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Vijapura C, Tobler J, Wahab RA, Smith ML, Brown AL, Pickle S, Stryker SD, Spalluto LB, England E, Kanfi A. Resident Attitudes and Experiences with a Novel Radiology-based Transgender Curriculum: A Qualitative Study. Acad Radiol 2024; 31:294-303. [PMID: 36914502 DOI: 10.1016/j.acra.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 03/16/2023]
Abstract
RATIONALE AND OBJECTIVES Transgender persons often experience healthcare disparities due to lack of provider knowledge. With increasing gender diversity awareness and prevalence of gender-affirming care, radiologists-in-training need to be aware of the unique health considerations for this patient population. Radiology residents have limited exposure to dedicated teaching on transgender medical care and imaging during training. Development and implementation of a radiology-based transgender curriculum can help close this gap in radiology residency education. The aim of this study was to explore radiology resident attitudes and experiences with a novel radiology-based transgender curriculum, guided by the conceptual framework of reflective practice. MATERIALS AND METHODS A qualitative approach was employed using semi-structured interviews to explore resident perspectives of a curriculum covering transgender patient care and imaging over 4 monthly sessions. Ten residents at the University of Cincinnati radiology residency participated in interviews consisting of open-ended questions. Interviews were audiotaped, transcribed, and thematic analysis was conducted across all responses. RESULTS Four themes emerged through the existing framework: 1) impactful/memorable aspects; things learned; increased awareness; and suggestions/feedback. Prominent subthemes included patient panel and stories, physician experts sharing knowledge and experiences, link to radiology and imaging, novel concept, gender-affirming surgeries and anatomy, appropriate radiology reporting, and patient interactions. CONCLUSION Radiology residents found the curriculum to be an effective novel educational experience that was previously unaddressed during their training. This imaging-based curriculum can be further adapted and implemented in a variety of radiology curricular settings.
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Affiliation(s)
- Charmi Vijapura
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Juliana Tobler
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Rifat A Wahab
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - M Lynne Smith
- College of Education, Criminal Justice, and Human Services, Cincinnati Ohio
| | - Ann L Brown
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sarah Pickle
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Shanna D Stryker
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lucy B Spalluto
- Department of Radiology, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Veterans Health Administration-Tennessee Valley Health Care System, Geriatric, Research, and Education Clinical Center (GRECC), Nashville, Tennessee
| | - Eric England
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alisa Kanfi
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Jeffrey S, Ashton L, Ferfolja T, Armour M. Transgender and gender diverse people with endometriosis: A perspective on affirming gynaecological care. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241251974. [PMID: 38742674 PMCID: PMC11095187 DOI: 10.1177/17455057241251974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/29/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024]
Abstract
Transgender and gender diverse people presumed female at birth experience gynaecological conditions, such as chronic pelvic pain at elevated rates, estimated to impact between 51% and 72% of this population, compared to rates of up to 26.6% in cisgender women. The negative impact of these conditions is likely amplified due to limited access to safe and affirming healthcare. Despite this high prevalence rate, there is limited research investigating the prevalence, presentation or management options for trans and gender diverse people with endometriosis. Cisgender women with endometriosis report barriers to accessing care, with lengthy times to diagnosis and limited treatment options available. However, barriers for trans and gender diverse individuals are enhanced by physician bias and lack of education in gender-affirming care. This is reflected in stories of discrimination and denial of basic healthcare. A healthcare environment built on the presumption that gynaecological patients are women, others trans and gender diverse patients, which can result in avoidance of needed medical care. A lack of knowledge of gender-affirming care alongside healthcare provider bias highlights a need for gender-affirming care and bias reduction training in undergraduate healthcare provider curricula. Research to date assessing current curriculum in Australia and Aotearoa (New Zealand) shows limited inclusion of lesbian, gay, bisexual, trans, queer, intersex, asexual and other related identities content as a whole with gender-affirming care being among the least-frequently addressed topics. This review will detail barriers to accessing gender-affirming healthcare specific to gynaecology, interweaving the experiences of a non-binary individual seeking access to gender-affirming endometriosis care.
