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Rahman E, Rao P, Webb WR, Philipp-Dormston WG, Sayed K, Almeida ART, Mosahebi A, Carruthers JDA, Carruthers A. Embracing Spectrum: Celebrating LGBTQIA+ Journeys in Aesthetic Medicine: A Kaleidoscope of Identity. Aesthetic Plast Surg 2024:10.1007/s00266-024-03923-4. [PMID: 38499877 DOI: 10.1007/s00266-024-03923-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/09/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE This synaptic systemised review critically examines the provision of aesthetic medical care to LGBTQIA+ (lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more) individuals, assessing both the clinical practices and the educational frameworks that guide interactions with LGBTQIA+ patients in aesthetic settings. METHODS Following PRISMA-S guidelines, a comprehensive review was conducted, initially identifying 159 potentially relevant articles. Upon stringent full-text review, 33 studies met the inclusion criteria and were subject to an in-depth thematic analysis. The scope encompassed qualitative studies, quantitative analyses, and a cross section of interdisciplinary research, predominantly from Western settings. RESULTS The analysis distilled four principal themes: the imperative of identity affirmation in aesthetic interventions, substantial barriers to inclusive and empathetic care, the critical need for patient empowerment, and the existing deficiencies within medical education regarding LGBTQIA+ care. These themes highlight a complex interplay between the clinical aspirations of LGBTQIA+ individuals and the current capacity of aesthetic medicine to cater to this diversity. CONCLUSIONS There is a pressing need for a paradigmatic shift towards more inclusive, competent, and sensitive aesthetic medical care for LGBTQIA+ patients. It underscores the necessity of reform in medical education and advocates for policy changes that promote a more equitable healthcare environment. This research serves as a call to action, emphasizing the ethical imperative to integrate comprehensive LGBTQIA+ care competencies into aesthetic medicine curricula and practice. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Eqram Rahman
- Research and Innovation Hub, Innovation Aesthetics, London, WC2H 9JQ, UK.
| | - Parinitha Rao
- Aesthetic Dermatology Practice, The Skin Address, Bangalore, India
| | | | | | - Karim Sayed
- Nomi Clinic, Oslo, Norway
- University of South East Norway, Notodden, Norway
| | - Ada R T Almeida
- Dermatologic Clinic, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | | | - Jean D A Carruthers
- Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada
| | - Alastair Carruthers
- Department of Dermatology, University of British Columbia, Vancouver, BC, Canada
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Greene Z, Tumin D, Kyle B. Measuring Medical Students' Inclusive Care for Sexual and Gender Minority Patients. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:242. [PMID: 38060406 DOI: 10.1097/acm.0000000000005585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
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Smith R, Kaplan B. Improving Family Medicine Residents' Provision of Gender-Affirming Care. Fam Med 2024; 56:126-130. [PMID: 38241743 DOI: 10.22454/fammed.2023.499815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND AND OBJECTIVES Family physicians are uniquely poised to provide gender-affirming care (GAC) to transgender and nonbinary patients, but current undergraduate and graduate medical education in this field is lacking. Little is known about the impact of various GAC curricula on the clinical care provided by resident physicians. We aimed to assess the efficacy of a multimodal educational framework on the quality of GAC provided by residents at a large academic family medicine program. METHODS This pilot study used chart review to assess the impact of a multifaceted educational intervention around GAC in an academic family medicine practice. Components included faculty-specific didactics, resident feedback and didactics, standardized note templates, and compiled resources. We completed pre- and postintervention analysis of resident-led GAC encounters using a novel rubric based on standards of care and compared these results using descriptive statistics. RESULTS Following a multimodal educational intervention, residents demonstrated improvement in multiple domains of gender-affirming care, including documenting informed consent, counseling on pregnancy and contraception, and laboratory monitoring for patients initiating gender-affirming hormone therapy. CONCLUSIONS This widespread improvement suggested that a multimodal approach to resident and faculty education may help enhance the quality of GAC provided by family medicine residents. Chart review offers a feasible and effective method for identifying gaps in resident knowledge and documentation in GAC. Further research should specifically explore faculty development in this area and expanded patient-centered quality metrics and outcomes that encompass GAC.
