The healthcare needs of people with diverse backgrounds, gender identities, and ages may differ, but every individual requires access to the same basic services, such as annual physical exams and treatment for common illnesses. Transgender patients, however, continue to face a number of barriers to basic healthcare that members of other populations do not. Now, some medical schools are taking proactive measures to ensure their students are prepared to provide competent, compassionate healthcare for this often-marginalized population.
[Above: Second-year medical students at the University of Louisville meet with a member of the LGBTQ community to discuss health needs.]
Transgender Healthcare Needs
“Transgender patients face challenges in all aspects of healthcare,” says Amy Holthouser, MD, associate dean for medical education at the University of Louisville School of Medicine. “Although the patient may be seeing subspecialists for gender-affirming care, there is a need for support from general practitioners who understand how to gather information and provide care for general health needs.”
The most significant challenges for transgender patients seeking care are not related to gender-affirming treatments, such as hormone therapy or surgical procedures, but to accessing even the most basic of services. Often, transgender patients face issues as soon as they walk in the door of a doctor’s office. Signing in at the front desk with a name that doesn’t match the person’s physical appearance might raise questions from the staff, or paperwork that doesn’t include gender designations matching their identity can make them feel unwelcome, says Holthouser. Being aware of these simple obstacles can help healthcare professionals create a more welcoming, inclusive environment.
Physicians should also recognize that transgender patients often experience high levels of abuse, bullying, and isolation, all of which put them at greater risk for anxiety, depression, substance abuse disorders, and other mental health concerns, Holthouser says. Doctors should understand that particular healthcare needs — such as screening for cancers that typically affect either men or women — may change as the patient undergoes hormone therapy or changes his or her anatomy.
Transgender-specific content was incorporated into the University of Louisville School of Medicine curriculum in 2015, making it the first medical school in the U.S. to fully integrate content addressing the 2014 Association of American Medical College competencies to care for LGBTQ individuals. Rather than establish separate courses that focus on transgender, lesbian, or gay issues, the information is blended into existing courses — something which Holthouser believes helps to reduce the stigma around marginalized patient populations.
For example, the school’s course on hormonal therapy now covers its use for all populations and conditions, whether that is menopause, cancer, growth issues, or gender-affirming treatment. “We discuss the risks, benefits, and complications for each use so that our students are comfortable having conversations with patients undergoing hormone therapy and so that they are aware of potential complications with treatment,” says Holthouser.
The school also offers an annual, full-day symposium that begins with a panel of physicians and community members who discuss best practices in transgender healthcare. Following the panel presentation, healthcare providers and transgender community leaders meet to network, identify gaps in care, and discuss steps needed to improve medical services for this population.
Case Western Reserve University School of Medicine
First-year medical students at Case Western Reserve University School of Medicine (CWRU SOM) in Cleveland, Ohio, learn how to interact with sexual minority and gender-nonconforming patients in two two-hour seminars that cover transgender terminology and barriers to care, says Kathy Cole-Kelly, co-director of the school’s Foundations of Clinical Medicine Office and a professor of family medicine.
While the school has offered a seminar in LGBTQ healthcare for the past 10 years, a session focused specifically on transgender healthcare was added three years ago. During the session’s panel discussion, members of the transgender community provide a firsthand perspective of their struggles accessing basic services. Afterwards, all students participate in clinical case scenarios where they must interact with a transgender patient; this experience helps uncover hidden biases that could affect how they communicate with and provide treatment for these individuals, says Cole-Kelly.
“The seminars make the less familiar more familiar and focus on how we can be more sensitive to patient perceptions and concerns,” says Molly Howland, a CWRU SOM student who will graduate in spring 2018. “The stories of the panel participants have a lasting effect and have made me think about how I will organize my office — from the front desk to the bathrooms.”
University of California San Francisco School of Medicine
At the University of California, San Francisco (UCSF) School of Medicine, students are taught to be competent — both culturally and clinically — in providing care for transgender patients, says John Davis, PhD, MD, associate dean for curriculum.
“We weave the information throughout all courses by introducing key concepts, including appropriate terminology when talking with transgender patients, as well as specific clinical issues,” says Davis. “We also discuss improvement of communications with patients so that students will be prepared to critically evaluate how intake forms, medical assessment forms, and conversations between physician and patient are presented to ensure that the patient experience is positive.”
Beyond coursework, UCSF medical students are able to work directly with transgender patients through clinical clerkships that serve diverse patient populations.
“We are also working with residency and fellowship programs to integrate transgender issues throughout the programs, just as we’ve done with our medical school curriculum,” says Davis. The school also offers continuing education credits for practicing physicians who attend a variety of lectures and seminars addressing transgender health issues.
Training medical students and practitioners to provide better care for transgender patients is an imperative, Davis says. “By teaching students to be aware of issues that affect specific patient populations, we prepare them to provide culturally competent care, which improves their ability to care for all patients,” he says.
Being able to provide expert care for the transgender population is a significant advancement for America’s healthcare system and a momentous gain in the struggle for transgender rights. By ensuring that the next generation of physicians can provide compassionate, knowledgeable care for these patients, schools like UofL, CWRU, and UCSF are setting the standard for modern, inclusive medical education.
Sheryl Jackson is a contributing writer for INSIGHT Into Diversity. This article ran in our May 2018 issue.