First year medical student experiences with a clinical skills seminar emphasizing sexual and gender minority population complexity

Abstract

Purpose: Patients identifying as sexual and gender minorities (SGMs) face healthcare barriers. This problem is partly due to medical training.1 We evaluated first year medical student experiences during a novel four-hour seminar, in which students answered discussion questions, participated in peer role-plays, and interviewed two standardized patients
 Method: A constructivist qualitative design employed audio-recorded and transcribed student focus groups. Using generic content analysis, transcripts were iteratively coded, emergent categories identified, sensitizing concepts applied, and a thematic framework created.
 Results: Thirty-five students (71% female) participated in five focus groups. Two themes were developed: SGM bias (faculty, standardized patients [SPs], students, curriculum), and Adaptive Expertise in Clinical Skills (case complexity, learner support, skill development). SPs identifying as SGM brought authenticity and lived experience to their roles. Preceptor variability impacted student learning. Students were concerned when a lack of faculty SGM knowledge accompanied negative biases. Complex SP cases promoted cognitive integration and preparation for clinical work.
 Conclusions: These students placed importance on the lived experiences of SGM community members. Persistent prejudices amongst faculty negatively influenced student learning. Complex SP cases can promote student adaptive expertise, but risk unproductive learning failures. The lessons learned have implications for clinical skills teaching, learning about minority populations, and medical and health professions education in general.

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

“…The most commonly reported barrier related to the training interventions was lack of appropriate educational materials (Park & Safer, 2018 ; Rosendale & Josephson, 2017 ; Vance et al, 2020 , 2021 ). Facilitation-related barriers primarily centered around the lack of expertise or experience among faculty or instructors to facilitate the training (Berenson et al, 2020 ; Biro et al, 2021 ; Block et al, 2020 ; Click et al, 2019 , 2020 ; Greene et al, 2017 ; Marshall et al, 2017 ; McCave et al, 2019 ; Park & Safer, 2018 ; Rosendale & Josephson, 2017 ; Sawning et al, 2017 ; Sequeira et al, 2012 ; Stumbar et al, 2021 ; Thompson et al, 2020 ; Ufomata et al, 2020 ; Vance et al, 2018 ) and availability of transgender simulation patients (Berenson et al, 2020 ; Biro et al, 2021 ; Block et al, 2020 ; Click et al, 2019 , 2020 ; Greene et al, 2017 ; Marshall et al, 2017 ; McCave et al, 2019 ; Park & Safer, 2018 ; Rosendale & Josephson, 2017 ; Sawning et al, 2017 ; Sequeira et al, 2012 ; Stumbar et al, 2021 ; Thompson et al, 2020 ; Ufomata et al, 2020 ; Vance et al, 2018 ). Low participation rates among certain subgroups (e.g., male and cisgender people) was the most reported barrier related to the audience (Braun et al, 2017 ; Minturn et al, 2021 ; Pathoulas et al, 2021 ).…”

“…Low participation rates among certain subgroups (e.g., male and cisgender people) was the most reported barrier related to the audience (Braun et al, 2017 ; Minturn et al, 2021 ; Pathoulas et al, 2021 ). Institutional/contextual barriers included time constraints in the majority of sources and costs associated with consultation, curriculum development, as well as recruiting and fairly compensating transgender simulation patients/guest speakers (Altneu et al, 2020 ; Bi et al, 2020 ; Biro et al, 2021 ; Braun et al, 2017 ; Click et al, 2019 ; Cooper et al, 2018 ; Kidd et al, 2016 ; Marshall et al, 2017 ; Minturn et al, 2021 ; Rosendale & Josephson, 2017 ; Roth et al, 2020 ; Salkind et al, 2019 ; Sawning et al, 2017 ; Stumbar et al, 2021 ; Ufomata et al, 2020 ; Underman et al, 2016 ; Vance et al, 2020 ; Ward-Gaines et al, 2021 ). Kidd and colleagues critiqued the limited effectiveness of ‘one-shot’ educational interventions, on which much of residency education relies, [which] may not necessarily result in sustained improvements” ( 2016 , p. 4).…”

“…The sources also featured a variety of instructional methods to engage students in active learning. The most favored approach to training medical students and residents in transgender health was the use of interactive modalities such as case-based formats, clinical scenarios, mock patient encounters, role-play and/or live interviews that provided students with opportunities to practice interviewing skills and conducting a history with a transgender patient (Altneu et al, 2020 ; Barrett et al, 2021 ; Berenson et al, 2020 ; Bi et al, 2020 ; Biro et al, 2021 ; Click et al, 2019 ; Greene et al, 2017 ; Kidd et al, 2016 ; McCave et al, 2019 ; Park & Safer, 2018 ; Salkind et al, 2019 ; Sequeira et al, 2012 ; Streed et al, 2019 ; Stumbar et al, 2021 ; Taylor et al, 2018 ; Underman et al, 2016 ; Vance et al, 2017 , 2018 , 2021 ; Ward-Gaines et al, 2021 ). Authors also suggested the use of group discussions and debriefing sessions to compliment and build upon interactive activities, which presented opportunities to provide guidance, answer questions and work through any tension or discomfort (Kidd et al, 2016 ; Salkind et al, 2019 ; Sequeira et al, 2012 ; Underman et al, 2016 ).…”

Coming to terms with the languages we use in medical education: hidden meanings and unintended consequences

“…In First year medical student experiences with a clinical skills seminar emphasizing sexual and gender minority population complexity, 19 Biro, Song, and Nyhof-Young reported a qualitative evaluation study to explore how first-year medical students experienced a sexual and gender minority (SGM) clinical skills seminar. They found that recognizing the lived experiences of SGM community members, developing allies, and promoting faculty development are necessary elements of future curricular interventions in this area.…”

Writing, reading, and critiquing reviews

“…Response to "First year medical student experiences with a clinical skills seminar emphasizing sexual and gender minority population complexity" by Kumar and Hassan 44 acknowledged the previously published article by Biro et al 45 that explored limitations in medical training for the LGBTQ2S community. However, Kumar and Hassen advocated for further progress and reform for medical training to address the health requirements for sexual and gender minorities.…”