Perspectives of Transgender and Genderqueer Standardized Patients

Abstract

Phenomenon: Disparities in health and healthcare for gender minorities (GMs) such as transgender people are significant, and medical educators have a responsibility to ensure trainees master the clinical skills required to provide them with quality care. We implemented a standardized patient (SP) scenario designed to measure students’ ability to provide gender-affirming care and sought to understand the experiences and perceptions of the GMs who served as SPs in this case. Our key research question was: how do GM SPs describe the experience of serving as an SP on a gender-affirming care clinical case? Approach: Semi-structured focus groups were conducted with GM SPs (n = 10) to understand their experiences and gauge their perceptions of portraying a patient seeking gender-affirming care. The patient they portrayed matched their own gender identity. Focus groups were transcribed verbatim and analyzed using inductive thematic analysis. Findings: We developed three primary themes in our analysis: personal connection, gap identification, and insight into medical education. The SPs reported a personal connection to this case, enabling them to give nuanced feedback, confront bias they encountered, and foster connection to their broader community. They were able to identify specific gaps related to communication skills, assumptions, and knowledge about gender identity and gender-affirming care. They gained valuable insight into medical education such as the complexity of learning clinical skills and roadblocks to inclusive simulation. Insights: By sharing the perspectives of GMs in patient simulation, this study demonstrates that GMs can also benefit from engagement with medical education, as the SPs in our study described hope, empowerment, and engagement as positive aspects of participation. This study also shows that GMs’ lived experiences seeking medical care were instrumental in their ability to note gaps, which provides valuable insight for other institutions attempting to improve students’ GM clinical skills. Further, GM SPs’ perspectives are valuable to provide a rationale and guidance to other schools implementing gender-affirming education. Efforts to create and implement gender-affirming care curriculum should include GMs in order to build partnerships and prioritize the voices and agency of GMs.

Keywords:

• gender minorities
• transgender
• LGBTQ
• simulation
• standardized patients

Acknowledgements

The authors would like to acknowledge the dedicated members of our local GM community who shared their time, energy, and expertise to educate medical students by participating in this case. This work would not have been possible without the staff of our standardized patient program, especially Zack Kennedy and Mimi Reddy who were instrumental in SP hiring and training. We would also like to acknowledge Stacie Steinbock, Aaron Weathers, Lisa Gunterman, Brian Buford, and other staff of UofL LGBT Center. Their long-standing work with SGMs in our community paved the way for positive relationships between the University of Louisville and community members. Finally, we acknowledge ULSOM Dean Toni Ganzel and Senior Associate Dean Amy Holthouser; their commitment to LGBTQ health education was the catalyst for this work and the eQuality Project.