGNB-specific care. Provider and staff cultural competence and a TGNB-affirming clinic environment were also important, particularly early in the patient-provider relationship, and if combined with TGNB clinical competence. Discussion: Provider-focused training and education programs should combine components of TGNB clinical and cultural competence to facilitate development of positive relationships between TGNB patients and providers, thereby improving the health and wellbeing of TGNB people.

Transgender health content in medical education: a theory-guided systematic review of current training practices and implementation barriers & facilitators

Health disparities faced by transgender people are partly explained by barriers to trans-inclusive healthcare, which in turn are linked to a lack of transgender health education in medical school curricula. We carried out a theory-driven systematic review with the aim to (1) provide an overview of key characteristics of training initiatives and pedagogical features, and (2) analyze barriers and facilitators to implementing this training in medical education. We used queer theory to contextualize our findings. We searched the PubMed/Ovid MEDLINE database (October 2009 to December 2021) for original studies that reported on transgender content within medical schools and residency programs (N = 46). We performed a thematic analysis to identify training characteristics, pedagogical features, barriers and facilitators. Most training consisted of single-session interventions, with varying modes of delivery. Most interventions were facilitated by instructors with a range of professional experience and half covered general LGBT+-content. Thematic analysis highlighted barriers including lack of educational materials, lack of faculty expertise, time/costs constraints, and challenges in recruiting and compensating transgender guest speakers. Facilitators included scaffolding learning throughout the curriculum, drawing on expertise of transgender people and engaging learners in skills-based training. Sustainable implementation of transgender-health objectives in medical education faces persistent institutional barriers. These barriers are rooted in normative biases inherent to biomedical knowledge production, and an understanding of categories of sex and gender as uncomplicated. Medical schools should facilitate trans-inclusive educational strategies to combat transgender-health inequities, which should include a critical stance toward binary conceptualizations of sex and gender throughout the curriculum.

Affirming and Inclusive Care Training for Medical Students and Residents to Reducing Health Disparities Experienced by Sexual and Gender Minorities: A Systematic Review

Purpose

Providing inclusive and comprehensive gender-affirming care is critical to reducing health disparities (gaps in care) experienced by sexual and gender minorities (SGM). Currently, little is known about how medical students and residents are being trained to address the health needs of SGM persons or of the most effective methods.

Methods

We conducted a systematic review of the research literature from 2000 to 2020 on the effectiveness of teaching medical students and residents on knowledge, attitudes, and skills in addressing the health of SGM persons and the strength of the research sample, design, and methods used.

Results

We identified a total of 36 articles that assessed the impact of medical student and resident education on knowledge, comfort, attitudes, confidence, and skills in working with SGM patients. All studies utilized quasi-experimental designs, and found efficacious results. No study examined the impact of training on patient outcomes.

Conclusion

Future studies will need to be powered and designed to assess the impact of training on patient outcomes.

Cultural Competency Curricula in US Graduate Medical Education: A Scoping Review

BACKGROUND

Cultural competency training provides participants with knowledge and skills to improve cross-cultural communication and is required for all graduate medical education (GME) training programs.

OBJECTIVE

The authors sought to determine what cultural competency curricula exist specifically in GME.

METHODS

In April 2020, the authors performed a scoping review of the literature using a multidatabase (PubMed, Ovid, MedEdPORTAL) search strategy that included keywords relevant to GME and cultural competency. The authors extracted descriptive data about the structure, implementation, and analysis of cultural competency curricula and analyzed these data for trends.

RESULTS

Sixty-seven articles met criteria for inclusion, of which 61 (91%) were focused exclusively on residents. The most commonly included specialties were psychiatry (n=19, 28.4%), internal medicine (n=16, 23.9%), and pediatrics (n=15, 22.4%). The shortest intervention was a 30-minute online module, while the longest contained didactics, electives, and mentoring programs that spanned the entirety of residency training (4 years). The sample sizes of included studies ranged from 6 to 833 participants. Eight (11.9%) studies utilized OSCEs as assessment tools, while 17 (25.4%) conducted semi-structured interviews or focus groups. Four common themes were unique interventions, retention of learning, trainee evaluation of curricula, and resources required for implementation.

