Transgender health care: improving medical students’ and residents’ training and awareness

Abstract

Background

A growing body of research continues to elucidate health inequities experienced by transgender individuals and further underscores the need for medical providers to be appropriately trained to deliver care to this population. Medical education in transgender health can empower physicians to identify and change the systemic barriers to care that cause transgender health inequities as well as improve knowledge about transgender-specific care.

Methods

We conducted structured searches of five databases to identify literature related to medical education and transgender health. Of the 1272 papers reviewed, 119 papers were deemed relevant to predefined criteria, medical education, and transgender health topics. Citation tracking was conducted on the 119 papers using Scopus to identify an additional 12 relevant citations (a total of 131 papers). Searches were completed on October 15, 2017 and updated on December 11, 2017.

Results

Transgender health has yet to gain widespread curricular exposure, but efforts toward incorporating transgender health into both undergraduate and graduate medical educations are nascent. There is no consensus on the exact educational interventions that should be used to address transgender health. Barriers to increased transgender health exposure include limited curricular time, lack of topic-specific competency among faculty, and underwhelming institutional support. All published interventions proved effective in improving attitudes, knowledge, and/or skills necessary to achieve clinical competency with transgender patients.

Conclusion

Transgender populations experience health inequities in part due to the exclusion of transgender-specific health needs from medical school and residency curricula. Currently, transgender medical education is largely composed of one-time attitude and awareness-based interventions that show significant short-term improvements but suffer methodologically. Consensus in the existing literature supports educational efforts to shift toward pedagogical interventions that are longitudinally integrated and clinical skills based, and we include a series of recommendations to affirm and guide such an undertaking.

Keywords:

• medical education
• transgender
• LGBT health
• medical training
• residency

This article is referred to by:

Surgical healthcare needs for transgender patients: surgeons’ perspectives

Transgender health and its current omission from medical school curriculum: medical students’ perspective

Supplementary material

Search databases and terms

Education Source (EBSCO)

(“Transgender Persons” OR “Transsexualism” OR “Health Services for Transgender Persons” OR “Disorders of Sex Development” OR “differences of sex development” OR “difference of sex development” OR “disorders of sex development” OR “disorder of sex development” OR “gender incongruence” OR “gender fluidity” OR “gender reassigned” OR “gender reassignment” OR “gender minority” OR “gender non conformity” OR “gender nonconformity” OR “gender nonconforming” OR “gender non conforming” OR “gender expression” OR “gender variance” OR “gender-variant” OR “crossgender” OR “F2M” OR “female-to-male” OR “gender change” OR “gender changes” OR “gender dysphoria” OR “gender dysphorias” OR “gender queer” OR “gender queering” OR “gender transition” OR “gender transitioning” OR “genderqueer” OR “genderqueer” OR “genderqueers” OR “M2F” OR “male-to-female” OR “sex change” OR “sex changed” OR “sex changer” OR “sex changers” OR “sex changes” OR “sex reversal” OR “sex reversals” OR “sex transition” OR “trans female” OR “trans females” OR “trans male” OR “trans males” OR “trans man” OR “trans men” OR “trans people” OR “trans woman” OR “trans-sexuality” OR “transexual” OR “transgender” OR “transgendered” OR “transgenders” OR “transsexual” OR “transsexualism” OR “transsexuality” OR “transsexuals” OR “transvestite”) AND (“medical students” OR “medical student” OR “medical education” OR “medical college” OR “medical curriculum” OR “clinical clerkship” OR “clinical clerkships” OR “clinical rotation” OR “clinical rotations” OR “clinical curriculum” OR “medical training” OR “Internship and Residency” OR “Teaching Rounds” OR “Students, Medical” OR “Schools, Medical” OR “Education, Medical” OR “Education, Medical, Undergraduate” OR “Education, Medical, Graduate” OR “Education, Medical, Continuing”) AND (“medical students” OR “medical student” OR “medical education” OR “medical college” OR “medical curriculum” OR “clinical clerkship” OR “clinical clerkships” OR “clinical rotation” OR “clinical rotations” OR “clinical curriculum” OR “medical training” OR “Internship and Residency” OR “Teaching Rounds” OR “Students, Medical” OR “Schools, Medical” OR “Education, Medical” OR “Education, Medical, Undergraduate” OR “Education, Medical, Graduate” OR “Education, Medical, Continuing”)

LGBT Life (EBSCO)

