TRANSforming Medical Education

By Chelsea Fullerton, M.Ed.

Katie Couric’s recent interview with transgender model Carmen Carrera and Orange is the New Black star Laverne Cox—and the controversy that quickly followed—calls attention to a rarely discussed subject in the medical community, yet one that intersects with medicine and patient care intricately: the lives and experiences of transgender people.

Transgender persons are individuals who do not identify with the sex they were assigned at birth. Transgender people may fall outside societal expectations of what it means to be a man or a woman, transgress gender categories, or identify outside of the traditional gender binary altogether.

Though the transgender community has experienced gains in social visibility in recent years, homelessness, discrimination, and transphobic violence are constant realities for many transgender individuals. Additionally, significant health disparities present many challenges for transgender persons that have not been addressed by the medical community at large; these disparate health outcomes are heightened for transgender people of color and those who are low-income.

Notably, the Department of Health and Human Services announced last month that it would re-examine the ban on gender-related surgeries for transgender individuals with Medicare coverage.  Thus, it is likely that transgender-related issues in medicine will become more widely recognized and thoroughly addressed in the years to come.

Despite this promising development, transgender persons face disparities not only in access to care but also in the quality of that care.  Disproportionate numbers report being refused necessary treatment, receiving sub-optimal care, or having to educate their medical providers about their bodies.

It is essential that medical schools take great care in ensuring that the next generation of physicians is not only aware of the existence of transgender people but prepared to serve them effectively. Educational experiences in this area cannot simply be limited to lectures; they must also include meaningful and intentional interactions with members of the transgender community.

One promising practice to promote transgender awareness and competency in medical education is through simulated patient encounters. As part of a new course at New York University School of Medicine entitled the “Gender and Health Selective,” the Office of Diversity Affairs piloted a simulated transgender patient encounter for first-year medical students with the assistance of the New York Simulation Center for the Health Sciences.

Prior to the simulations, the medical students in the course received a preparatory lecture on taking a patient’s sexual history but were given limited information on the simulation experience itself. Students were only told that the patients identified as transgender and had agreed to discuss their sexual history. The students then spoke with transgender patient actors in a simulated clinical interaction, covering both transition- and non-transition-related content during the ten-minute conversation.

The actors—who also identified as transgender—were given extensive training on the case by the course director and course coordinator, and responded to struggling students with openness and grace. After each simulation, the actors debriefed with the students one-on-one and offered feedback based on their own experiences.

Both the med students and the actors reported that the simulation was a positive and constructive interaction that would assist in their future patient and provider interactions. Based on the success of this initiative, a more advanced version of the case was used for the Health Disparities Concentration, a course for clinical-level students who desire to focus their work in disparity reduction and health equity.

It is through engaging educational experiences such as these that biases are challenged, prejudice is dismantled, and true change occurs. By providing students with interactive learning opportunities, issues that were once only academic become tangible and three-dimensional, with the lessons learned impacting them long thereafter.

Equalizing health quality and access for transgender patients requires educators and physicians alike to commit to relentlessly pursuing innovative, effective learning methods.  This manner of engagement will cultivate physicians who are truly inclusive and fully prepared to serve their patients.

To connect with the Office of Diversity Affairs at New York University School of Medicine, visit our LGBTQ Resources page or find us on Facebook. For additional resources on transgender patient care, visit the National LGBT Health Education Center.

ChelseaFullertonChelsea Fullerton is a social justice educator, queer activist, and student affairs practitioner currently serving as a program coordinator in the Office of Diversity Affairs at NYU School of Medicine. She has worked with organizations on both local and national levels creating engaging ways to educate and mobilize others on LGBTQ awareness and allyship, anti-racist practice, and a variety of other social justice issues. In her current role, Chelsea works to integrate health disparity content throughout the medical school curriculum and coordinates LGBTQ inclusion initiatives in both the medical school and medical center. She can be reached at Chelsea.Fullerton@nyumc.org. The initiative above is also described in the forthcoming May 2014 issue of Medical Education (“Transgender History-Taking through Simulation Activity”).

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