CONCLUSIONS

Wide variation exists in the design, implementation, and evaluation of cultural competency curricula for residents and fellows.

Psychosis in transgender and gender non-conforming individuals: A review of the literature and a call for more research

Epidemiological studies have described higher rates of psychotic disorder diagnoses in transgender, as compared to cisgender, individuals. With the exception of this work and a small number of published case studies, however, there has been little consideration of gender diversity in psychosis research or clinical care. In this paper, we will review and critically evaluate the limited literature on gender diversity and clinical psychosis and articulate the critical need for more work in this field, more specifically on the following areas and how they bear on clinical care: 1) diagnostic biases; 2) how chronic non-affirmation and bias, gender dysphoria, and other gender minority stressors may operate as trauma and can contribute to clinically significant psychotic symptoms; 3) the potential impact of gender-affirming care, such as hormone therapies, on mental health and barriers for receiving such care in transgender and nonbinary individuals; and 4) culturally-sensitive and gender-affirming approaches for addressing psychosis. Finally, we consider ways in which researchers may engage in ethical, gender-affirming, and accurate approaches to better address gender identity in psychosis research. We hope that such research will aid in the creation of clinical guidelines for understanding, diagnosing, and treating psychosis in gender diverse individuals.

Transgender Surgery: Perspectives Across Levels of Training in Medical and Surgical Specialties

Purpose: Approximately 1.4 million adults identify as transgender in the United States. Transgender patients face societal, legal, and medical discrimination that can lead to health disparities. The objective of this study was to evaluate knowledge and perceptions of transgender health care across various levels of medical training and specialties. Methods: Between April 1, 2019 and May 1, 2019, an anonymous survey was distributed to residents and attendings, in both medical and surgical specialties, at a university-affiliated hospital. Participants were recruited into the study with survey distribution by email to residency program directors, residents, and residency-affiliated attendings. Results: There was a response rate of 29.5% (118/400). Across all respondents, 34.7%, 31.4%, and 39% knew where to refer transgender patients for hormone replacement, psychotherapy, or surgery, respectively. Only 37.9% of residents and 46.2% of attendings reported that they were confident of providing care for a transgender patient (p=0.130). In addition, less than one-third of surgical respondents reported sufficient knowledge to describe transgender surgery. The most common reasons affecting comfort level when caring for transgender patients were lack of exposure (53.4%) and lack of formal education (47.6%), with other reasons being personal, moral, and religious reasons (11%, 8.5%, and 6.8%, respectively). Conclusion: Despite literature demonstrating the effectiveness of formal didactics and education in transgender health, there remain disparities in the knowledge and comfort of residents and attendings across all specialties. To deliver competent health care to transgender patients, efforts must focus on improving the availability of system-wide resources and educational opportunities for all specialties.

A Call for LGBTQ Content in Graduate Medical Education Program Requirements

A well-developed body of literature demonstrates that lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals experience poorer health outcomes and report worse health care experiences than straight/cisgender individuals. Many reforms since 2010 have addressed the LGBTQ-related education of future health care professionals at the undergraduate medical education (UME) level; however, reforms at the graduate medical education (GME) level are lagging, and new literature suggests that didactic education at the UME level is not enough to prepare future physicians to properly and compassionately care for LGBTQ patients. Recently, the Accreditation Council for Graduate Medical Education (ACGME) implemented a major revision of its Common Program Requirements that requires residents to demonstrate, as a competence, respect and responsiveness to diverse populations. Given these revisions and the ongoing failure of many GME training programs to adequately prepare future physicians to care for LGBTQ patients, the authors argue that now is the time for the ACGME to develop and implement LGBTQ health-related residency requirements. In addition, the authors outline a path by which the academic medical community may develop and implement these requirements.

