Development and Implementation of a Transgender Medicine Curriculum for Internal Medicine residents

Abstract Background: Two-spirit, lesbian, gay, bisexual, transgender, queer, intersex, and asexual (2SLGBTQIA+) individuals present with unique health care needs and are known to have higher rates of chronic disease and substance misuse disorders. Further, patients who identify as transgender or gender non-conforming present with explicit health care needs as it relates to addressing gender dysphoria, psychosocial support, and medication access. Considering this, medical education strategies should be implemented to train the next generation of Internal Medicine physicians to be competent in this area. Methods: We adopted Kern’s six step approach to curriculum design to create and implement an educational curriculum for teaching Internal Medicine residents the necessary skills to care for transgender patients (1). Semi-structured individual interviews of Internal Medicine Faculty and Residents were conducted to understand the needs for delivering content related to transgender health during residency training. The results informed the development and implementation of an academic half day (AHD) session and objective structured clinical examination (OSCE). Prior to the AHD, participants were sent three journal articles highlighting key concepts related to the medical care of transgender patients (2–4). A numeric assessment form was distributed to participants before and after the AHD which provided subjective assessment of comfort providing gender-affirming care. Results: There was a significant increase in subjective comfort providing gender-affirming care (p = 0.042) following delivery of the AHD content. During the OSCE station, formal grading was conducted across five educational domains of transgender health. Most residents scored “acceptable” or “exemplary” on a global assessment scale by faculty raters. Both the clinical case and OSCE scenario were developed via an iterative review process by study investigators. Conclusions: We implemented a novel Transgender Medicine curriculum for Internal Medicine residents. Following completion of the curriculum, residents have demonstrated competency in communication skills, basic knowledge on gender-affirming hormone therapy, and health promotion activities (e.g., screening for and management of chronic disease, discussion of sexual health, community supports, peer engagement).