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Affiliation(s)
- Sam Jeffrey
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | | | - Tania Ferfolja
- School of Education, Western Sydney University, Penrith, NSW, Australia
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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Voultsos P, Papana A, Alexandri S, Zymvragou CE. Transgender Attitudes and Beliefs Scale-Greek (TABS-Gr) version: translation and initial evaluation of psychometric properties among medical students. BMC MEDICAL EDUCATION 2023; 23:704. [PMID: 37759217 PMCID: PMC10523621 DOI: 10.1186/s12909-023-04666-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Transgender people face significantly greater discrimination and health disparities in health care settings than cisgender people. The role of education in eliminating this phenomenon has been increasingly recognized by many medical schools. However, transgender health content is sparse or lacking in the medical curricula of many countries. METHOD This study was designed to validate the Greek version of the Transgender Attitudes and Beliefs Scale (TABS-Gr). The study adopted a cross-sectional, comparative-descriptive research design. Participants (N = 203) were contacted through online recruitment and invited to complete an anonymous web-based survey. The data were collected between December 2022 and February 2023. RESULTS The overall reliability of the TABS-Gr questionnaire was high (Cronbach's α = 0.961, p. from Hotelling's T-squared test < 0.000). High Cronbach's alpha values were estimated for the three subscales, with α = 0.958 for Interpersonal Comfort, α = 0.906 for Gender Beliefs, and α = 0.952 for Human Values. Hotelling's T-squared test confirmed that all items on the scale had the same mean (p < 0.001 for all subgroups). Explanatory factor analysis (EFA) demonstrated adequate fit. Convergent and discriminant validity were validated based on the estimated correlations. The three-factor structure of the Greek TABS version was confirmed. The mean total score was 155.95 (SD = 30.63), indicating that medical students had a moderately positive attitude towards transgender people. Participants showed significantly less biased (more tolerant, positive) attitudes towards transgender people on the Interpersonal Comfort (IC) and Human Value (HV) subscales than on the Sex/Gender Beliefs (SGB) subscale. A demographic comparison was conducted and demonstrated a correlation between scores and sociodemographics, except for place of origin. A statistically significant increase in the total mean score was estimated for women compared to men. CONCLUSION The overall psychometric findings provide some evidence to support the validity of the Greek version of the TABS. However, we call for further validation research in Greek medical schools. Since our claims for validity are based in part on an exploratory factor analysis, a future confirmatory factor analysis (CFA) is part of our call for further validation research. While the results of this study are mostly in line with the results of previous research, some nuances were identified. These results may inform educators, medical school curricula and education policy-makers.
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Affiliation(s)
- Polychronis Voultsos
- Laboratory of Forensic Medicine & Toxicology (Division: Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, Thessaloniki, GR 54124, Greece.
| | - Angeliki Papana
- School of Mathematics, Aristotle University, University Campus, Thessaloniki, GR 54124, Greece
| | - Stella Alexandri
- Laboratory of Forensic Medicine & Toxicology (Division: Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, Thessaloniki, GR 54124, Greece
| | - Christina-Erato Zymvragou
- Laboratory of Forensic Medicine & Toxicology (Division: Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, Thessaloniki, GR 54124, Greece
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Besse M, Signerski-Krieger J, Engelmann H, Fink N, Methfessel I, Belz M. Community-supported teaching on the topic of transgender identity in undergraduate medical education - a pilot project. GMS JOURNAL FOR MEDICAL EDUCATION 2023; 40:Doc58. [PMID: 37881525 PMCID: PMC10594031 DOI: 10.3205/zma001640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/30/2023] [Accepted: 07/18/2023] [Indexed: 10/27/2023]
Abstract
Introduction and objectives Future physicians are insufficiently prepared for the topic of transgender identity during their studies. Relevant courses during undergraduate medical education are heterogeneous and not widely established within the curricula. At our university, we investigated if students' knowledge of transgender identity could be increased through medical specialist teaching and teaching delivered by representatives of the trans* community (community-supported teaching). Methods During summer semester 2021 (SS21), the knowledge level on transgender identity of 134 medical students in their fifth clinical semester was evaluated (phase 1). In addition, knowledge gain on gender incongruence through the module "psychiatry" was retrospectively surveyed across two dimensions: 1. diagnostic criteria, 2. treatment/care. During winter semester 2021/22 (WS 21/22), a 90-minute seminar on transgender identity was held either community-supported or by medical specialists (phase 2). Following the psychiatry exam, a re-evaluation was carried out by 115 students (phase 3). Results The students in SS21 did not feel sufficiently educated in the topic of transgender identity through their studies, but rated the relevance of the topic for their later profession as high. Learning gain improved after the introduction of the seminar in WS21/22 compared to the previous semester (both dimensions p<.001). Community-supported and specialist teaching achieved equivalent results. Conclusion One 90-minutes seminar led to a significant learning gain regarding the topic of transgender identity. Community-supported teaching is a promising way to impart knowledge in a qualified manner: Medical faculties should use this form of teaching to convey established knowledge to students in future curricula.
