Sandre Anthony R, Sidhu Bikrampal, Awad Sara
Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.
Division of Endocrinology, Department of Medicine, Queen's University, Kingston, Canada.
BMC Med Educ. 2025 Jan 2;25(1):4. doi: 10.1186/s12909-024-06567-9.
Transgender or gender diverse patients present with health care needs as it relates to gender-affirming care, psychosocial support, and medication access. Considering this, medical education strategies should be implemented to train the next generation of Internal Medicine physicians in this area.
We adopted Kern's six step approach to curriculum design to create and implement an educational curriculum for teaching Internal Medicine residents about transgender patients at a single academic institution in Canada (Kern et al, Curriculum Development for Medical Education, 2009). Semi-structured individual interviews of Internal Medicine faculty and residents were conducted to understand the needs for delivering content related to transgender health during residency training. The results informed the development and implementation of an academic half day session and objective structured clinical examination (OSCE). Prior to the academic half day, participants were sent three journal articles highlighting key concepts related to the medical care of transgender patients (CMAJ 193:E562-5, 2021; BMC Public Health 15:525, 2015; Bourns A, Guidelines for gender-affirming primary care with trans and non-binary patients, 2019). A pre- and post-intervention numeric assessment form evaluated residents' comfort in providing gender-affirming care across five domains: general care, communication, hormone therapy, side effects, and prevention strategies. Faculty raters, equipped with training in transgender health, evaluated performance in an OSCE on key transgender health issues. Both the clinical case and OSCE scenario were developed via an iterative review process by study investigators.
Residents reported an increase in subjective comfort of providing gender-affirming care (p = 0.042) following delivery of the academic half day content. The OSCE demonstrated that most residents achieved "acceptable" or "exemplary" ratings across multiple domains.
We implemented a Transgender Medicine curriculum for Internal Medicine residents in the Canadian context. The curriculum improved resident comfort in providing gender-affirming care including basic knowledge on gender-affirming hormone therapy, and health promotion activities (e.g., screening for and management of chronic disease, discussion of sexual health, community supports, peer engagement). Further assessment is needed to determine whether these skills are retained in clinical practice.
跨性别或性别多样化患者存在与性别肯定性医疗、心理社会支持及药物获取相关的医疗保健需求。鉴于此，应实施医学教育策略，以培训下一代内科医生在该领域的能力。
我们采用克恩的课程设计六步法，为加拿大一所学术机构的内科住院医师创建并实施了一门关于跨性别患者教学的教育课程（克恩等人，《医学教育课程开发》，2009年）。对内科学系教师和住院医师进行了半结构化个人访谈，以了解住院医师培训期间提供与跨性别健康相关内容的需求。这些结果为一个学术半天课程和客观结构化临床考试（OSCE）的开发与实施提供了参考。在学术半天课程之前，向参与者发送了三篇期刊文章，突出了与跨性别患者医疗护理相关的关键概念（《加拿大医学协会杂志》193:E562 - 5，2021年；《BMC公共卫生》15:525，2015年；伯恩斯A，《跨性别和非二元性别患者性别肯定性初级护理指南》，2019年）。一份干预前后的数字评估表评估了住院医师在五个领域提供性别肯定性护理方面的舒适度：一般护理、沟通、激素治疗、副作用和预防策略。具备跨性别健康培训的教师评估者在OSCE中对关键跨性别健康问题的表现进行评估。临床病例和OSCE场景均由研究调查人员通过迭代审查过程制定。
在提供学术半天课程内容后，住院医师报告在提供性别肯定性护理方面的主观舒适度有所提高（p = 0.042）。OSCE表明，大多数住院医师在多个领域获得了“可接受”或“优秀”的评分。
我们在加拿大背景下为内科住院医师实施了一门跨性别医学课程。该课程提高了住院医师在提供性别肯定性护理方面的舒适度，包括性别肯定性激素治疗的基础知识以及健康促进活动（如慢性病筛查与管理、性健康讨论、社区支持、同伴参与）。需要进一步评估以确定这些技能在临床实践中是否得以保留。
