International Journal of Healthcare Simulation

Background:

Recent interest in the United States addressing Lesbian, Gay, Bisexual, Transgender (LGBT) healthcare issues, particularly obstacles faced by transgender individuals, has resulted in newly developed programming addressing these concerns. Training students and faculty on nuances of LGBT patients, with a specific focus on transgender patients, is critical if outcomes for this population are to improve. Data show 23% of survey respondents avoided seeing a doctor when needed, fearing mistreatment as a transgender person ^[1]. This programming also addresses the anxiety of healthcare practitioners when interacting with members of a marginalized community which frequently stems from inadequate training and infrequent direct experience with patients from that community.

Aim:

The aims of the study were to increase empathy and awareness of LGBT healthcare needs and to improve communication and patient/practitioner relationships through experiential learning with live transgender standardized patients.

Method/design:

The programmes developed address fundamentals for healthcare professionals about serving LGBT patients: inclusivity, rapport, effective communication without creating anxiety or offense, language to avoid, and other practical knowledge including various surgeries and gender-affirming care available to transgender individuals. Initial panel discussions with members of the LGBT community have proved very effective in covering realities faced by transgender patients. Implementation of Teaching OSCEs (Objective Structured Clinical Exams) utilizing transgender individuals applies gained knowledge from lectures and discussions. It is critical for learners to experience working with an actual transgender standardized patient to effectively simulate encounters. Only a person from a marginalized community can accurately portray unique experiences affecting that particular community. Advanced medical training has also been developed including training for forensic examiners.

Implementation outline:

These programmes include an LGBT didactic presentation, followed by a moderated panel (conducted virtually or in-person) of transgender individuals from varied backgrounds to share personal experiences receiving healthcare. Trainees are encouraged to ask panellists questions regarding concerns on proper communication, inquire about experiences in receiving gender-affirming care and discuss how to improve healthcare for transgender patients. Subsequently, trainees have the opportunity to participate in scenarios scripted and led by transgender standardized patients (SPs) or Trans Teaching Associates (TTAs). These scenarios can be conducted virtually, focussing on interview/history taking and communication skills, which makes global reach possible. In-person hands-on OSCEs can further assist trainees by providing opportunities to visualize trans anatomy. Learner feedback on improved understanding and empathy has been overwhelmingly positive, proving the necessity of providing training for learners in the care and treatment of transgender patients.