Attitudes Toward Transgender People Among Medical Students in South Korea

Introduction

Interventions aimed at changing knowledge, attitudes, and beliefs of resident physicians and medical students have been made to incite a significant positive increase in attitudes, comfort, and knowledge toward the lesbian, gay, bisexual, and transgender (LGBT) community, as well as increased levels of competency among participants.

Aim

To use insights from the attitudes of medical students toward transgender people and demonstrate that adding lectures on transgenderism would make the medical school curricula more comprehensive and trans-inclusive by improving overall attitudes toward the LGBT community.

Methods

A total of 49 medical students completed the preintervention survey with the Genderism and Transphobia Scale and Attitudes Toward Transgendered Individuals Scale, and then took a class on transgenderism, whereas 39 individuals completed the 4-week postintervention survey following the same measures.

Main Outcome Measure

Three items of survey were demographic characteristics, the Genderism and Transphobia Scale, and the Attitude Toward Transgender Individuals Scale.

Results

Although there was no significant difference in mean score between the preintervention and postintervention surveys, those who had minority individuals as peers and those who had previous LGBT-related education showed significantly positive attitudes than those without after the lecture. As a result of analyzing all the data from the pre/postintervention surveys, being of the female gender and having minority individuals as peers positively affected attitude.

Conclusion

Although there was no significant attitude change after the lecture, those who had previous LGBT-related education showed significantly positive attitudes at pre/postintervention surveys than those without. These findings suggest that raising awareness and education should be continued for a positive attitude toward more vulnerable groups such as the LGBT. Given the lack of studies on transgenderism that involve students in the medical profession in South Korea, this study shows the necessity of curricula creation of transgenderism education. This study aims to serve as a basis for curricula creation and student guidance that will help creating more positive attitudes toward sexual and gender minorities.

Lee SR, Kim M-A, Choi MN, et al. Attitudes Toward Transgender People Among Medical Students in South Korea. Sex Med 2021;9:100278.

Implementation of sexual and gender minority health curricula in health care professional schools: a qualitative study

BACKGROUND

Lesbian, gay, bisexual, transgender, queer, and intersex people-inclusively termed "sexual and gender minorities"-have unique health and health care needs that are not being met by most healthcare providers due to lack of training in health care professional schools. The purpose of this qualitative study was to examine implementation factors for advancing sexual and gender minority health professional student curricula in academic settings.

METHODS

Semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR) were conducted with sixteen curricular champions to identify factors relevant to curricular adoption, integration, and sustainment. Themes were coded using a hybrid of deductive and inductive approaches and reported using major CFIR domains.

RESULTS

Facilitators supporting implementation of sexual and gender minority health curricula included collaboration among multiple stakeholders, alignment of formal and hidden curricula, fostering an organizational culture that valued inclusion and diversity, engagement with external subject matter experts or faculty with content expertise, and thoughtful and inclusive planning.

CONCLUSION

This study contributes to health care professional education research as well as to implementation science. Facilitators that were identified in this study can be used to increase the adoption, integration, and sustainment of sexual and gender minority health curricula in diverse academic settings.

Debate: Why should gender-affirming health care be included in health science curricula?

BACKGROUND

Every person who seeks health care should be affirmed, respected, understood, and not judged. However, trans and gender diverse people have experienced significant marginalization and discrimination in health care settings. Health professionals are generally not adequately prepared by current curricula to provide appropriate healthcare to trans and gender diverse people. This strongly implies that health care students would benefit from curricula which facilitate learning about gender-affirming health care.

MAIN BODY

Trans and gender diverse people have been pathologized by the medical profession, through classifications of mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Disease (ICD). Although this is changing in the new ICD-11, tension remains between depathologization discourses and access to gender-affirming health care. Trans and gender diverse people experience significant health disparities and an increased burden of disease, specifically in the areas of mental health, Human Immunodeficiency Virus, violence and victimisation. Many of these health disparities originate from discrimination and systemic biases that decrease access to care, as well as from health professional ignorance. This paper will outline gaps in health science curricula that have been described in different contexts, and specific educational interventions that have attempted to improve awareness, knowledge and skills related to gender-affirming health care. The education of primary care providers is critical, as in much of the world, specialist services for gender-affirming health care are not widely available. The ethics of the gatekeeping model, where service providers decide who can access care, will be discussed and contrasted with the informed-consent model that upholds autonomy by empowering patients to make their own health care decisions.

