Overcoming the Challenges in Providing Gender-Affirming Care: A Call for Structured Training
The LGBTQ community has unique healthcare needs, and it is crucial for healthcare providers to have training in using gender-affirming language and techniques. However, a lack of education in medical schools and few opportunities for hands-on training pose significant challenges for healthcare professionals in providing quality care for LGBTQ patients.
Unique Healthcare Needs of LGBTQ Patients
LGBTQ patients have unique healthcare needs that require a compassionate, understanding approach from healthcare professionals. For example, clinicians should use gender-affirming language and techniques when interacting with patients and during physical examinations. They should ask patients how they prefer to be referred to, including their name and pronoun, how they identify their gender, and the words they want used to describe their body parts. A patient may have a different name and gender identity than what's listed on their medical records and insurance. Instead of asking for their "real" name, medical staff can ask, "Could your chart be under a different name?" or "What is the name on your insurance?"1
These thoughtful, gender-affirming interactions will lead to better communication between patients and providers and make patients feel more at ease sharing information about their health.
During physical exams, LGBTQ patients may feel uneasy due to past experiences or ongoing dysphoria. To ease their anxiety, healthcare providers should talk with patients about what to expect during the exam, explain why certain parts are necessary, and offer alternatives such as self-inserting a speculum or having a chaperone present during sensitive procedures.
The Lack of Gender-Affirming Care Education
Unfortunately, a major obstacle to quality gender-affirming care for LGBTQ people is the lack of training of healthcare providers. A survey of 399 emergency medicine physicians in the U.S. found that while 88% had experience caring for transgender and gender-nonconforming patients, a staggering 82% had no formal training in this area.2
This lack of education can be traced back to gaps in medical school curricula, which provide little training on LGBTQ cultural and clinical competency. In fact, there is a lack of cultural and clinical education across all levels of education – undergraduate, graduate, residency, or continuing education – in transgender and gender diverse healthcare. This is due to various reasons, such as a lack of faculty knowledge and experience, discomfort with the subject matter, faculty bias, limited space in existing curricula, and a lack of guidance on how to integrate these topics.3
The Unmet Needs for Gender-Affirming Care Training
In a survey of 153 physicians and nurses, the main drivers for seeking gender-affirming care training were to fill a community need and/or having met a transgender patient in a clinical setting who requested care.4 According to this survey, most providers (72.7%) reported self-study of literature and guidelines as the most accessible training opportunity. Other sources of training were workshops at professional conferences (57.3%) and mentorship (41.3%).
However, self-study in this area is not ideal, and survey respondents recommended structured clinical experience with LGBTQ patients as the best training method. In considering scalable solutions to address this need, one approach is to use standardized patients (SPs), which provide real-life experiences for trainees without risking harm to real patients.
In a study that involved students from a range of health disciplines and professions, 93% of students found the experience of working with a simulated transgender patient "useful" or "very useful." The students felt better prepared to care for real transgender patients and were confident in communicating with other healthcare professionals about these patients to optimize interprofessional care.5
SIMclusive is a psychologically safe space to practice inclusive healthcare, where cultural competency training meets human simulation online. SP encounters unlock a deeper level of “learning-by-doing” that encourages reflection and change. This methodology helps providers feel more confident in their patient engagements, while ensuring diverse patient populations feel more confident in their clinicians. If you’d like to learn more about adding the power of SPs to your curriculum, please click here to contact us.
- The National LGBTQIA+ Health Education Center. Affirmative Services for Transgender and Gender-Diverse People: Best Practices for Frontline Health Care Staff. https://www.lgbtqiahealtheducation.org/wp-content/uploads/2020/03/TFIE-40_Best-Practices-for-Frontline-Health-Care-Staff-Publication_web_final.pdf. Accessed Feb. 1, 2023.
- Chisolm-Straker, Makini, et al. "Transgender and Gender-Nonconforming Patients in the Emergency Department: What Physicians Know, Think, and Do." Annals of Emergency Medicine, vol. 71, no. 2, 2018, pp. 183-188.e1.
- Coleman, E., et al. "Standards of Care for the Health of Transgender and Gender Diverse People, Version 8." International Journal of Transgender Health, vol. 23, 2022, S1-S260.
- Stryker, Shanna Duffy, et al. "Considerations on Medical Training for Gender-Affirming Care: Motivations and Perspectives." International Journal of Transgender Health, vol. 21, no. 1, Nov. 2019, pp. 79-88.
- McCave, Emily L et al. "Promoting Affirmative Transgender Health Care Practice Within Hospitals: An IPE Standardized Patient Simulation for Graduate Health Care Learners." MedEdPORTAL: The Journal of Teaching and Learning Resources, vol. 15, Dec. 2019, 10861.