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Affiliation(s)
- Riley Smith
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC
| | - Benjamin Kaplan
- Benjamin Kaplan, Department of Family Medicine, University of North Carolina, Chapel Hill, NC
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Hoffner-Heinike A, Iwamoto SJ, Saxon DR, Cogdall NA, Davies RD, Lee RS, Chiappone A, Thomas JF, Rothman MS. ECHO "Bootcamp": An Innovative Training Model to Onboard Providers in the Care of Gender Diverse Patients. Telemed J E Health 2024; 30:430-437. [PMID: 37499094 DOI: 10.1089/tmj.2023.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Purpose: Extension for Community Health Outcomes (ECHO) is a model of continuing medical education meant to connect academic medical center-based specialists with community providers to increase capacity in managing complex health conditions. The purpose of this study was to evaluate the effectiveness of a shortened "bootcamp" ECHO model in increasing participant competence with topics related to transgender and gender diverse (TGD) health care and the impact of "bootcamp" participation on enrollment in an ongoing ECHO series. Methods: An ongoing monthly ECHO series was instituted on topics of TGD health. After 2 years, the team implemented a four-session "bootcamp" for four consecutive weeks during March 2022 to introduce foundational topics for new participants who had joined or were considering joining the ongoing series. Qualitative and quantitative results were collected from self-reported pre-/post-surveys as well as from in-session quizzes. Results: There were 71 participants in the "bootcamp" including health care providers and support staff. Attendees reported a 10.3% increase (p = 0.02) in self-reported comfort providing care to transgender patients. Pre-/post-knowledge improved in areas of health inequities (50% vs. 74% correct pre/post), surgical requirements (33% vs. 74%), and effects of masculinizing (55% vs. 70%) and feminizing (64% vs. 89%) hormone therapy. Prescribing providers reported a significant change across four areas of practice competency. Among 71 "bootcamp" participants, 15 registered for the ongoing program. Conclusion: Use of a "bootcamp" highlights ways to increase participant comfort and knowledge in providing TGD health care in a shortened timeframe and recruit new participants to an ongoing ECHO curriculum.
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Affiliation(s)
| | - Sean J Iwamoto
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Endocrinology, Medicine Service, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - David R Saxon
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Endocrinology, Medicine Service, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Nicholas A Cogdall
- ECHO Colorado, Peer Mentored Care Collaborative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Robert D Davies
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rita S Lee
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alethea Chiappone
- ECHO Colorado, Peer Mentored Care Collaborative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John F Thomas
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- ECHO Colorado, Peer Mentored Care Collaborative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Micol S Rothman
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Blanchard E, Evans R, Abdullatif H, Brown M, Carter T, LaChenaye J. Beliefs and Intentions of Anesthesia Physicians Toward Providing Culturally Competent Care to Transgender Patients. Transgend Health 2023; 8:542-549. [PMID: 38130981 PMCID: PMC10732157 DOI: 10.1089/trgh.2022.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose Anesthesiologists have limited relationships with their patients before delivering care and have little time for patient interactions. Yet, they should possess the knowledge and skills to treat all patients in an equitable, culturally competent manner, including transgender patients. The study's purpose was to determine behavioral factors influencing culturally competent care by anesthesia physicians with transgender patients. Methods A two-phase design was utilized in 2020 to examine the attitudes, subjective norms, and perceived behavioral control of anesthesia physicians, both in training and practicing independently. Phase 1 allowed exploration of themes related to facilitators and barriers of the provision of culturally competent care to transgender patients. Phase 2 involved the creation and deployment of a 51-question survey informed by phase 1 to 100 anesthesia physicians at a single academic medical center in the southeastern United States. Results Thematic analysis was performed on results from the phase 1 elicitation survey, which informed the creation of the survey for phase 2. One hundred phase 2 surveys were distributed, with a 70% response rate. Analyses were conducted to determine the largest influence of intent to interact with transgender patients in a culturally competent manner, as well as to establish the reliability of the tool. Conclusion Attitude followed by subjective norms were positive influencers of intent, while lack of knowledge was a negative influencer. Strengthening attitudes and subjective norms, while implementing programs to increase knowledge, competence, and humility, would be goals for future studies and actions toward improving healthcare of transgender individuals.
