Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts; Stanford University School of Medicine, Stanford, California.
Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts; UMass Chan Medical School, Worcester, Massachusetts.
J Surg Educ. 2023 Dec;80(12):1826-1835. doi: 10.1016/j.jsurg.2023.08.007. Epub 2023 Aug 30.
Transgender and gender diverse (TGD) individuals in the U.S. face significant healthcare disparities, which can be further exacerbated by providers' unfamiliarity with this population's specific needs. ACGME currently does not have requirements for gender-affirming surgery (GAS) in the residency programs of surgical specialties that are responsible for providing this care. This systematic review evaluates gender-affirming care (GAC) and GAS training in surgical residency programs in the U.S. through the analysis of survey respondent data.
Six databases (PubMed, Embase, Web of Science and Scopus, Cochrane Library and Google Scholar) were searched in December 2022 and May 2023. The search process ultimately yielded 22 survey-based studies, published between 2015 and 2023, with responses from 3020 respondents (2582 trainees and/or attending physicians, 438 program directors).
Six different surgical specialties were the focus of included studies, and common questions revolved around GAS training availability, comfort in treating TGD patients, and the importance of GAS in graduate surgical education (GSE). Less than half of trainees indicated that they received some form of previous GAC or GAS training, and less than half of program directors indicated that their residency or fellowship program offered such training.
While comfort levels around treating TGD patients ranged, the studies indicated an overall perceived importance of GAS training. These findings highlight the need to incorporate GAS training into graduate surgical education to improve access to and quality of care for TGD patients.
美国的跨性别和性别多样化（TGD）个体面临着严重的医疗保健差距，而提供者对这一人群特定需求的不熟悉可能会进一步加剧这种差距。ACGME 目前并没有要求外科专业住院医师培训计划中包含性别肯定手术（GAS），而这些计划负责提供这种护理。本系统评价通过分析调查受访者的数据，评估了美国外科住院医师培训计划中的性别肯定护理（GAC）和 GAS 培训。
2022 年 12 月和 2023 年 5 月在六个数据库（PubMed、Embase、Web of Science 和 Scopus、Cochrane 图书馆和 Google Scholar）中进行了搜索。搜索过程最终产生了 22 项基于调查的研究，发表时间在 2015 年至 2023 年之间，共有 3020 名受访者（2582 名学员和/或主治医生，438 名项目主任）做出了回应。
六项不同的外科专业是纳入研究的重点，常见的问题围绕着 GAS 培训的可用性、治疗 TGD 患者的舒适度以及 GAS 在研究生外科教育（GSE）中的重要性。不到一半的学员表示他们接受过某种形式的先前 GAC 或 GAS 培训，不到一半的项目主任表示他们的住院医师或研究员计划提供这种培训。
尽管治疗 TGD 患者的舒适度有所不同，但这些研究表明，总体上认为 GAS 培训很重要。这些发现强调了将 GAS 培训纳入研究生外科教育的必要性，以改善 TGD 患者获得护理的机会和提高护理质量。
