MedicalResearch.com Interview with:
Richard E. Greene, MD, FACP
Medical Director, Bellevue Adult Primary Care Center
Assistant Professor, NYU School of Medicine
Associate Program Director, Primary Care Residency Program
Director, Gender and Health Education, Office of Diversity Affairs, NYU School of Medicine, OUTList
Medical Director, CHIBPS, The Center for Health, Identity, Behavior and Prevention Studies
VP of Membership and Development, GLMA-Health Professionals Advancing LGBT Equality
MedicalResearch.com: What is the background for this study?
Response: Transgender individuals face complex health disparities and have historically been mistreated and even denied care in medical settings. As a provider in New York City, I saw how this affected my trans patients, resulting in mistrust of the health care system, resulting in negative health outcomes. This sparked my interest in improving medical education to serve the needs of trans patients. It’s important to teach medical students and residents that they are not just treating a set of symptoms, they are working with a individuals with complex lived experiences who deserve compassionate care.
I found with traditional didactic methods, like lectures, learners smiled and nodded in agreement, but when faced with a patient who was transgender, they would stammer and feel uncomfortable with aspects of the cases that were specific to transgender patients, from pronouns to hormones.
Residents should be prepared to treat transgender patients not only with dignity, but also in medically appropriate ways. Without exposure to the transgender community, it’s difficult for providers to decipher their trans patients’ health care needs and contextualize them within a care plan.
In order to provide a low stakes environment for residents to practice these skills, we developed an OSCE focused on a transgender woman with health care needs specific to her transition. The goal of the case was to discuss the patient’s medical concerns while also taking into consideration her goals around her hormone therapy and surgical interests.
MedicalResearch.com: What are the main findings?
Response: While many of our residents felt comfortable working with a transgender patient and could rely on good communication skills to get through the visit and put the patient at ease generally, only a quarter of were able to effectively engage with our standardized patient around her transition-specific care needs. The utilization of this case identified a curricular gap that we are now looking to correct.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: More than anything, our findings exemplify the discomfort of medical professionals in asking direct questions, in an appropriate way, about transgender patients’ medical history and health needs.
The use of simulation with transgender standardized patients is effective in creating a low stakes simulation environment for residents to practice working with the transgender population.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Working with one trans patient does not effectively prepare students for the wide range of health care needs within the transgender community.
In the future, we would like to infuse our curriculum, with both medical students and residents with several cases that include trans patients in a variety of cases, to allow students to develop critical thinking skills.
– Teaching cases to train faculty
– Spiral cases, that become more complex as a learner develops from a medical student to a resident and beyond into faculty development
MedicalResearch.com: Is there anything else you would like to add?
Response: Of note, working with transgender identified standardized patients is essential to provide an authentic experience for learners. We met with members of the trans community to vet the medical and psychosocial content of the case. If no actors who identify as transgender are available, community members can be trained to act as standardized patients.
Offering an opportunity to practice these skills leads to meaningful debriefs and self-reflection that will improve trans patient care in the future.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Transgender actors effective in teaching residents to provide respectful and effective care
By Richard E. Greene, MD (co-authors: Hanley KH, Cook TE, Gillespie C, Zabar SR)
June 15 2017 in the Journal of Graduate Medical Education.
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.