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

Abstract

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.

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

“…Many of the recommendations, desires, and provider preferences argued by posters to better prepare healthcare professionals for a diverse patient population were supported by the literature on transgender medical education. Broad themes ran parallel to reviews of TGD health training and reflected the crucial need for the institutionalization of TGD content throughout the medical training process [24]. More specifically, quotes regarding curricular changes to medical education echoed common interventions to improve training.…”

“…More specifically, quotes regarding curricular changes to medical education echoed common interventions to improve training. Authors highlighted adopting TGD health electives in medical school curricula, including student-delivered presentations, elective rotations, interactive online modules, and standardized patient panels that included TGD patients [24,25].…”

Prevalence of social and economic stressors among transgender veterans with alcohol and other drug use disorders

“…While evidence suggests that supportive housing programs are reaching transgender VA patients ( Blosnich, Rodriguez, et al, 2020 ; Montgomery, Shipherd, Kauth, Harris, & Blosnich, 2020 ), it is unclear whether other VA social programs are also reaching these patients, and whether these programs are addressing SUDs synergistically. Evaluations of these efforts are needed, including implementation and evaluation of provider and staff training programs to create welcoming environments for minority patient populations ( van Heesewijk, Kent, van de Grift, Harleman, & Muntinga, 2022 ). Finally, the present study's findings highlight the adverse sequelae of transphobic social structures and norms.…”

Impact of Depsychopathologization of Transgender and Gender Diverse Individuals in ICD-11 on Care Delivery: Looking at Trans Expertise through a Trans Lens

“…Improving health pathways is based on depsychopathologization [ 4 , 5 , 7 ] and calls for improving communication, access to affordable surgeries, training of staff, and administrative procedures. Professional training is also a sufficiently salient element to constitute an autonomous cluster [ 36 ]. Barriers in access to care seem equally based on the perceived excessive waiting time and the inadequacy of current dedicated services.…”