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Jardine L, Edwards C, Janeway H, Krempasky C, Macias‐Konstantopoulos W, Whiteman P, Hsu A. A guide to caring for patients who identify as transgender and gender diverse in the emergency department. J Am Coll Emerg Physicians Open 2024; 5:e13217. [PMID: 38903764 PMCID: PMC11187815 DOI: 10.1002/emp2.13217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/22/2024] Open
Abstract
Through a review of current research, standards of care, and best practices, this paper serves as a resource for emergency physicians (EPs) caring for persons who identify as transgender and gender diverse (T/GD) in the emergency department (ED). Both patient- and physician-based research have identified existent potential knowledge gaps for EPs caring for T/GD in the ED. T/GD have negative experiences related to their gender identity when seeking emergency medical care and may even delay emergency care for fear of discrimination. Through the lens of cultural humility, this paper aims to address potential knowledge gaps for EPs, identify and reduce barriers to care, highlight gender-affirming hospital policies and protocols, and improve the care and experience of T/GD in the ED.
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Affiliation(s)
- Logan Jardine
- Mount Sinai Beth Israel Department of Emergency MedicineNew YorkNew YorkUSA
| | | | - Hannah Janeway
- White Memorial Medical Center/West Los Angeles VAUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | | | - Wendy Macias‐Konstantopoulos
- Center for Social Justice and Health Equity, Department of Emergency MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | | | - Antony Hsu
- Department of Emergency MedicineTrinity Health Ann ArborYpsilantiMichiganUSA
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2
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Primeau CA, Philpott HT, Vader K, Unger J, Le CY, Birmingham TB, MacDermid JC. Knowledge, behaviours, and training related to 2SLGBTQIA+ health education amongst entry-level physiotherapy students in Canada: results of a nationwide, cross-sectional survey. BMC MEDICAL EDUCATION 2023; 23:519. [PMID: 37468895 DOI: 10.1186/s12909-023-04499-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 07/04/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Individuals who identify as 2SLGBTQIA+ report worse health outcomes than heterosexual/cisgender counterparts, in part due to poor experiences with healthcare professionals. This may stem from inadequate 2SLGBTQIA+ health and inclusiveness training in health professional student education. The purpose of the study was to evaluate knowledge, behaviours, and training related to 2SLGBTQIA+ health education and inclusiveness for entry-level physiotherapy students in Canada. METHODS We conducted a nationwide, cross-sectional survey with physiotherapy students from accredited Canadian physiotherapy programs. We administered the survey through Qualtrics and recruited students through targeted recruitment emails and social media posts on Twitter and Instagram between August and December 2021. Survey responses are reported as frequencies (percentage). We also completed multivariable logistic regressions to evaluate associations among question responses related to working with 2SLGBTQIA+ individuals (i.e., communication, feeling prepared and assessment competency). Covariates included training hours (< 10/10 + hours) and 2SLGBTQIA+ identity (yes/no). RESULTS A total of 150 students responded to the survey, with 35 (23%) identifying as 2SLGBTQIA+ . Many students felt confident in communicating effectively with clients who identify as 2SLGBTQIA+ (69%). However, only half (47%) felt comfortable assessing clients who identify as 2SLGBTQIA+ . Routine practice of inclusive behaviours such as using pronouns, considering identities are fluid and a patient's gender identity and/or sexual orientation may shift from one visit to the next, and considering trauma-informed care practices were reported from less than half of the students (< 45%). Around 29% of students reported no 2SLGBTQIA+ training in their physiotherapy program, while 47% reported 0-10 hours, and 24% reported 10 + hours of training. Students with 10 + hours of training had 92% higher odds of feeling competent in assessing 2SLGBTQIA+ clients, compared to those with < 10 hours of training. CONCLUSIONS Entry-level physiotherapy students in Canada show a lack of understanding and awareness for 2SLGBTQIA+ health and inclusive behaviours which can meaningfully impact patient experience. Students report feeling incompetent when working with 2SLGBTQIA+ patients, which may be associated with lack of 2SLGBTQIA+ training in their programs. Greater efforts and attention towards increasing 2SLGBTQIA+ health education and inclusivity in Canadian entry-level physiotherapy programs is critically needed.
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Affiliation(s)
- Codie A Primeau
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada.
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada.
- Bone and Joint Institute, Western University, London, ON, Canada.
