Department of Family and Community Medicine at Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo MI.
Department of Family Medicine at the Medical College of Georgia, Augusta, GA.
Fam Med. 2021 Sep;53(8):676-683. doi: 10.22454/FamMed.2021.509974.
Transgender persons face many barriers to accessing health care, including identifying a knowledgeable physician. Medical schools have made curricular changes addressing cultural competence in transgender medicine, but changes are inadequate to graduate physicians competent in gender-affirming health care. The aim of this study was to assess the current state of education on the comprehensive health care of transgender patients, including gender-affirming health care (GAH) strategies (hormone therapy, surgical interventions) in US and Canadian family medicine clerkships (FM clerkships) in addition to the beliefs and actions of the directors making those curricular decisions.
Questions regarding transgender education within FM clerkships were included in the 2018 Council of Academic Family Medicine's Educational Research Alliance (CERA) survey of family medicine clerkship directors. The online survey was distributed via email invitation to 128 US and 16 Canadian FM clerkship directors between June 21, 2018 and August 4, 2018.
Seventy-two percent (68/94) of FM clerkship directors agreed transgender health care should be a required part of the medical school curriculum. Sixty-six percent report active advocacy within their institutions for increased curricular time devoted to transgender health care. Fifty-six percent (53/94) treat transgender patients in their own clinical practice, but just 26% agreed they were comfortable teaching transgender health care to medicals students. While the presence of transgender patients within the clinical practice did not have a significant impact on FM clerkship directors' comfort teaching this subject, having transgender friends or acquaintances did.
FM clerkships are primed for inclusion of comprehensive transgender and GAH education in their curriculum. Increasing comfort of FM clerkship directors in teaching this subject area by providing accessible curriculum may encourage further uptake of this content into FM clerkships.
跨性别者在获得医疗保健方面面临诸多障碍，包括找到知识渊博的医生。医学院校已经针对跨性别医学中的文化能力进行了课程改革，但这些改革还不足以培养出在性别肯定性保健方面有能力的医生。本研究旨在评估美国和加拿大家庭医学实习（FM 实习）中跨性别患者全面医疗保健（包括性别肯定性保健（GAH）策略[激素治疗、手术干预]）的教育现状，以及制定这些课程决策的主任的信念和行动。
在 2018 年家庭医学教育研究联盟（CERA）对家庭医学实习主任的调查中，包括 FM 实习中关于跨性别教育的问题。该在线调查于 2018 年 6 月 21 日至 8 月 4 日通过电子邮件邀请向 128 名美国和 16 名加拿大 FM 实习主任分发。
72%（68/94）的 FM 实习主任同意跨性别保健应该成为医学院课程的必修部分。66%的人报告在他们的机构内积极倡导增加专门用于跨性别保健的课程时间。56%（53/94）在自己的临床实践中治疗跨性别患者，但只有 26%的人同意他们能够为医学生教授跨性别保健。尽管临床实践中有跨性别患者并不会显著影响 FM 实习主任教授这一主题的舒适度，但他们有跨性别朋友或熟人则会有影响。
FM 实习为在其课程中纳入全面的跨性别和 GAH 教育做好了准备。通过提供易于获取的课程来提高 FM 实习主任在教授这一主题领域的舒适度，可能会鼓励进一步将这一内容纳入 FM 实习。
