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Perspectives on medical education
01, 2022;11 (1): 36-44.

An undergraduate medical curriculum framework for providing care to transgender and gender diverse patients: A modified Delphi study.

Rachel H Ellaway, Nicole L Thompson, Claire Temple-Oberle, Dani��le Pacaud, Helena Frecker, Theodore J Jablonski, James Demers, Fiona Mattatall, Joe Raiche, Andrea Hull, Rabiya Jalil
Author Information
  1. Rachel H Ellaway: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. rachel.ellaway@ucalgary.ca. ORCID
  2. Nicole L Thompson: Department of Obstetrics and Gynecology, University of British Columba, Vancouver, British Columbia, Canada.
  3. Claire Temple-Oberle: Department of Plastic Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
  4. Dani��le Pacaud: Department of Pediatric Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
  5. Helena Frecker: Department of Obstetrics and Gynecology, University of Toronto School of Medicine, Toronto, Ontario, Canada.
  6. Theodore J Jablonski: Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
  7. James Demers: Queer Education Foundation, Calgary, Alberta, Canada.
  8. Fiona Mattatall: Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
  9. Joe Raiche: Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
  10. Andrea Hull: Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
  11. Rabiya Jalil: Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
PMID: 34792753 DOI: 10.1007/s40037-021-00692-7

Abstract

INTRODUCTION: The lack of attention to transgender and gender diverse (TGD) people in undergraduate medical education (UME) is a point of concern, particularly among medical students. A project was undertaken to develop a UME curriculum framework for teaching the healthcare needs of TGD people.
METHODS: Using a modified Delphi methodology, four rounds of surveys were presented to an expert stakeholder group that included content experts, generalist physicians, UME teaching faculty, and medical students. Questions covered what content should be taught, who should teach the content, and how much time should be dedicated for this teaching. Once the Delphi process was complete, feedback on the provisional framework was sought from members of the TGD community to ensure it represented their needs and perspectives.
RESULTS: 71 panel members and 56 community members participated in the study. Core values included the scope of the framework, and topics such as inclusivity, and safety in practice and in teaching. The framework included terminology, epidemiology, medical and surgical treatment, mental health, sexual and reproductive health, and routine primary care. There was also guidance on who should teach, time to be allocated, and the learning environment.
DISCUSSION: There is a clear need to train tomorrow's doctors to provide competent and respectful healthcare services to and for TGD patients. Although local factors will likely shape the way in which this framework will be implemented in different contexts, this paper outlines a core UME-level curriculum framework for Canada and, potentially, for use in other parts of the world.

