From the Standardized Patient Program (C.A.B.), Medical Education Research Unit (E.J.N., L.A.W.), Department of Undergraduate Medical Education, University of Louisville School of Medicine; Health Promotion and Behavioral Sciences (R.M.C.), University of Louisville School of Public Health and Information Sciences; and LGBT Center Health Sciences Campus (A.E.W.), University of Louisville, Louisville, KY.
Simul Healthc. 2021 Dec 1;16(6):e151-e158. doi: 10.1097/SIH.0000000000000532.
A provider's ability to translate knowledge about transgender health to affirming patient care is key to addressing disparities. However, standardized patient (SP) programs have little published guidance for gender-affirming care or addressing disparities experienced by transgender and nonbinary patients.
Between 2018 and 2019, we invited all 208 accredited US and Canadian medical schools to participate in a study to determine how gender minorities are represented in SP encounters. Responding programs (n = 59, response rate = 28%) that represented patients with diverse gender identities were invited to complete semistructured interviews about SP case content, impact, and barriers to this work. Discussions were analyzed using a modified grounded theory method.
Fifty nine of 208 eligible programs (response rate = 28.3%) completed our survey and 24 completed interviews. More than half of programs used gender minority SPs (n = 35, 59.3%). More than half of the programs also reported portraying gender minority cases (n = 31, 52.5%). Interviewees described how effective SP simulation required purposeful case development, engaging subject matter experts with lived experience, and ensuring psychological safety of gender minority SPs. Barriers included recruitment, fear of disrespecting gender minority communities, and transphobia. Engaging gender minorities throughout case development, training, and implementation of SP encounters was perceived to reduce bias and stereotyping, but respondents unanimously desired guidance on best practices on SP methodology regarding gender identity.
Many programs have established or are developing SP activities that portray gender minority patients. Effective SP simulation hinges on authenticity, but the decisions around case development and casting vary. Specifically, programs lack consensus about who should portray gender minority patients. This research suggests that input from gender minority communities both to inform best practices at the macro level and in an ongoing advisory capacity at the program level will be essential to teach gender-affirming care.
医疗服务提供者将 transgender 健康知识转化为支持患者护理的能力对于解决差异至关重要。然而，标准化患者（SP）计划对于性别肯定护理或解决 transgender 和非二进制患者所经历的差异几乎没有发布的指导。
在 2018 年至 2019 年期间，我们邀请了所有 208 所美国和加拿大的认证医学院参加一项研究，以确定性别少数群体在 SP 遭遇中的代表性。邀请了代表具有不同性别认同的患者的回应计划（n = 59，回应率 = 28%）完成有关 SP 案例内容、影响和开展这项工作的障碍的半结构化访谈。使用改进的扎根理论方法对讨论进行分析。
59 个符合条件的计划中的 59 个（回应率 = 28.3%）完成了我们的调查，24 个完成了访谈。超过一半的计划使用了性别少数群体的 SP（n = 35，59.3%）。超过一半的计划还报告了性别少数群体案例（n = 31，52.5%）。受访者描述了有效的 SP 模拟需要有目的的案例开发、让具有实际经验的主题专家参与，并确保性别少数群体 SP 的心理安全。障碍包括招募、担心不尊重性别少数群体社区以及跨性别恐惧症。受访者一致认为，在 SP 遭遇的案例开发、培训和实施过程中让性别少数群体参与，可减少偏见和刻板印象，但他们一致希望在 SP 方法的性别认同方面获得最佳实践指南。
许多计划已经建立或正在开发描绘性别少数群体患者的 SP 活动。有效的 SP 模拟取决于真实性，但围绕案例开发和选角的决策各不相同。具体来说，计划在谁应该描绘性别少数群体患者方面缺乏共识。这项研究表明，来自性别少数群体社区的意见对于在宏观层面上告知最佳实践以及在计划层面上提供持续的咨询意见至关重要，这将是教授性别肯定护理的关键。
