L.N. Petrey is a fourth-year medical student, University of Louisville School of Medicine, Louisville, Kentucky; ORCID: http://orcid.org/0000-0002-8406-9181 .
E.J. Noonan is assistant professor, Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, Kentucky; ORCID: http://orcid.org/0000-0002-7361-8229 .
Acad Med. 2022 Nov 1;97(11S):S107-S116. doi: 10.1097/ACM.0000000000004926. Epub 2022 Aug 9.
Despite recent advocacy for transgender and nonbinary (TGNB) health competencies in medical education, there is little guidance on how to represent diverse gender identities for clinical skills training. Published literature is one of few resources available to inform educators' decisions, so this study aims to summarize how medical education scholarship portrays TGNB identities in patient simulation.
This scoping review used PRISMA guidelines with search strings encompassing diverse gender identities and patient simulation. This search was completed in July 2021, and all years of publication were included. The authors completed a 3-tiered review to identify relevant studies and then extracted data to summarize how TGNB patients were portrayed and training outcomes.
After screening 194 total articles, 44 studies met the criteria for full review. Of these, 22 studies involved TGNB simulated patient cases. Within these, 15 (68%) reported the specific gender identities represented in the patient case, revealing mostly binary transgender identities. Sixteen studies (73%) reported the gender identities of all actors who portrayed the patient. The identities of all patients and actors matched in only 10 articles (45%), indicating that most programs portray TGNB identities with cisgender or unspecified standardized patients. Nearly all studies reported desirable learner outcomes. Several noted the advantage of authenticity in recruiting TGNB actors and the need to achieve more accurate representation of TGNB patients.
Educators are increasingly representing TGNB identities in clinical skills training. These results show a lack of nonbinary representation and discrepancies between TGNB patient cases and standardized patient identities. These data also suggest that simulation programs need and desire better recruitment strategies within TGNB communities. Because TGNB communities are not a monolith, reporting out and analyzing gender identities of simulation cases and people hired to portray TGNB patients helps ensure that TGNB care is taught effectively and respectfully.
尽管最近在医学教育中倡导 transgender 和 nonbinary（TGNB）健康能力，但对于如何为临床技能培训呈现多样化的性别认同，几乎没有指导。已发表的文献是为教育工作者的决策提供信息的少数资源之一，因此本研究旨在总结医学教育文献如何在患者模拟中描述 TGNB 身份。
本范围综述使用 PRISMA 指南，搜索字符串包含各种性别认同和患者模拟。该搜索于 2021 年 7 月完成，包括所有出版年份。作者完成了三级审查，以确定相关研究，然后提取数据以总结 TGNB 患者的描绘方式和培训结果。
在筛选出 194 篇文章后，44 篇研究符合全文审查标准。其中，22 项研究涉及 TGNB 模拟患者病例。在这些研究中，有 15 项（68%）报告了患者病例中代表的特定性别认同，主要是二元 transgender 身份。16 项研究（73%）报告了扮演患者的所有演员的性别认同。在仅有 10 篇文章（45%）中，患者和演员的身份完全匹配，这表明大多数项目都用顺性别或未指定的标准化患者来描绘 TGNB 身份。几乎所有研究都报告了理想的学习者结果。一些人指出，在招募 TGNB 演员方面，真实性具有优势，并且需要更准确地代表 TGNB 患者。
教育工作者越来越多地在临床技能培训中呈现 TGNB 身份。这些结果表明，非二元性代表不足，以及 TGNB 患者病例和标准化患者身份之间存在差异。这些数据还表明，模拟计划需要并希望在 TGNB 社区内制定更好的招聘策略。由于 TGNB 社区不是一个整体，报告和分析模拟案例和受雇描绘 TGNB 患者的人的性别认同有助于确保有效地和尊重地教授 TGNB 护理。