(“Transgender Persons” OR “Transsexualism” OR “Health Services for Transgender Persons” OR “Disorders of Sex Development” OR “differences of sex development” OR “difference of sex development” OR “disorders of sex development” OR “disorder of sex development” OR “gender incongruence” OR “gender fluidity” OR “gender reassigned” OR “gender reassignment” OR “gender minority” OR “gender non conformity” OR “gender nonconformity” OR “gender nonconforming” OR “gender non conforming” OR “gender expression” OR “gender variance” OR “gender-variant” OR “crossgender” OR “F2M” OR “female-to-male” OR “gender change” OR “gender changes” OR “gender dysphoria” OR “gender dysphorias” OR “gender queer” OR “gender queering” OR “gender transition” OR “gender transitioning” OR “genderqueer” OR “genderqueer” OR “genderqueers” OR “M2F” OR “male-to-female” OR “sex change” OR “sex changed” OR “sex changer” OR “sex changers” OR “sex changes” OR “sex reversal” OR “sex reversals” OR “sex transition” OR “trans female” OR “trans females” OR “trans male” OR “trans males” OR “trans man” OR “trans men” OR “trans people” OR “trans woman” OR “transsexuality” OR “transexual” OR “transgender” OR “transgendered” OR “transgenders” OR “transsexual” OR “transsexualism” OR “transsexuality” OR “transsexuals” OR “transvestite”) AND (“medical students” OR “medical student” OR “medical education” OR “medical college” OR “medical curriculum” OR “clinical clerkship” OR “clinical clerkships” OR “clinical rotation” OR “clinical rotations” OR “clinical curriculum” OR “medical training” OR “Internship and Residency” OR “Teaching Rounds” OR “Students, Medical” OR “Schools, Medical” OR “Education, Medical” OR “Education, Medical, Undergraduate” OR “Education, Medical, Graduate” OR “Education, Medical, Continuing”) AND (“medical students” OR “medical student” OR “medical education” OR “medical college” OR “medical curriculum” OR “clinical clerkship” OR “clinical clerkships” OR “clinical rotation” OR “clinical rotations” OR “clinical curriculum” OR “medical training” OR “Internship and Residency” OR “Teaching Rounds” OR “Students, Medical” OR “Schools, Medical” OR “Education, Medical” OR “Education, Medical, Undergraduate” OR “Education, Medical, Graduate” OR “Education, Medical, Continuing”)

MedEdPORTAL

(“Transgender”)

PsycINFO

(“Transgender” AND “Education”)

PubMed

(((“Medical education”[Journal] OR “Academic medicine: journal of the Association of American Medical Colleges”[Journal] OR “Advances in health sciences education: theory and practice”[Journal] OR “Medical teacher”[Journal] OR “Academic emergency medicine: official journal of the Society for Academic Emergency Medicine”[Journal] OR “Simulation in healthcare: journal of the Society for Simulation in Healthcare”[Journal] OR “Journal of surgical education”[Journal] OR “Evaluation & the health professions”[Journal] OR “BMC medical education”[Journal] OR “The Journal of continuing education in the health professions”[Journal] OR “Teaching and learning in medicine”[Journal] OR “The clinical teacher”[Journal] OR “Education for health (Abingdon, England)”[Journal] OR “Advances in physiology education”[Journal] OR “Canadian medical education journal”[Journal] OR “Journal of graduate medical education”[Journal] OR “Medical education online”[Journal] OR “Perspectives on medical education”[Journal] OR “Journal of research in interprofessional practice and education”[Journal] OR “Medical science educator”[Journal] OR “The journal of the International Association of Medical Science Educators: JIAMSE”[Journal]))) OR (“medical students”[tiab] OR “medical student”[tiab] OR “medical education”[tiab] OR “medical college”[tiab] OR “medical curriculum”[tiab] OR “clinical clerkship”[tiab] OR “clinical clerkships”[tiab] OR “clinical rotation”[tiab] OR “clinical rotations”[tiab] OR “clinical curriculum”[tiab] OR “medical training”[tiab] OR “Internship and Residency”[Mesh] OR “Teaching Rounds”[Mesh] OR “Students, Medical”[Mesh] OR “Schools, Medical”[Mesh] OR “Education, Medical”[Mesh] OR “Education, Medical, Undergraduate”[Mesh] OR “Education, Medical, Graduate”[Mesh] OR “Education, Medical, Continuing”[Mesh])

Acknowledgments

We wish to acknowledge Vania Rashidi for his assistance with making the figures. We also wish to acknowledge Dr Victoria Harnick for her early guidance in framing this article, as well as Joseph Nicholson for his input on our search strategy.

Disclosure

The authors report no conflicts of interest in this work.