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, N6A 3K7, Canada.
| | - Holly T Philpott
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, N6A 3K7, Canada
| | - Kyle Vader
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Janelle Unger
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Christina Y Le
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Trevor B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, N6A 3K7, Canada
| | - Joy C MacDermid
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
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Carreras Tartak JA, Rodriguez G, Goralnick E, Macias-Konstantopoulos WL, Egan DJ. Incorporation of a Case-based Health Equity Curriculum into Morbidity and Mortality Conference. West J Emerg Med 2023; 24:89-93. [PMID: 36602491 PMCID: PMC9897240 DOI: 10.5811/westjem.2022.11.57723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/19/2022] [Indexed: 01/06/2023] Open
Affiliation(s)
- Jossie A. Carreras Tartak
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts,Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Giovanni Rodriguez
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts,Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Eric Goralnick
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | | | - Daniel J. Egan
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts,Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
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Heron SL, Calderon Y, Moll J, Rotoli J, Franks N, Hassan M, Ander D, Brown I, Lewis J. Diversity, equity, inclusion, justice-Are we accountable? Acad Emerg Med 2023; 30:70-73. [PMID: 36420622 DOI: 10.1111/acem.14632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/10/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Sheryl L Heron
- James B. Williams Medical Education Building, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yvette Calderon
- Emergency Medicine, Mount Sinai Beth Israel Hospital, New York, New York, USA
| | - Joel Moll
- Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jason Rotoli
- Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Nicole Franks
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Moji Hassan
- Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
| | - Douglas Ander
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Italo Brown
- Emergency Medicine, Stanford University, Stanford, California, USA
| | - John Lewis
- Emory University School of Medicine, Atlanta, Georgia, USA
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van Heesewijk J, Kent A, van de Grift TC, Harleman A, Muntinga M. Transgender health content in medical education: a theory-guided systematic review of current training practices and implementation barriers & facilitators. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:817-846. [PMID: 35412095 PMCID: PMC9374605 DOI: 10.1007/s10459-022-10112-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 03/19/2022] [Indexed: 06/14/2023]
Abstract
Health disparities faced by transgender people are partly explained by barriers to trans-inclusive healthcare, which in turn are linked to a lack of transgender health education in medical school curricula. We carried out a theory-driven systematic review with the aim to (1) provide an overview of key characteristics of training initiatives and pedagogical features, and (2) analyze barriers and facilitators to implementing this training in medical education. We used queer theory to contextualize our findings. We searched the PubMed/Ovid MEDLINE database (October 2009 to December 2021) for original studies that reported on transgender content within medical schools and residency programs (N = 46). We performed a thematic analysis to identify training characteristics, pedagogical features, barriers and facilitators. Most training consisted of single-session interventions, with varying modes of delivery. Most interventions were facilitated by instructors with a range of professional experience and half covered general LGBT+-content. Thematic analysis highlighted barriers including lack of educational materials, lack of faculty expertise, time/costs constraints, and challenges in recruiting and compensating transgender guest speakers. Facilitators included scaffolding learning throughout the curriculum, drawing on expertise of transgender people and engaging learners in skills-based training. Sustainable implementation of transgender-health objectives in medical education faces persistent institutional barriers. These barriers are rooted in normative biases inherent to biomedical knowledge production, and an understanding of categories of sex and gender as uncomplicated. Medical schools should facilitate trans-inclusive educational strategies to combat transgender-health inequities, which should include a critical stance toward binary conceptualizations of sex and gender throughout the curriculum.
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Affiliation(s)
- Jason van Heesewijk
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1131, 1081 HX, Amsterdam, The Netherlands.
