Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA.
Soc Sci Med. 2024 Jun;351:116983. doi: 10.1016/j.socscimed.2024.116983. Epub 2024 May 15.
The aim of the study is to identify the barriers to gender-affirming health care education for providers from the perspectives of patients and providers.
A qualitative study based on grounded theory was conducted. Participants included transgender and gender diverse (TGD) patients seeking care, as well as resident physicians and attending physicians involved in care of patients seeking gender-affirming care. Semi-structured interviews were conducted over Zoom application and telephone calls. The study was conducted in Boston, Massachusetts, USA from November 2022 until February 2023.
Nine attending physicians, eight resident physicians, and fifteen patients were interviewed. Attending physicians noted barriers to include lack of formal training in medical school and residency, lack of adequate opportunities for faculty development to appropriately train resident physicians, lack of opportunities for trainees to provide dedicated clinical care, lack of community engagement initiatives, and need for additional training centered on cultural sensitivity and inclusivity. Resident physicians noted a lack of robust and longitudinal didactic curriculum, deficiency in dedicated clinical time, and inadequacy in interprofessional training as major barriers to their training. They noted that they generally felt unprepared to care for TGD patients. Patients' barriers included difficulty building trust in medical providers' knowledge and skills, being addressed with incorrect names and pronouns, lacking a sense of belonging as a patient, as well as difficulty in arranging care due to lack of a centralized care system.
Barriers to gender-affirming education include lack of adequate and formal training, lack of professional development opportunities, inadequacy in a multidisciplinary approach to treatment and education, and inadequacy in cultural and sensitivity training. Findings of this qualitative study based on interviews may help facilitate addressing such barriers through creation of routine lecture-based didactic opportunities for providers, investment in faculty development, creation of gender-affirming clinics, providing opportunities for trainees to provide longitudinal care to TGD patients, creation of interdisciplinary training modules, community engagement, and implementation of a multidisciplinary care model, which may help improve gender-affirming care in the long-run.
本研究旨在从患者和提供者的角度确定阻碍提供者提供性别肯定保健教育的因素。
这是一项基于扎根理论的定性研究。参与者包括寻求护理的跨性别和性别多样化（TGD）患者，以及参与照顾寻求性别肯定护理的患者的住院医师和主治医生。通过 Zoom 应用程序和电话进行半结构化访谈。该研究于 2022 年 11 月至 2023 年 2 月在美国马萨诸塞州波士顿进行。
共采访了 9 名主治医生、8 名住院医生和 15 名患者。主治医生指出的障碍包括：医学院和住院医师培训中缺乏正式培训、缺乏足够的教员发展机会以适当培训住院医师、缺乏学员提供专门临床护理的机会、缺乏社区参与举措，以及需要更多以文化敏感性和包容性为中心的培训。住院医师指出，缺乏强大且长期的专题教学课程、缺乏专门的临床时间以及缺乏专业间培训是他们培训的主要障碍。他们指出，他们普遍觉得自己没有准备好照顾 TGD 患者。患者的障碍包括难以建立对医疗服务提供者知识和技能的信任、被错误地称呼姓名和代词、缺乏作为患者的归属感，以及由于缺乏集中的护理系统而难以安排护理。
性别肯定教育的障碍包括缺乏足够和正式的培训、缺乏专业发展机会、治疗和教育缺乏多学科方法，以及文化和敏感性培训不足。基于访谈的这项定性研究的结果可能有助于通过为提供者创建常规基于讲座的教学机会、投资于教员发展、创建性别肯定诊所、为学员提供为 TGD 患者提供长期护理的机会、创建跨学科培训模块、社区参与和实施多学科护理模式来促进解决这些障碍，这可能有助于从长远来看改善性别肯定护理。
