The Case of Sean Smith: A Three-Part Interactive Module on Transgender Health for Second-Year Medical Students

• DOI: 10.15766/mep_2374-8265.10915
• Publication Date: 2020-07-21T09:00:21Z
• Authors: Marc G. Berenson; Samuel J. Gavzy; Lissette Cespedes; Aayush Gabrani; Michelle Davis; Kai Ingram; Dean Gailey; John Paul Sánchez
• Keywords: Medicine (General); Students, Medical; 4. Education; Original Publication; Gender Identity; Transgender Health; Communication Skills; L; Transgender Persons; Education; 3. Good health; 03 medical and health sciences; R5-920; Surveys and Questionnaires; Cultural Competence; Humans; Curriculum; 0305 other medical science; Diversity & Inclusion; LGBTQ+

OPEN ACCESSJuly 21, 2020The Case of Sean Smith: A Three-Part Interactive Module on Transgender Health for Second-Year Medical Students Marc G. Berenson, MD, Samuel J. Gavzy, MS, Lissette Cespedes, Aayush Gabrani, Michelle Davis, Kai Ingram, Dean Gailey, John Paul Sánchez, MPH MD https://orcid.org/0000-0002-0731-5326 Resident, Department Emergency Medicine, Rutgers New Jersey School , MS General Surgery, University Maryland Medicine Assistant Professor Pediatrics, Ingram Senior Environmental Service Person, Hospital Gailey Care Coordinator, Memorial Sloane Kettering Cancer Center Associate Dean, Diversity and Inclusion, School; Professor, Executive Director, Latino Student Association (LMSA) E-mail Address: [email protected] https://doi.org/10.15766/mep_2374-8265.10915 SectionsAboutPDF ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: While great strides have been made in favor the LGBT community overall, transgender individuals are still facing many legal challenges suffer from more marked health issues disparities compared to other members community. Our multimodal curriculum was designed accordance with Kern model address educational gaps area health. Methods: This three-part module consists of: (1) a didactic PowerPoint presentation reviewing unique experienced by patients, (2) small-group session viewing analyzing pair videos showcasing competent poor communication between provider patient, (3) large-group patient panel featuring Results: One hundred sixty-one students returned pre- postworkshop surveys 123 matched pairs. When comparing participants reported confidence levels, mean rating increased significantly all three learning objectives. Based 5-point Likert scale (1 = poor, 5 excellent), participants' ratings were highest at 4.5, 3.9 lecture, 3.8 video session. Discussion: The use this approach using session, video-based case discussion, provided strong foundation primer resulted an increase learner objectives regarding care Educational Objectives By end activity, learners will be able to: 1.Describe transgender-identified individuals.2.Describe medical transitioning hormonal therapies individuals.3.Describe best practices promoting culturally affirming individuals. Introduction community.1 Moreover, caring intersectional identities, such as gender identity, expression, sexual orientation, makes particularly challenging considering lack prior formal training providers any these singular dimensions. 2011 Institute Report Health2 driving factor hastening efforts schools better prepare trainees needs members. Among multiple factors that contribute members, bias, prejudice, stereotyping part can differences care.3 Coverage literature has grown rapidly recent years. Despite being important component health, data transgender-specific student scant. Most existing concludes rate themselves poorly competence, likely due inadequate time allotted issues.4-11 review revealed only about one-third (31%) published studies focused specifically issues.4 Examinations interventions Vance et al. found significant difference scale-based self-perception comfort levels (medical students, residents, advanced practice nurses) after completing consisting interactive online modules observational experience multidisciplinary pediatric clinic.7 Another study demonstrated improvement validated transphobia 10-hour curriculum.5 Similar students' self-reported willingness patients incorporated into preclinical endocrinology didactic,9 combined direct clinical exposure patients,12 or integrated history taking sessions built around standardized patients.13 These highlight importance early introduction content professional training. health-specific undergraduate curricula MedEdPORTAL 14 dedicated modules, aimed addressing health,14-16 submission module. majority briefly cover but do not treatment options. Of curricula, each 1 hour didactics primarily covering terminology, disparities, skills, sensitive communication. utilized cases (SP) encounters. focuses mainly thorough assessment identity.14 SP encounters trans-identified who presenting general physical.15 own (covering screening guidelines, interviewing strategies, medical/surgical management, local resources), pronoun instructional created Callen-Lorde Community Center, discussion centered simulated patient-physician encounter contrasting proficient Uniquely, our describe transmale is hormone therapy presents complaint. one used panel,17 we no others exclusively comprising At (NJMS), longitudinal includes introductory first year, second testing skills OSCE setting during third/clinical year. collaboration faculty leadership, extensive involvement, consultation essential design, implementation, evaluation curriculum, which consistent previous work area.18 All development completed six-step model,19 applied follows: 1.Problem identification assessment: Team conducted search education analyzed how could developed fit broader NJMS. Built first-year served basis modules.2.Targeted Data develop refine course content. In addition, gap analysis performed identify areas requiring further exploration. Specific effort placed identifying topics basic science well illustrated systems-based course.3.Goals objectives: To patients; therapies; continue promote care.4.Educational strategies: workshop features specific focus teaching office-based masculinizing femininizing therapies, community.5.Implementation: 2.5-hour administered genitourinary/endocrine organ system second-year