Use of Standardized Patients in Endocrinology Fellowship Programs to Teach Competent Transgender Care

Abstract

Purpose Transgender and gender-nonconforming individuals have unique health care needs and have difficulty accessing health care services because of a lack of qualified health care providers, insurance coverage, mistreatment, and bias by the medical community. Medical trainees and physicians report a lack of education in, and exposure to, the clinical care and unique aspects of this field. We assessed the use of a standardized patient as a tool to evaluate 4 core medical competencies (patient care, medical knowledge, professionalism, and interpersonal communication) of endocrinology fellows at a single training program. Methods Endocrine fellows were evaluated by faculty in different aspects of transgender care and completed a self-assessment before and after the exercise. Faculty viewed the fellows during the Objective Clinical Structured Examination. Fellows were provided feedback by a faculty member and the standardized patient after the exercise. Results Deficits were found in patient care and professionalism. Fellows scored well in medical knowledge. Fellows did not report an improvement in comfort and communication skills after the exercise. Interestingly, fellows’ self-assessment scores in several domains declined after the standardized patient encounter, highlighting an occasion for self-reflection and growth within the realms of cultural competency and medical knowledge. Main conclusions We conclude that use of standardized patients to teach medical competencies in transgender medicine may be one approach to improve exposure to, and training in, transgender medicine. Endocrine fellows still had discomfort treating transgender individuals after the standardized patient encounter and require other training activities that may include didactics and clinical case discussions.

Gender Diverse Representation in Patient Simulation: A Scoping Review

“…Only 1 study reporting self-assessment outcomes indicated a negative result, which the authors hypothesized was due to postencounter increased awareness of their own areas of weakness. 21…”

“…We completed the data extraction form for the final 22 included studies and summarized these findings in Table 1. [17][18][19][20][21][22]…”

“…Only 1 study reporting self-assessment outcomes indicated a negative result, which the authors hypothesized was due to postencounter increased awareness of their own areas of weakness. 21 Three studies (14%) assessed learners' knowledge gain, focusing on the formation of gender identity and medical knowledge regarding gender-affirming care. Of these, 2 reported positive outcomes, while the other reported minimal change in learner knowledge as a result of their intervention.…”

Trans health training objectives: A scoping review

“…34,36,39,41,43 to assess outcomes pertaining to knowledge, attitudes, or skills. 26,35,37,[39][40][41][42][43] One consensus-based study was a working group designed and administered to develop LGBTQ competencies. 34 Two studies were qualitative and focussed on deriving training objectives that the transgender community wanted their health practitioner to know and learn.…”

“…32 Ultimately, 11 studies met our inclusion criteria for data extraction and their study characteristics are summarised in Table 1. 26,[34][35][36][37][38][39][40][41][42][43] Six of these studies focussed solely on transgender health objectives as their main objectives, 26,35,37,38,40,42 while the remaining five studies had transgender health objectives grouped in or developed as part of overarching LGBTQ health objectives. 34,36,39,41,43 to assess outcomes pertaining to knowledge, attitudes, or skills.…”