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Affiliation(s)
- Erin Blanchard
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Retta Evans
- Department of Community Health & Human Services, School of Education, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hussein Abdullatif
- Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michelle Brown
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tekuila Carter
- Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jenna LaChenaye
- Department of Human Studies, School of Education, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Kamal K, Keuroghlian AS, Potter J. Promoting Sexual and Gender Minority Health Clinical Skills Training for All Medical Students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:987-993. [PMID: 37043757 DOI: 10.1097/acm.0000000000005240] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Despite societal, legal, and cultural improvements in their well-being, sexual and gender minority (SGM) people in the United States still face substantial physical and mental health disparities that are exacerbated by physician stigma and lack of training. Although there have been efforts at medical schools nationwide to address these disparities and interweave SGM health education into existing preclerkship courses, opportunities to practice related clinical skills during the clerkship years remain largely elective. Furthermore, national survey data from 2020 indicate that SGM Americans continue to delay or avoid medical care because of physician discrimination. By providing predominantly opt-in opportunities for hands-on SGM health clinical training, educators risk perpetuating existing structural inequities and widening health disparities. In this article, the authors advocate for required SGM health clinical training for all undergraduate medical students, regardless of intended specialty. They highlight 3 types of elective SGM health clinical training models currently in use at medical schools across the country, including student-run clinics, advanced electives, and longitudinal scholarly concentrations. Using these examples, the authors then outline ways that educators can interweave required SGM health clinical training into undergraduate medical education, including with the recruitment and retention of SGM faculty, staff, and students; required SGM standardized patient experiences; the integration of SGM clinical opportunities throughout the core clerkships; and partnerships with SGM health centers. Using these methods, medical schools can mobilize passionate students, faculty, and leaders to both counter the bigotry and hate faced by SGM populations and develop innovative strategies to improve SGM patient health outcomes and expand opportunities for SGM health scholarship.
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Affiliation(s)
- Kanika Kamal
- K. Kamal is a medical student, Harvard Medical School, Boston, Massachusetts
| | - Alex S Keuroghlian
- A.S. Keuroghlian is director, Division of Education and Training, The Fenway Institute, director, Division of Public and Community Psychiatry, Massachusetts General Hospital, and codirector, Harvard Medical School Sexual and Gender Minority Health Equity Initiative, Boston, Massachusetts
| | - Jennifer Potter
- J. Potter is cochair, The Fenway Institute, program lead, Harvard Medical School-Fenway Health LGBTQIA+ Health Fellowship Program, codirector, Harvard Medical School Sexual and Gender Minority Health Equity Initiative, and internist, Division of General Medicine, Beth Israel Lahey Health, Boston, Massachusetts
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Kopel J, Beck N, Almekdash MH, Varma S. Trends in transgender healthcare curricula in graduate medical education. Proc AMIA Symp 2023; 36:620-626. [PMID: 37614850 PMCID: PMC10443998 DOI: 10.1080/08998280.2023.2228140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/05/2023] [Accepted: 06/15/2023] [Indexed: 08/25/2023] Open
Abstract
Background Recent studies have shown deficiencies in resident knowledge concerning transgender healthcare. However, there has not been an updated survey examining transgender healthcare training by medical residency directors. We assessed whether accredited residency programs in the United States and Canada were providing education on the healthcare needs of transgender patients. Methods We performed an exploratory descriptive survey study in 2022 of residency programs in the United States and Canada to assess residency education on transgender health using program directors listed in the website directory of the Accreditation Council for Graduate Medical Education. Results Out of 1680 residency program directors, 160 programs responded (response rate, 10%). Among the residency programs, education in transgender health was taught periodically throughout the curriculum (52.5%), in discrete modules (34.4%), or not taught at all (10.6%). However, 60% of residency program directors who responded reported that their program lacked any clinical rotation in which residents directly work with transgender patients. The most common areas of transgender care omitted from residency education on transgender health were barriers associated with chronic illness and mental health. Conclusion There remains a need for robust transgender medical training in residency programs through clinical rotations on transgender health.
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Affiliation(s)
- Jonathan Kopel
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Nancy Beck
- Department of Pediatrics, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas, USA
| | - Mhd Hasan Almekdash
- Biostatistics, Clinical Research Institute, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Surendra Varma
- Department of Pediatrics, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas, USA
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