R.E. Greene is associate professor of internal medicine and director, Health Disparities Education, Office of Diversity Affairs, New York University Grossman School of Medicine, New York, New York; ORCID: https://orcid.org/0000-0001-8618-7723.
G. Blasdel is research associate, Department of Urology, New York University Grossman School of Medicine, New York, New York; ORCID: https://orcid.org/0000-0002-5431-6540.
Acad Med. 2020 Dec;95(12S Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments):S156-S162. doi: 10.1097/ACM.0000000000003704.
To describe the effect of transgender health-related objective structured clinical examination (THOSCE) case exposure on learner activation regarding gender-affirming care.
A modified grounded theory approach was applied to identify the educational value of THOSCE cases. Focus groups with current and former primary care internal medicine residents who participated in THOSCE cases were conducted in 2018-2019. Transcripts were analyzed and coded until saturation to identify themes.
Eighteen (72%) eligible learners participated in the focus groups. Themes were identified relating to gender-affirming care, and modified grounded theory analysis was used as a framework to organize the themes into 4 stages of learner activation: (1) believing the learner role is important, (2) having the confidence and knowledge necessary to take action, (3) taking action to maintain and improve one's skills, and (4) staying the course even under stress.
Residents were grateful for the opportunity to practice the skills involved in transgender health in a simulation. Many felt unprepared and were concerned about how they were perceived by the standardized patient and faculty. Residents identified feeling more comfortable with gender-affirming language in the inpatient setting, which may provide an opportunity for learning in the future. Residents identified the psychosocial skills of gender-affirming care as more directly relevant while biomedical aspects of gender-affirming care seemed less accessible to residents, given the lack of outpatient experience. The authors propose a staged approach to teaching the skills of gender-affirming care using simulation to address learners of all levels.
描述 transgender 健康相关客观结构化临床考试（THOSCE）病例暴露对学习者在性别肯定护理方面的积极性的影响。
采用修正的扎根理论方法来确定 THOSCE 病例的教育价值。2018 年至 2019 年期间，对参加过 THOSCE 病例的现任和前任初级保健内科住院医师进行了焦点小组讨论。对焦点小组的记录进行了分析和编码，直到达到饱和，以确定主题。
18 名（72%）符合条件的学习者参加了焦点小组。确定了与性别肯定护理相关的主题，并使用修正的扎根理论分析作为框架，将主题组织成学习者积极性的 4 个阶段：（1）相信学习者角色很重要，（2）有必要的信心和知识采取行动，（3）采取行动来维持和提高技能，（4）即使在压力下也坚持学习。
住院医师很高兴有机会在模拟中练习与跨性别健康相关的技能。许多人感到准备不足，并担心他们在标准化患者和教师眼中的形象。住院医师发现，在住院环境中使用性别肯定语言更加自在，这可能为未来的学习提供机会。住院医师认为性别肯定护理的心理社会技能更直接相关，而性别肯定护理的生物医学方面似乎对住院医师来说不太容易获得，因为缺乏门诊经验。作者提出了一种分阶段的方法，使用模拟来教授性别肯定护理技能，以满足各级学习者的需求。