CONCLUSION

There is an ethical imperative for health professionals to reduce health care disparities of trans and gender diverse people and practice within the health care values of social justice and cultural humility. As health science educators, we have an ethical duty to include gender-affirming health in health science curricula in order to prevent harm to the trans and gender diverse patients that our students will provide care for in the future.

Current State of Transgender Medical Education in the United States and Canada: Update to a Scoping Review

BACKGROUND

The published literature on education about transgender health within health professions curricula was previously found to be sporadic and fragmented. Recently, more inclusive and holistic approaches have been adopted. We summarize advances in transgender health education.

METHODS

A 5-stage scoping review framework was followed, including a literature search for articles relevant to transgender health care interventions in 5 databases (Education Source, LGBT Source, MedEd Portal, PsycInfo, PubMed) from January 2017 to September 2019. Search results were screened to include original articles reporting outcomes of educational interventions with a transgender health component that included MD/DO students in the United States and Canada. A gray literature search identified continuing medical education (CME) courses from 12 health professional associations with significant transgender-related content.

RESULTS

Our literature search identified 966 unique publications published in the 2 years since our prior review, of which 10 met inclusion criteria. Novel educational formats included interdisciplinary interventions, post-residency training including CME courses, and online web modules, all of which were effective in improving competencies related to transgender health care. Gray literature search resulted 15 CME courses with learning objectives appropriate to the 7 professional organizations who published them.

CONCLUSIONS

Current transgender health curricula include an expanding variety of educational intervention formats driven by their respective educational context, learning objectives, and placement in the health professional curriculum. Notable limitations include paucity of objective educational intervention outcomes measurements, absence of long-term follow-up data, and varied nature of intervention types. A clear best practice for transgender curricular development has not yet been identified in the literature.

Incorporating Lesbian, Gay, Bisexual, and Transgender Training into a Residency Program

Lesbian, gay, bisexual, and transgender (LGBT) patients experience vast health care disparities. Numerous government and professional organizations have attempted to address these disparities by calling for improvement in LGBT health and increased research endeavors. Despite these initiatives, residents still receive inadequate education and training in LGBT health. Here, the authors review these shortcomings and provide a framework for how to improve resident education and training in LGBT health. They describe methods of curricular enhancements and departmental/institutional climate optimization to improve resident competency. Finally, they discuss how LGBT-competent physicians can publicize their expertise and improve overall LGBT health care delivery.

Medical Student Perspectives on LGBTQ Health

Introduction

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) community members experience adverse health outcomes at higher rates than non-LGBTQ individuals. We examined the impact of student demographics as well as gender and sexuality didactic instruction on the attitudes of first-year medical students toward LGBTQ patients.

Methods

In January 2017, 255 first-year students at an urban allopathic medical school participated in a gender and sexuality health curriculum. We assessed student attitudes regarding LGBTQ patients using anonymous pre- and postintervention surveys. Each item was measured on a 5-point Likert scale.

Results

Of 255 possible respondents, we received 244 responses to the preintervention survey (95.7% response rate) and 253 to the postintervention survey (99.2% response rate). Participants were predominantly white (66.8%), heterosexual (94.7%), and cisgender (100%). Respondents who identified as LGBQ were significantly (P<.05) more likely than heterosexual students to agree with the following preintervention statements, among others: (1) Discordance between birth sex and gender is a natural human phenomenon, (2) When meeting a patient for the first time, I feel comfortable asking what pronoun they use, (3) I am able to empathize with the life experience of an LGB/T patient, (4) I am motivated to seek out opportunities to learn more about LGBTQ-specific health care issues. Statistically significant changes in attitudes between time points are seen in 4 out of 15 items.

Conclusion

A focused gender and sexuality curriculum appears to impact medical student attitudes regarding LGBTQ patients. Furthermore, recruitment of LGBTQ-identifying medical students may translate into improved workforce motivation to provide health care for LGBTQ patients.

