Background: Transgender healthcare is not a formal learning requirement in Internal Medicine residency or fellowship. The National LGBTQ Task Force appealed to urgently train clinicians on the effective care of transgender patients. Few studies address the successful implementation of transgender healthcare teaching and education in graduate medical education. Purpose: The purpose was to design an online asynchronous curriculum to address the need for improved transgender healthcare education in graduate medical education and assess change in knowledge and comfort in transgender healthcare for residents and fellow learners. Methods: A 6-module curriculum was developed using established guidelines and ACGME competencies as a framework for content. To assess curriculum effectiveness, participants received anonymous pre- and post-curriculum surveys which included a multiple-choice knowledge assessment, Likert scale comfort questions focusing on healthcare skills, and open-ended feedback questions. Results: Twenty-six internal medicine residents and fellows participated in the curriculum (2022-2023). There was a 69% post-survey response rate. Participants improved their gender-affirming knowledge after completing the curriculum (p < 0.05). Comfort in using pronouns, recognizing barriers to care and initiation of gender-affirming medical treatment significantly increased (p < 0.05). All participants agreed on the importance of what they were asked to learn and that their knowledge and skills increased. Resource access improved post curriculum (p < 0.05). Participants found the content was comprehensive and accessible, but indicated the automated narrator and module navigation could be improved. Post-curriculum, a variety of anticipated practice improvement strategies were shared. Conclusion: This online curriculum was successful in increasing knowledge and comfort in transgender care for IM residents and fellows. It provides a promising framework to address this gap in curricular content.
References
[1]
Grant, J.M., et al. (2011) Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. https://transequality.org/sites/default/files/docs/resources/NTDS_Report.pdf
[2]
Nolan, I.T., Blasdel, G., Dubin, S.N., Goetz, T.G., Greene, R.E. and Morrison, S.D. (2020) Current State of Transgender Medical Education in the United States and Canada: Update to a Scoping Review. Journal of Medical Education and Curricular Development, 7, 1-13. https://doi.org/10.1177/2382120520934813
[3]
Van Heesewijk, J., Kent, A., Van de Grift, T.C., Harleman, A. and Muntinga, M. (2022) Transgender Health Content in Medical Education: A Theory-Guided Systematic Review of Current Training Practices and Implementation Barriers & Facilitators. Advances in Health Sciences Education, 27, 817-846. https://doi.org/10.1007/s10459-022-10112-y
[4]
Kopel, J., Beck, N., Almekdash, M.H. and Varma, S. (2023) Trends in Transgender Healthcare Curricula in Graduate Medical Education. Baylor University Medical Center Proceedings, 36, 620-626. https://doi.org/10.1080/08998280.2023.2228140
[5]
Obedin-Maliver, J., Goldsmith, E.S., Stewart, L., White, W., Tran, E., Brenman, S., et al. (2011) Lesbian, Gay, Bisexual, and Transgender–Related Content in Undergraduate Medical Education. JAMA, 306, 971-977. https://doi.org/10.1001/jama.2011.1255
[6]
Davidge-Pitts, C.J., Nippoldt, T.B. and Natt, N. (2018) Endocrinology Fellows’ Perception of Their Confidence and Skill Level in Providing Transgender Healthcare. Endocrine Practice, 24, 1038-1042. https://doi.org/10.4158/ep-2018-0307
[7]
Malek, R., Sarmiento, M. and Lamos, E. (2022) ODP410 Exposure to Transgender Teaching in Internal Medicine Residents and Established Providers. Journal of the Endocrine Society, 6, A660-A661. https://doi.org/10.1210/jendso/bvac150.1366
[8]
Hembree, W.C., Cohen-Kettenis, P.T., Gooren, L., Hannema, S.E., Meyer, W.J., Murad, M.H., et al. (2017) Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 102, 3869-3903. https://doi.org/10.1210/jc.2017-01658
[9]
Coleman, E., Radix, A.E., Bouman, W.P., Brown, G.R., De Vries, A.L.C., Deutsch, M.B., et al. (2022) Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, 23, S1-S259. https://doi.org/10.1080/26895269.2022.2100644
[10]
D. of F. and C. M. UCSF Gender Affirming Health Program (2024) Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People. https://transcare.ucsf.edu/guidelines
[11]
Eno, C., et al. (2024) Milestones Guidebook for Residents and Fellows. https://www.acgme.org/globalassets/PDFs/Milestones/MilestonesGuidebookforResidentsFellows.pdf
[12]
Accreditation Council for Graduate Medical Education (ACGME) (2024) Internal Medicine Milestones the Accreditation Council for Graduate Medical Education. https://www.acgme.org/Specialties/Internal-Medicine/Milestones
[13]
Cooper, R.L., Ramesh, A., Radix, A.E., Reuben, J.S., Juarez, P.D., Holder, C.L., et al. (2023) Affirming and Inclusive Care Training for Medical Students and Residents to Reduce Health Disparities Experienced by Sexual and Gender Minorities: A Systematic Review. Transgender Health, 8, 307-327. https://doi.org/10.1089/trgh.2021.0148
[14]
Streed, C.G., Hedian, H.F., Bertram, A. and Sisson, S.D. (2019) Assessment of Internal Medicine Resident Preparedness to Care for Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning Patients. Journal of General Internal Medicine, 34, 893-898. https://doi.org/10.1007/s11606-019-04855-5
[15]
Vance, S.R., Lasofsky, B., Ozer, E. and Buckelew, S.M. (2018) Teaching Paediatric Transgender Care. The Clinical Teacher, 15, 214-220. https://doi.org/10.1111/tct.12780
[16]
Vance, S.R., Deutsch, M.B., Rosenthal, S.M. and Buckelew, S.M. (2017) Enhancing Pediatric Trainees’ and Students’ Knowledge in Providing Care to Transgender Youth. Journal of Adolescent Health, 60, 425-430. https://doi.org/10.1016/j.jadohealth.2016.11.020
[17]
Vance, S.R., Buckelew, S.M., Dentoni-Lasofsky, B., Ozer, E., Deutsch, M.B. and Meyers, M. (2020) A Pediatric Transgender Medicine Curriculum for Multidisciplinary Trainees. MedEdPORTAL, 16, Article No. 10896. https://doi.org/10.15766/mep_2374-8265.10896
[18]
Ufomata, E., Eckstrand, K.L., Spagnoletti, C., Veet, C., Walk, T.J., Webb, C., et al. (2020) Comprehensive Curriculum for Internal Medicine Residents on Primary Care of Patients Identifying as Lesbian, Gay, Bisexual, or Transgender. MedEdPORTAL, 16, Article No. 10875. https://doi.org/10.15766/mep_2374-8265.10875
