Care across the gender spectrum: A transgender health curriculum in the Obstetrics and Gynecology clerkship

Abstract

Background A lack of undergraduate medical curricula on providing healthcare to transgender and gender diverse (TGD) patients has contributed to significant health disparities for TGD communities. To address this gap, we designed and evaluated a novel curriculum to train Obstetrics and Gynecology (OB/GYN) clerkship students in caring for TGD patients. Methods Following Kern’s 6-step method for curriculum development, we created a two-part curriculum on TGD healthcare topics – an online module on gender-affirming care, followed by a series of interactive cases on TGD-specific health topics. Undergraduate medical students completing their core OB/GYN clerkships at a university academic medical center (January-December 2021) were invited to complete this curriculum. Participants completed pre/post assessment surveys to assess their experience caring for TGD patients, as well as a scored knowledge assessment before and after completing the curriculum. Results Sixty-five students participated in this curricular assessment. Prior to completing the module, 45% agreed that they had received adequate TGD health training. Following module completion, students reported increased comfort in caring for transgender patients (49.2% vs. 81.5%; p < .001) and endorsed an improved fund of knowledge of both healthcare maintenance for TGD patients (61.5% vs. 100%; p < .001) and gender affirming medical therapies (60.0% vs. 96.9%; p < .001). Knowledge scores increased from a mean of 9.65 (1.81) to 12.5 (2.20) out of 15 (p < .001). In post-assessment surveys, 95% of participants agreed that the module was helpful for their learning. Qualitatively, students suggested longitudinal integration of TGD-topics into the pre-clinical curriculum, and expanded opportunities to practice patient counseling. Conclusion The findings of this study support the need for student education on TGD health. Integration of interactive, case-based TGD-care curricula into clinical training may increase medical students’ knowledge and comfort in caring for TGD patients. Ongoing efforts to integrate TGD health training into undergraduate medical student curricula are necessary.

LGBTQ+ health education for medical students in the United States: a narrative literature review

“…There was 1 required intervention on this topic area that involved both the pre-clinical and clinical curriculum, as well as 5 optional interventions that were not specified as occurring in a specific part of the curriculum. Among these interventions that focused on aspects related to gender identity and affirming care: 13 significantly increased knowledge [ 25 , 61 , 62 , 68 , 71 , 73 , 75–78 , 81 , 85 , 89 ]; 7 significantly increased comfort with aspects of providing care [ 25 , 37 , 47 , 48 , 71 , 73 , 85 ]; and 4 significantly increased confidence in providing care [ 21 , 59 , 62 , 86 ].…”

“…This review sheds light on educational interventions that could be utilized to address these gaps, as there were 34 studies on interventions related to the health of people who identify as transgender or gender diverse and gender-affirming care, and 19 of these studies that showed statistically significant improvement in student outcomes. These interventions had a significant impact on multiple aspects of trainees preparation: 13 significantly increased knowledge [ 25 , 61 , 62 , 68 , 71 , 73 , 75–78 , 81 , 85 , 89 ]; 7 significantly increased comfort with aspects of providing care [ 25 , 37 , 47 , 48 , 71 , 73 , 85 ]; and 4 significantly increased confidence in providing care [ 21 , 59 , 62 , 86 ]. Educational interventions on this topic area also align with the guidance in the 2014 AAMC report.…”

Care of the transgender population: are the Indian gynaecology residents sufficiently trained?

“…10 In a study conducted by Schmidt et al regarding curriculum development, only 22% felt competent to provide transrelevant services and 90% desired additional clinical training. 2 Hence, they suggested a curriculum which should include the different vocabulary used to address people with non-binary non-conforming gender expansive population and describe all the eligibility criteria for various hormonal and surgical treatments available for them. In a trial attempt to integrate TGP care into medical curriculum, significant (95%) improvement in the knowledge of students was observed.…”

“…In a trial attempt to integrate TGP care into medical curriculum, significant (95%) improvement in the knowledge of students was observed. 2 In the study conducted by Tappy et al after a 2.5 hour training program residents felt more prepared to collect TG focused history, provide referral and access additional educational resources. 15 Steps that can be taken to address the structural, interpersonal, and anticipation barriers to transgender healthcare include enacting policy changes related to insurance coverage for gender-affirming healthcare, reforming medical school curricula to prepare future physicians to provide competent care to transgender patients and continuing education for healthcare providers.…”

“…1 Negative experiences faced by TGP may put them off preventive care resulting in conditions like unplanned pregnancy, sexually transmitted infections, late-stage cancers, and unmonitored hormone therapy, hence placing their health at hazard. 2 Other challenges that transmen encounter, besides the lack of provider expertise, include the stigma associated with being transgender and the difficulty in approaching women-centric clinics to DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20231212 Department of Obstetrics and Gynecology, Shri Sathya Sai Medical College and Research Institute, SBV University, Tamil Nadu, India explain their unique needs due to the fear of mistreatment they may experience. To reduce the inequality experienced by the TGP, the provision of inclusive healthcare is essential.…”