McPhail Deborah, Rountree-James Marina, Whetter Ian
Community Health Sciences, Max Rady College of Medicine, University of Manitoba.
Max Rady College of Medicine, University of Manitoba.
Can Med Educ J. 2016 Oct 18;7(2):e70-e78. eCollection 2016 Oct.
Transgender people (those people whose sex at birth does not "match" their felt gender identity) are a priority group for healthcare as they experience high rates of discrimination and related illnesses. Despite this, there is a trend of poor healthcare access for trans people due, in large part, to the denial of care on the part of physicians. A small body of literature is beginning to suggest that this denial of care may be due to a lack of physician knowledge as well as, in some cases, to transphobia. There is a dearth of research in Canada, however, exploring whether and/or how knowledge gaps create barriers to quality care, and whether medical education can attend to these gaps while and through addressing gender normativity.
To fill these gaps in the literature, we undertook a qualitative study with 30 trans identified people and 11 physicians (=41) in Winnipeg, Manitoba. Methods included semi-structured individual interviews and focus groups. Data were transcribed and analyzed with NVivo qualitative data software using iterative methods.
An overwhelming finding of this study was a lack of physician knowledge, as reported both by trans people and by physicians, that resulted in a denial of trans-specific care and also impacted general care. Transphobia was also identified as a barrier to quality care by both trans people and physicians. Physicians were open to learning more about trans health and healthcare.
The findings suggest a pressing need for better medical education that exposes students to basic skills in trans health so that they can become competent in providing care to trans people. This learning must take place alongside anti-transphobia education. Based on these findings, we suggest key recommendations at the close of the paper for providing quality trans health curriculum in medical education.
跨性别者（即出生时的性别与其所认同的性别不“匹配”的人）是医疗保健的重点群体，因为他们遭受着高比例的歧视及相关疾病。尽管如此，跨性别者获得医疗保健的机会仍呈不佳趋势，这在很大程度上是由于医生拒绝提供治疗。一小部分文献开始表明，这种拒绝治疗可能是由于医生缺乏相关知识，在某些情况下也是由于恐跨症。然而，加拿大缺乏相关研究，未探讨知识差距是否以及如何对优质护理造成障碍，以及医学教育能否在解决性别规范性问题的同时弥补这些差距。
为填补文献中的这些空白，我们在曼尼托巴省温尼伯市对30名跨性别者和11名医生（共41人）进行了一项定性研究。方法包括半结构化的个人访谈和焦点小组讨论。数据进行了转录，并使用NVivo定性数据软件通过迭代方法进行分析。
本研究一个压倒性的发现是，跨性别者和医生都表示医生缺乏相关知识，这导致了对跨性别者特定护理的拒绝，也影响了一般护理。恐跨症也被跨性别者和医生都认定为优质护理的障碍。医生愿意更多地了解跨性别健康和医疗保健。
研究结果表明迫切需要更好的医学教育，让学生掌握跨性别健康的基本技能，以便他们能够胜任为跨性别者提供护理的工作。这种学习必须与反恐跨症教育同步进行。基于这些发现，我们在论文结尾提出了在医学教育中提供优质跨性别健康课程的关键建议。