Keywords

Canada Curriculum Delphi Gender nonconforming Safety Syllabus Transgender

References

  1. Department of Health. Lesbian, gay, bisexual, and transgender health. 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health . Accessed 1 June 2021.
  2. Health4LGBTI Project. Health4LGBTI state-of-the-art synthesis report. 2017. https://ec.europa.eu/health/sites/health/files/social_determinants/docs/stateofart_report_en.pdf . Accessed 1 June 2021.
  3. Safer JD, Coleman E, Feldman J, et al. Barriers to health care for transgender individuals. Curr Opin Endocrinol Diabetes Obes. 2016;23:168���71. [DOI: 10.1097/MED.0000000000000227]
  4. Sachdeva I, Aithal S, Yu W, et al. The disparities faced by the LGBTQ+ community in times of COVID-19. Psychiatry Res. 2021;297:113725. [DOI: 10.1016/j.psychres.2021.113725]
  5. Obedin-Maliver J, Goldsmith ES, Stewart L, et al. Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education. JAMA. 2011;306:971���7. [DOI: 10.1001/jama.2011.1255]
  6. Lim F, Johnson M, Eliason M. A national survey of faculty knowledge, experience, and readiness for teaching lesbian, gay, bisexual, and transgender health in baccalaureate nursing programs. Nurs Educ Perspect. 2015;36:144���52. [DOI: 10.5480/14-1355]
  7. Sequeira GM, Chakraborti C, Panunti BA. Integrating lesbian, gay, bisexual, and transgender (LGBT) content into undergraduate medical school curricula: a qualitative study. Ochsner J. 2012;12:379���82.
  8. Dubin SN, Nolan IT, Streed CG Jr, et al. Transgender health care: improving medical students��� and residents��� training and awareness. Adv Med Educ Pract. 2018;9:377���91. [DOI: 10.2147/AMEP.S147183]
  9. Johnston CD, Shearer LS. Internal medicine resident attitudes, prior education, comfort, and knowledge regarding delivering comprehensive primary care to transgender patients. Transgend Health. 2017;2:91���5. [DOI: 10.1089/trgh.2017.0007]
  10. Yan H, Ahmad T, Kulkarni A. Health care for transgender patients: medical education and patient access. Canadian federation of medical students (CFMS). 2015. https://www.cfms.org/files/position-papers/2015%20CFMS%20Transgender%20Health%20Care.pdf . Accessed 1 June 2021.
  11. Cruz TM. Assessing access to care for transgender and gender nonconforming people: a consideration of diversity in combating discrimination. Soc Sci Med. 2014;110:65���73. [DOI: 10.1016/j.socscimed.2014.03.032]
  12. de Vries E, Kathard H, M��ller A. Debate: why should gender-affirming health care be included in health science curricula? BMC Med Educ. 2020;20:51. [DOI: 10.1186/s12909-020-1963-6]
  13. Click IA, Mann AK, Buda M, et al. Transgender health education for medical students. Clin Teach. 2020;17:190���4. [DOI: 10.1111/tct.13074]
  14. Marshall A, Pickle S, Lawlis S. Transgender medicine curriculum: integration into an organ system-based preclinical program. MedEdPORTAL. 2017;13:10536. [DOI: 10.15766/mep_2374-8265.10536]
  15. Encandela J, Zelin NS, Solotke M, Schwartz ML. Principles and practices for developing an integrated medical school curricular sequence about sexual and gender minority health. Teach Learn Med. 2019;31:319���34. [DOI: 10.1080/10401334.2018.1559167]
  16. Park JA, Safer JD. Clinical exposure to transgender medicine improves students��� preparedness above levels seen with didactic teaching alone: a key addition to the Boston university model for teaching transgender healthcare. Transgend Health. 2018;3:10���6. [DOI: 10.1089/trgh.2017.0047]
  17. Ziegler E, Valaitis R, Carter N, Risdon C, Yost J. Primary care for transgender individuals: a review of the literature reflecting a Canadian perspective. SAGE Open Med. 2020;10(3):21582440209.
  18. Nolan IT, Blasdel G, Dubin SN, Goetz TG, Greene RE, Morrison SD. Current state of transgender medical education in the United States and Canada: update to a scoping review. J Med Educ Curric Dev. 2020;7:2382120520934813. [DOI: 10.1177/2382120520934813]
  19. Morris M, Cooper RL, Ramesh A, et al. Training to reduce LGBTQQ-related bias among medical, nursing, and dental students and providers: a systematic review. BMC Med Educ. 2019;19:325. [DOI: 10.1186/s12909-019-1727-3]
