Researchers at New York University (NYU) developed a simulated training experience for primary care residents to learn more about the unique health needs of transgender patients. Findings, published in the Journal of Graduate Medical Education, highlight training outcomes and the value in learning through transgender community partnerships.
“Qualitative feedback from learners indicated that even those who had baseline knowledge of the basics of care for transgender patients found that the opportunity to interact with a patient in a low-stakes setting increased learners’ comfort during future real-world encounters.”
Richard Greene and his team of researchers call attention to commonly reported experiences of transgender patients who confront discrimination and substandard care when seeking medical services. Some propose that these blunders are a result of providers lacking adequate knowledge, training, and experience. The intervention designed by Greene and colleagues seeks to address this directly by providing a simulated experience in which residents interact with a transgender patient.
The team hired transgender actors who presented as women with high blood pressure and high blood potassium, and who were interested in undergoing an orchiectomy, the surgical removal of one or both testicles. In this case, the patient was presented as taking medication to treat high blood pressure, and estradiol, a form of estrogen.
After meeting with the patient, the primary care residents were tasked with developing a treatment plan for managing her high blood pressure and high blood potassium in a way that was collaborative and respectful to her values surrounding hormone treatment. Following the training, they were asked to complete a survey assessing their preparedness, perceived performance, and challenges.
The transgender actor and a faculty member also rated and provided feedback on the performance of each of the 23 residents who underwent the training. Criteria for their performance were developed from transgender health guidelines and specifics pertinent to this case but focused particularly on core communication skills, patient satisfaction, and case-specific skills.
“Learning objectives included asking patients their name, pronouns, and gender identity; discussing sexuality, sexual activity, and associated risks; and avoiding assumptions about hormone use or surgical treatments.”
When communication score and patient satisfaction score were compared to those in nine control cases, results demonstrated no significant difference between them. However, frequencies of specific treatment examples and qualitative data illuminate noteworthy findings. Despite not attaining statistical significance, both communication score and patient satisfaction score were higher after the training.
“Feedback helped residents identify learning needs, including how to ask directly about transition, appropriate terminology, how to admit lack of knowledge to a patient, and putting aside preconceptions about a patient’s identity.”
Additional outcomes indicated that 61% of residents made the patient feel comfortable and directly asked about her gender identity. While 58% of residents correctly identified the high blood pressure medication as causing dangerously high potassium levels, only 25% engaged in a discussion on possible remedies for high potassium. About 58% of the residents collected details on medically relevant information surrounding the patient’s transition. Finally, only 39% of residents offered the patient treatment for high blood pressure.
The residents’ performances demonstrated that good communication skills may serve as a method to overcome errors in clinical judgment surrounding transgender-specific cases. Yet, the authors note that the importance of implementing training programs such as this one is underscored by the fact that most residents did not directly inquire about the patient’s gender identity or long term goals of care.
Their observations lead the authors to encourage the development and implementation of training programs similar to this one, emphasizing the value in having representation from transgender individuals.
“We advocate for the use of transgender actors to play transgender roles, as their insights about patient experience are imperative to provide appropriate feedback.”
Greene, R. E., Hanley, K., Cook, T. E., Gillespie, C., & Zabar, S. (2017). Meeting the Primary Care Needs of Transgender Patients Through Simulation. Journal of Graduate Medical Education, 9(3), 380-381. (Link)
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