| | - Alex Kent
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Tim C van de Grift
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1131, 1081 HX, Amsterdam, The Netherlands
- Departments of Plastic, Reconstructive and Hand Surgery and of Psychosomatic Gynecology and Sexology, Amsterdam University Medical Center, Location VUmc and AMC, Amsterdam, The Netherlands
| | - Alex Harleman
- Centre for Sexual Health, GGD Amsterdam, Amsterdam, The Netherlands
| | - Maaike Muntinga
- Department of Ethics, Law and Humanities, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
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Westafer LM, Freiermuth CE, Lall MD, Muder SJ, Ragone EL, Jarman AF. Experiences of Transgender and Gender Expansive Physicians. JAMA Netw Open 2022; 5:e2219791. [PMID: 35767255 PMCID: PMC9244607 DOI: 10.1001/jamanetworkopen.2022.19791] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/16/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Although LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority) physicians experience bias in the workplace, there is a paucity of data on the experiences of physicians who identify specifically as transgender and/or gender expansive (TGE; gender expansive is an umbrella term encompassing individuals and gender identities that may exist beyond the binary framework [eg, may include nonbinary, genderqueer, and agender individuals]). Objectives To explore the professional experiences of TGE physicians, identify barriers to inclusion, and highlight stakeholder-derived strategies that promote an inclusive workplace. Design, Setting, and Participants This qualitative study informed by semistructured interviews was conducted among 24 TGE physicians in the US from April 1 to December 31, 2021. The sample of TGE physicians was recruited using convenience and snowball sampling. Interviews were recorded and transcribed. Using thematic analysis, at least 2 members of the research team performed blinded coding of each transcript, in an iterative process. Main Outcomes and Measures Data collection and thematic analysis examining themes of physicians' experiences. Results Among 24 physicians (mean [SD] age, 39 [1.4] years) interviewed, 8 (33%) self-identified as transgender women, 7 (29%) as transgender men, 4 (17%) as nonbinary, 3 (13%) as transgender and nonbinary, and 2 (8%) as genderqueer. Prominent themes of the interviews included emotional distress as a result of transphobia, dominance of a rigid binary gender paradigm, and structural and institutional factors that are associated with psychological and physical safety and feelings of isolation as a TGE physician. Clear steps of affirmation were identified that could mitigate the emotional stressors, including signs of safety, active allyship, and mentorship by other TGE physicians. Conclusions and Relevance In this qualitative study, TGE physicians reported facing both overt and subtle biases associated with their identity and gender presentation. Participants also noted several interpersonal and structural factors that mitigate the effect of these biases.
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Affiliation(s)
- Lauren M. Westafer
- Department for Healthcare Delivery and Population Science, University of Massachusetts Chan Medical School–Baystate, Springfield
- Department of Emergency Medicine, University of Massachusetts Chan Medical School–Baystate, Springfield
| | - Caroline E. Freiermuth
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michelle D. Lall
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Sarah J. Muder
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Eleanor L. Ragone
- Department of Emergency Medicine, University of Massachusetts Chan Medical School–Baystate, Springfield
| | - Angela F. Jarman
- Department of Emergency Medicine, University of California, Davis, Sacramento
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Hsiang E, Ritchie AM, Lall MD, Driver L, Moll J, Sonn B, Totten VY, Williams DB, McGregor AJ, Egan DJ. Emergency care of LGBTQIA+ patients requires more than understanding the acronym. AEM EDUCATION AND TRAINING 2022; 6:S52-S56. [PMID: 35783082 PMCID: PMC9222885 DOI: 10.1002/aet2.10750] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/06/2021] [Accepted: 11/21/2021] [Indexed: 06/15/2023]
Abstract
Emergency physicians (EPs) frequently deliver care to members of the LGBTQIA+ community in the emergency department. This community suffers from many health disparities important to understand as part of comprehensive care, and these disparities are infrequently discussed in emergency medicine education. Previous data also suggest a need for broader education to increase the comfort of EPs caring for LGBTQIA+ patients. A group of content experts identified key disparities, opportunities for expanded education, and strategies for more inclusive care of LGBTQIA+ patients.
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Affiliation(s)
- Elaine Hsiang
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Amanda M. Ritchie
- Departments of Emergency Medicine and Internal MedicineLouisiana State UniversityNew OrleansLouisianaUSA
| | - Michelle D. Lall
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Lachlan Driver
- Department of Emergency MedicineHarvard Affiliated Emergency Medicine ResidencyMass General BrighamBostonMassachusettsUSA
| | - Joel Moll
- Department of Emergency MedicineVCU School of MedicineVCU HealthRichmondVirginiaUSA
| | | | | | - Dustin B. Williams
- Department of Emergency MedicineUT‐Southwestern Medical CenterDallasTexasUSA
| | - Alyson J. McGregor
- Department of Emergency MedicineDivision of Sex and Gender in Emergency MedicineWarren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Daniel J. Egan
- Department of Emergency MedicineHarvard Affiliated Emergency Medicine ResidencyMass General BrighamBostonMassachusettsUSA
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