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Affiliation(s)
- Matthias Besse
- University Medical Center Göttingen, Clinic for Psychiatry and Psychotherapy, Göttingen, Germany
| | - Jörg Signerski-Krieger
- University Medical Center Göttingen, Clinic for Psychiatry and Psychotherapy, Göttingen, Germany
| | - Hannah Engelmann
- Trans*Counseling Göttingen c/o Queer Center Göttingen, Göttingen, Germany
| | - Né Fink
- Trans*Counseling Göttingen c/o Queer Center Göttingen, Göttingen, Germany
| | - Isabel Methfessel
- University Medical Center Göttingen, Clinic for Psychiatry and Psychotherapy, Göttingen, Germany
| | - Michael Belz
- University Medical Center Göttingen, Clinic for Psychiatry and Psychotherapy, Göttingen, Germany
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Woods AL, Raskin ER, Keller DS. TransCare Initiative: An Institutional Knowledge-to-Action Project for Surgery and Gender Equity Education. JOURNAL OF SURGICAL EDUCATION 2023; 80:853-863. [PMID: 36931912 DOI: 10.1016/j.jsurg.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/13/2023] [Accepted: 02/18/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND The transgender/gender nonconforming (TGNC) population is growing exponentially, but surgeon education has not advanced accordingly. Our objective was to assess department-wide understanding, awareness, and comfort in treating TGNC patients and identify specific gaps in education and training needs. METHODS A survey covering 4 domains (personal perceptions; prior healthcare training/experience; comfort providing care; barriers to access) regarding TGNC patients was distributed to surgery faculty and trainees at an urban referral center. The survey contained 24 5-point Likert scale and 6 multiple choice demographic items. There was a 4-week response window. Descriptive statistics assessed the relative frequency of responses. The main outcome measures were the gaps and variation in each domain. RESULTS There was a 47.59% (89/187) response rate and split evenly between trainees and attendings. Over half (51.21%, n = 44) reported formal TGNC training, mainly in medical school (27.5%, n = 22). Most knew (72.41%, n = 63) and had experience caring for TGNC patients (74.71%, n = 65). There was disparity understanding general concepts, with disagreement on definitions (8.99%, n = 8) and gender choice (14%, n = 12). Most reported comfort with communication, and could initiate conversations on pronouns (75.6%, n = 65) and gender identity (71.7%, n = 65). Over 40% could not complete a comprehensive history and admitted discomfort performing physical exams. Despite this, 88.51% (n = 77) felt they could provide an adequate level of care. Most respondents recognized unique TGNC health risks (91.86%, n = 79) and access barriers (82.76%, n = 72), including providers' lack of TGNC cultural competency (82.76%, n = 72). CONCLUSION Disparities existed across all domains needed for inclusive TGNC surgical care. Respondents were aware of unique health needs and barriers to access. Provider self-perceived experience did not match the knowledge and skill required to provide optimal care for TGNC patients.
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Affiliation(s)
- Alexis L Woods
- Department of Surgery, University of California at Davis Medical Center, Sacramento, California.
| | | | - Deborah S Keller
- General Surgery, Marks Colorectal Surgical Associates, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
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Streed CG, Navarra M, Klein J. Advancing undergraduate medical education regarding the care of transgender and gender Diverse persons and communities. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:306-308. [PMID: 36435909 PMCID: PMC9743931 DOI: 10.1007/s40037-022-00732-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Carl G Streed
- Center for Transgender Medicine & Surgery, Boston Medical Center, 02118, Boston, MA, USA.
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 02118, Boston, MA, USA.
| | - May Navarra
- Center for Transgender Medicine & Surgery, Boston Medical Center, 02118, Boston, MA, USA
| | - Jorden Klein
- Division of Emergency Medicine, Department of Medicine, University of Toronto, M5S 1A1, Toronto, Ontario, Canada
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Tamrat J. "Trans-forming" dental practice norms: Exploring transgender identity and oral health implications. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2022; 56:131-139. [PMID: 36451990 PMCID: PMC9674002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE This narrative review explores current research to broaden understanding and awareness of the transgender experience while identifying oral health needs and proposing strategies of inclusivity to optimize oral health outcomes. METHODS A comprehensive electronic literature search was conducted in the following online databases: PubMed, Google Scholar, CINAHL, and Education Source. The search yielded 35 articles with a wide range of study designs and methodologies. RESULTS & DISCUSSION Several themes emerged from the literature, including psychosocial oral health implications, barriers to oral health care, inclusive dental practice strategies, and cultural competence of oral health providers. CONCLUSION The transgender population experiences many social and health disparities that stem from discrimination. Systemic inequalities, coupled with other barriers to care, have significant oral health implications for this population. Implementing inclusivity strategies and gaining awareness of the transgender experience will contribute to better oral health outcomes in this community.
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Affiliation(s)
- Jessica Tamrat
- Alumna, Dental Hygiene Degree Program, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada. This literature review was written in partial fulfillment of the requirements for the BDSc(DH) program at the University of British Columbia.
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