students. Small-group facilitators included allied NJMS.6.Evaluation feedback: Workshop asked complete form. Methods featured sessions: Sessions done format; however, two was, should be, implemented smaller groups 10-15 (or staffing permits) ensure safe robust discussion. presented within also appropriate faculty, (e.g., nursing). had primed initial facilitator sessions, divided facilitators. member, resident, background and/or patients. For recruited diverse set facilitators, including various sexual, racial, generational perspectives. optimal timing 2.5 hours. may shortened 1.5 hours having format rather than them experience; authors recommend feedback received implementations. preparation printed copies forms (Appendix A), Genderbread Person B), worksheet participant. We suggest small card laminated. Additional materials needed administer pens, audiovisual equipment, room, set-up chairs tables support per table. began room preworkshop survey A) assess their homophobic transphobic comments campus. space pose questions facilitator. Next, 55-minute Best Practices C), core objective description transition patients). Each copy B) approximately 2-minute titled Pronouns Matter D) provide testimonies why it consider person's pronoun. Facilitator Guide E) detailed instructions flow presentation. then moved spaces begin 40-minute, facilitated, activity. activity watching 2.5-minute Patient-Provider Poor Communication F), depicted Smith, trans man chief complaint worsening extremity skin infection self-administered therapy. After video, utilize Video Reflection Worksheet G) note what communicating while stratifying responses Learners reflect four dimensions sexuality addressed patient. Then led responses, sample elicit additional understanding before showing 4.25-minute Competent H). same scenario showcased provider. again debrief reflections room. final 35-minute panel. Leading up panelists through known author contacts LGBTQ organizations employees family affiliated hospital. Questions mirrored similar interviews throughout phase asking experiences community, interactions environment, beliefs professionals toward Predetermined advance allow prepare; afforded opportunity ask live Panelists aware consented question phase. Following panel, assessed learner's thus allowed comparison postworkshop. Pre- paired t tests. assessing satisfaction module, segments providing narrative strengths suggestions improvement. Results Since 2016, mandatory fall semester. During time, class size 178 third implementation (2018-2019 academic year), 161 partial surveys, match quantitative pairs (69% response rate), subjective drawn entries. Perceived Campus Climate (Transphobic Remarks) As survey, whether they heard school premises school-sponsored events since beginning year (approximately 3 months). 154 submitted six respondents indicated hearing least comment. comments, ranged "refer[ing] possibly 'tranny'…in clinic" describing "transgender mental illness." added, "when talking men…about STIs, inmates fun [person] talked HPV risks," reference outreach event jail. Self-Perceived Confidence Addressing Learning Using (0 confidence, 4 confidence), (describe individuals) 1.6 2.8 ( p < 0.001) Participants' 1.1 Lastly, individuals), 2.9 Overall Evaluation Similarly, very good excellent (90%) (76%) (74%). There 58 commented question, "please comment today's sessions/activities." Respondents noted "gives insight patients' expectations care" "was informative us perspective It honest look lives journey." Discussion slides, cases, reacted favorably both methodologies. participant indicating greater comprehension issues, when participation LGBTQ-identified substantially improved delivery program. there markedly few population, those previously involved possessed area, facilitated successful sessions. build niche leadership scholarship opportunities, anecdotally observed improve job burnout prevention. nested course. furthered learners' knowledge base social affecting believe stepwise allows revisit content, refresh gained knowledge, integrate new concepts. nontraditional formats years, incorporating concurrently endocrine physiology OB/GYN helpful lesson learned revisiting covered earlier necessary reorient receive content; person reinforcement. function highly rated exercise physician communicate given instruction invaluable would less effective. helped videos, women sex women18 exaggerated provider-patient encounter. errors subtle portion personal nature augmented value added visibility over past several years media, hear directly, positively impact ability underserved population future. Limitations pleased 69% rate, ideally liked captured participants. metric perception acquisition assumed include behavior change, future study. Furthermore, material expression identity apply did related differentiation (which elsewhere NJMS curriculum) newer terminology nonconforming. acknowledge recruitment prove certain geographic areas. interaction therefore if cannot convened, attempt conference bidirectional Facilitators reach out national assistance recruiting conferences. conclusion, continues programs across country. discussions, panels provides grow careers. correlated References1. Reisner SL, Murchison GR. global research synthesis HIV STI biobehavioural risks female-to-male adults. Glob Public Health. 2016;11(7-8):866–887. https://doi.org/10.1080/17441692.2015.1134613Medline, Google Scholar2. Medicine. Lesbian, Gay, Bisexual, People: Building Foundation Better Understanding. National Academies Press; 2011.Google Scholar3. 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Download CitationBerenson Cespedes L, Gabrani Davis M, Sánchez JP. Students. 2020;16:10915. Copyright & Permissions© 2020 open-access publication distributed under terms Creative Commons Attribution-NonCommercial license.KeywordsGender IdentityLGBTQ+Communication SkillsCultural CompetenceTransgender HealthDiversity InclusionAcknowledgmentsThank you Dr. Lisa Dever serving actor videos. Disclosures None report. Funding/Support Informed Consent identifiable persons resource granted permission. Ethical Approval Institutional Review Board approved PDF DownloadLoading ...