Experiences of Transgender and Gender Nonbinary Medical Students and Physicians

Purpose: To explore the experiences of transgender and gender nonbinary (TGNB) medical students and physicians in the United States.

Methods: The authors conducted a 79-item online survey using Likert-type and open-ended questions to assess the experiences of TGNB-identified U.S. medical students and physicians. Variables included demographic data, disclosure of TGNB status, exposure to transphobia, and descriptions of educational and professional experiences. Recruitment was conducted using snowball sampling through Lesbian, Gay, Bisexual, Transgender, Queer professional groups, list-servs, and social media. The survey was open from June 2017 through November 2017.

Results: Respondents included 21 students and 15 physicians (10 transgender women, 10 transgender men, and 16 nonbinary participants). Half (50%; 18) of the participants and 60% (9) of physicians had not disclosed their TGNB identity to their medical school or residency program, respectively. Respondents faced barriers on the basis of gender identity/expression when applying to medical school (22%; 11) and residency (43%; 6). More than three-quarters (78%; 28) of participants censored speech and/or mannerisms half of the time or more at work/school to avoid unintentional disclosure of their TGNB status. More than two-thirds (69%; 25) heard derogatory comments about TGNB individuals at medical school, in residency, or in practice, while 33% (12) witnessed discriminatory care of a TGNB patient.

Conclusion: TGNB medical students and physicians faced significant barriers during medical training, including having to hide their identities and witnessing anti-TGNB stigma and discrimination. This study, the first to exclusively assess experiences of TGNB medical students and physicians, reveals that significant disparities still exist on the basis of gender identity.

LGBT-Specific Education in General Psychiatry Residency Programs: a Survey of Program Directors

OBJECTIVE

Lesbian, gay, bisexual, transgender (LGBT) and other sexual minority individuals are at higher risk than non-LGBT individuals for multiple psychiatric conditions and suicide. However, little is known regarding LGBT-specific training among psychiatric residents. The authors sought to characterize LGBT-specific training among adult psychiatry residency programs.

METHODS

An anonymous, cross-sectional survey was electronically distributed to U.S.-based adult psychiatry program directors between February and April 2018. Survey topics included program demographics, characteristics of LGBT-specific training, perceived barriers to implementation, and anticipated needs.

RESULTS

Seventy-two program directors (30.8%) provided complete survey responses. Over half (55.6%) of these programs had ≤ 5 h of LGBT-specific training ("lower-hour programs"). Lower- and higher-hour (> 5 h of LGBT-specific education) programs were similar on measured demographic variables, but lower-hour programs covered fewer LGBT-specific topics and program directors were more likely to report lack of interested or topic-expert faculty as a barrier to enhancing LGBT-specific training.

CONCLUSIONS

Results of this survey suggest a need for the development and implementation of LGBT-specific educational curricula for use in U.S.-based adult psychiatry programs. In addition, future research may explore effective ways for programs to recruit, retain, and support teaching faculty with LGBT-specific expertise.

Mental Health Promotion for Gender Minority Adolescents

The current study uses an ecological model of biopsychosocial vulnerability to guide the description of risk and protective factors for the mental health of gender minority (i.e., transgender and gender non-conforming) adolescents at the individual, family, community, and societal levels. Minority stress is the vulnerability of youth who are lesbian, gay, bisexual, and transgender (LGBT) to adverse mental health outcomes due to stigma. In addition, unlike cisgender (non-transgender) LGB individuals, gender minorities may experience internal stress related to gender dysphoria. Gender dysphoria may lead to interaction with health care providers who may not be educated in the care of gender minority youth. The ecological model is an organizing framework for understanding domains of health risks that affect such youth to assist nurses in intervening to promote the health of gender minority adolescents. Specific attention is paid to the potential contributions of psychiatric-mental health nurses to the care of gender minority adolescents. [Journal of Psychosocial Nursing and Mental Health Services, 56(12), 22-30.].