  20. Roberts T, Fantz C. Barriers to quality health care for the transgender population. Clin Biochem. 2014;47:983���7. [DOI: 10.1016/j.clinbiochem.2014.02.009]
  21. Winter S, Diamond M, Green J, et al. Transgender people: health at the margins of society. Lancet. 2016;388:390���400. [DOI: 10.1016/S0140-6736(16)00683-8]
  22. Seelman KL, Col��n-Diaz MJP, LeCroix RH, Xavier-Brier M, Kattari L. Transgender noninclusive healthcare and delaying care because of fear: connections to general health and mental health among transgender adults. Transgend Health. 2017;2:17���28. [DOI: 10.1089/trgh.2016.0024]
  23. Bath H. The three pillars of trauma-informed care. Reclaiming Child Youth. 2008;17:17���21.
  24. Parliament of Canada. Bill C���16, an act to amend the Canadian human rights act and the criminal code. 1st Sess, 42nd Parl. 2017. https://www.parl.ca/DocumentViewer/en/42-1/bill/c-16/royal-assent . Accessed 1 June 2021.
  25. Jones J, Hunter D. Consensus methods for medical and health services research. BMJ. 1995;311:376���80. [DOI: 10.1136/bmj.311.7001.376]
  26. Humphrey-Murto S, Varpio L, Gonsalves C, Wood TJ. Using consensus group methods such as Delphi and nominal group in medical education research. Med Teach. 2017;39:14���9. [DOI: 10.1080/0142159X.2017.1245856]
  27. Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. 2000;32:1008���15.
  28. Raja S, Hasnain M, Hoersch M, Gove-Yin S, Rajagopalan C. Trauma informed care in medicine: current knowledge and future research directions. Fam Community Health. 2015;38:216���26. [DOI: 10.1097/FCH.0000000000000071]
  29. Stroumsa D, Shires DA, Richardson CR, Jaffee KD, Woodford MR. Transphobia rather than education predicts provider knowledge of transgender health care. Med Educ. 2019;53:398���407. [DOI: 10.1111/medu.13796]
  30. Burke SE, Dovidio JF, Przedworski JM, et al. Do contact and empathy mitigate bias against gay and lesbian people among heterosexual first-year medical students? A report from the medical student CHANGE study. Acad Med. 2015;90:645���51. [DOI: 10.1097/ACM.0000000000000661]
  31. Moseson H, Lunn MR, Katz A, et al. Development of an affirming and customizable electronic survey of sexual and reproductive health experiences for transgender and gender nonbinary people. PLoS ONE. 2020;15:e232154. [DOI: 10.1371/journal.pone.0232154]
  32. Player M, Jones A. Compulsory transgender health education: the time has come. Fam Med. 2020;52:395���7. [DOI: 10.22454/FamMed.2020.647521]
  33. Martins RS, Saleh R, Kamal H, et al. The need for transgender healthcare medical education in a developing country. Adv Med Educ Pract. 2020;11:405���13. [DOI: 10.2147/AMEP.S255483]
  34. Rees CE. The problem with outcomes-based curricula in medical education: insights from educational theory. Med Educ. 2004;38:593���8. [DOI: 10.1046/j.1365-2923.2004.01793.x]
  35. Whitehead C. Scientist or science-stuffed? Discourses of science in North American medical education. Med Educ. 2013;47:26���32. [DOI: 10.1111/j.1365-2923.2011.04136.x]
  36. Sangganjanavanich VF. Trans identities, psychological perspectives. In: Wong A, Wickramasinghe M, Hoogland R, Naples NA, editors. The Wiley Blackwell encyclopedia of gender and sexuality studies. New York: Wiley; 2015. https://doi.org/10.1002/9781118663219.wbegss293 . [DOI: 10.1002/9781118663219.wbegss293]
  37. Kcomt L, Gorey KM, Barrett BJ, McCabe SE. Healthcare avoidance due to anticipated discrimination among transgender people: a call to create trans-affirmative environments. SSM Popul Health. 2020;11:100608. [DOI: 10.1016/j.ssmph.2020.100608]
  38. Kuhar R, Monro S, Tak��cs J. Trans* citizenship in post-socialist societies. Crit Soc Policy. 2018;38:99���120. [DOI: 10.1177/0261018317732463]

MeSH Term

Curriculum
Delphi Technique
Education, Medical, Undergraduate
Humans
Students, Medical
Transgender Persons
Male
Female
Journal Article
Article has an altmetric score of 7

Word Cloud

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