Gaps in transgender medical education among healthcare providers: A major barrier to care for transgender persons

A lack of access to knowledgeable providers is the greatest reported barrier to care for transgender individuals. The purpose of this manuscript is to review the recent literature characterizing transgender medicine education for medical providers and to summarize effective interventions for improving education in transgender care. The PubMed database was searched for all literature that assessed transgender medical education among physicians or trainees and all papers that reported results of transgender-specific educational interventions. Literature that only evaluated general lesbian, gay, bisexual, and transgender (LGBT) educational interventions was excluded. The lack of education in transgender care continues among providers across all levels of medical education from medical students and physician trainees to primary care providers, endocrinologists and other specialists involved in transgender care. Several interventions have been shown to effectively improve transgender knowledge and cultural competency. Education among healthcare providers is deficient and is considered a major barrier to care for transgender individuals. Effective interventions should be applied to fundamental medical education. Additional focused education also should be taught with specialty-appropriate content to produce needed proficiency among providers of transgender care.

LGBT Cultural Competence and Interventions to Help Oncology Nurses and Other Health Care Providers

OBJECTIVES

To define and give an overview of the importance of lesbian, gay, bisexual, and transgender (LGBT) cultural competency and offer some initial steps on how to improve the quality of care provided by oncology nurses and other health care professionals.

DATA SOURCES

A review of the existing literature on cultural competency.

CONCLUSION

LGBT patients experience cancer and several other diseases at higher rates than the rest of the population. The reasons for these health care disparities are complex and include minority stress, fear of discrimination, lower rates of insurance, and lack of access to quality, culturally competent care. Addressing the health care disparities experienced by LGBT individuals and families requires attention to the actual needs, language, and support networks used by patients in these communities. Training on how to provide quality care in a welcoming and non-judgmental way is available and can improve health equity.

IMPLICATIONS FOR NURSING PRACTICE

Health care professionals and institutions that acquire cultural competency training can improve the overall health of LGBT patients who currently experience significant health care disparities.

Inclusion of Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Health in Australian and New Zealand Medical Education

PURPOSE

This study aims at establishing the scope of lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI) health in Australian and New Zealand medical curricula.

METHODS

We sent medical school curriculum administrators an online cross-sectional survey.

RESULTS

The response rate was 15 medical schools (71%): 14 Australian schools and 1 New Zealand school. Respondents included program directors (n = 5; 33%), course coordinators (n = 4; 27%), Heads of School (n = 2; 13%), one Dean (7%), and three others (20%). Most schools (n = 9; 60%) reported 0-5 hours dedicated to teaching LGBTQI content during the required pre-clinical phase; nine schools (60%) reported access to a clinical rotation site where LGBTQI patient care is common. In most schools (n = 9; 60%), LGBTQI-specific content is interspersed throughout the curriculum, but five schools (33%) have dedicated modules. The most commonly used teaching modalities include lectures (n = 12; 80%) and small-group sessions (n = 9; 60%). LGBTQI content covered in curricula is varied, with the most common topics being how to obtain information about same-sex sexual activity (80%) and the difference between sexual behavior and identity (67%). Teaching about gender and gender identity is more varied across schools, with seven respondents (47%) unsure about what is taught. Eight respondents (53%) described the coverage of LGBTQI content at their institution as "fair," two (13%) as "good," and two (13%) as "poor," with one respondent (7%) describing the coverage as "very poor." None of the respondents described the coverage as "very good."

CONCLUSIONS

Currently, medical schools include limited content on LGBTQI health, most of which focuses on sexuality. There is a need for further inclusion of curriculum related to transgender, gender diverse, and intersex people.

The primary health care of transgender adults

Gender dysphoria is associated with significant health disparity. Gender services perform specialised activities such as diagnosis, endocrine management and liaison with surgical services. Although providing these specialised transition services appears to be safe and improves well-being, significant health disparity remains. Engaging primary care providers is an important part of any strategy to improve the health care of transgender people. The relationships between gender dysphoria and a range of primary care issues such as mental health, cardiovascular disease and cancer are explored.