Abstract
Clinical education programs are positioned to train future health care professionals to provide excellent health care for transgender and gender-diverse patients. The purpose of this resource, Advancing Inclusion of Transgender and Gender-Diverse Identities in Clinical Education: A Toolkit for Clinical Educators, is to facilitate critical inquiry among clinical educators regarding their approach to teaching about sex, gender, the historical and sociopolitical context of transgender health, and how to prepare their students to apply standards of care and clinical care guidelines set forth by national and international professional organizations.
Introduction
Gender-affirming health care is limited by a lack of adequate training for students in clinical education programs; the majority of medical students receive little or no training specific to transgender health (Arthur et al., 2021; Institute of Medicine, 2011; Obedin-Maliver et al., 2011; Tollemache et al., 2021). Leading organizations including the American Association of Medical Colleges, the Institute of Medicine, and the Joint Commission have called on medical educators to adapt their curricula to address the health needs of lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients (Hollenbach et al., 2017; Institute of Medicine, 2011; The Joint Commission, 2011). While most attention has been paid to medical education, training for students in clinical education programs across all health care disciplines is requisite to creating a pipeline of gender-affirming clinicians for addressing the holistic needs of transgender and gender-diverse patients.
Clinical education programs are positioned to train future health care professionals to provide excellent health care for transgender and gender-diverse patients. The purpose of this resource, Advancing Inclusion of Transgender and Gender-Diverse Identities in Clinical Education: A Toolkit for Clinical Educators, is to facilitate critical inquiry among clinical educators regarding their approach to teaching about sex, gender, the historical and sociopolitical context of transgender health, and how to prepare their students to apply standards of care and clinical care guidelines set forth by national and international professional organizations.
This toolkit is designed for educators in medical and allied health clinical education programs. Clinical educators may be from the disciplines of medicine, nursing, social work, psychology, psychiatry, therapy, occupational therapy, physical therapy, athletic training, speech, and nutrition and dietetics, among others.
Description Of Toolkit Development
The Toolkit Authors and Illustrator
The toolkit was authored by transgender educators and an interprofessional collaborative of researchers, clinicians, and clinical educators whose work centers on promoting the health and well-being of the transgender community from the Transgender Health Collaborative at Saint Louis University in St. Louis, Missouri. Our respective disciplines include family medicine; medical family therapy; nutrition and dietetics; and speech language pathology. We sought to capture diversity within the transgender and gender-diverse community through our mix of authors, including transgender female, transgender male, and non-binary authors, though we recognize certain perspectives were not captured, including those of certain racial and ethnic groups (American Indian or Alaska Native, Asian, Native Hawaiian or Pacific Islander), older adults, and those residing in different regions of the country.
The toolkit was designed and illustrated by a queer artist who specializes in joyful, inclusive imagery. The illustrations aim to convey inclusion with respect to gender, race, ethnicity, ability, and body size when depicting patients, health care providers, and students (i.e., page 17), as well as humility and patient-centeredness, such as the illustration where the health care provider is depicted below the patient with warm and open body language (page 4). Other illustrations capture the written content through symbolism, such as the knitted lines of the transgender flag to express the tensions and complexities of working with students who express resistance to learning (page 19).
The Toolkit Development and Dissemination Process
The toolkit development process included three stages from December 2021 through November 2022. The first stage involved a listening session with transgender and gender-diverse leaders from two community-based organizations in the St. Louis, Missouri region. The attendees were either employed by community-based organizations in a leadership capacity or were students working with the organizations to fulfill practicum requirements for their clinical programs. One person was not able to attend the listening session and provided written feedback. The listening session followed a guided discussion with three question prompts: (1) What would you consider to be best practices for clinical educators thinking about inclusion of transgender and gender-diverse identities in their curricula? (2) How can clinical educators create safe and inclusive spaces for their own transgender and gender-diverse students? (3) What else do you want clinical educators to be thinking about? This resulted in a robust discussion about the state of transgender health care and attendees’ own lived experiences. Portions of the discussion moved toward what attendees wished medical and allied health professions should know, which the first author guided towards how that could be translated backwards into the training of medical and allied health professional students. Given the richness of the conversation, the attendees were invited to participate as authors on the toolkit, four of whom agreed.
The second stage involved draft writing by the toolkit authors. The first author led this process by developing an outline and inviting feedback; authors provided suggestions for additional content such as the history of the World Professional Association for Transgender Health (WPATH). The first author assigned sections to authors based on their expertise areas, who then developed a draft of the content. All authors reviewed the toolkit and provided feedback. Discourse occurred asynchronously using the comments function of the document, such as how to frame the vision for excellent transgender health care and how to work with students who express resistance to learning. The conversation was civil, productive, and open to diverse viewpoints. All authors agreed on the final draft of the toolkit.
The third stage involved design and illustration by the aforementioned artist. This too was an iterative process where the artist suggested content to encapsulate some of the more complex topics (i.e., working with students who expressed resistance to learning) and the first author provided feedback. All authors were invited to provide feedback on the illustrated version; no changes were requested.
Methods of dissemination include professional conferences in our respective disciplines (Nutrition and Dietetic Educators and Preceptors 2022 Spring Meeting, Society of Teachers of Family Medicine 2023 Annual Spring Conference) and a workshop for the faculty and staff at our home institution, Saint Louis University. Dissemination also includes open-access publication in a scientific journal article to allow for access by the general public.
Toolkit Evaluation and Future Research
Future evaluation is needed to explore the utility of the toolkit by the intended audience. The authors envision this evaluation to include clinical educators who we can recruit from our respective disciplines. We anticipate a mixed-methods approach may be ideal to triangulate findings and explore future directions (Merriam & Tisdell, 2016). Ultimately, future research can explore the perspectives of students in clinical education programs and the quality of care provided to transgender patients and clients.
Key Features of the Toolkit
Key features of the toolkit include:
A robust literature review of existing transgender health educational interventions
A vision for what excellent transgender health care can look like
Seven pragmatic strategies for clinical educators to consider
Touchpoints for sample curricula in medicine, psychotherapy and counseling, and nutrition and dietetics
Considerations for simulation-based learning and tensions about who should play transgender and gender-diverse patients
A discussion on working with students who express resistance to learning about transgender health
Additional resources for all health professions, plus those specific to medicine, mental health, athletic training, nutrition and dietetics, speech language pathology, nursing, physical therapy, and occupational therapy
Conclusion
By implementing evidence-based and community-driven strategies, clinical educators can train their students to provide excellent health care for their future transgender and gender-diverse patients. This toolkit provides clinical educators with pragmatic strategies and considerations for how best to prepare their students to care for a gender-diverse patient population. The authors of this toolkit aimed to center transgender voices and perspectives on how best to achieve this aim. Future projects or programming can establish or strength partnerships between clinical educators in academic settings and educators from the community they intend to serve.
Supplemental Material
sj-pdf-1-hpp-10.1177_15248399231183643 – Supplemental material for Advancing Inclusion of Transgender and Gender-Diverse Identities in Clinical Education: A Toolkit for Clinical Educators
Supplemental material, sj-pdf-1-hpp-10.1177_15248399231183643 for Advancing Inclusion of Transgender and Gender-Diverse Identities in Clinical Education: A Toolkit for Clinical Educators by Whitney Linsenmeyer, Katie Heiden-Rootes, Theresa Drallmeier, Rabia Rahman, Emily Buxbaum, Willow Rosen, Beth Gombos and Ashton Otte in Health Promotion Practice
Footnotes
Authors’ Note:
The authors are grateful for the collaboration between members of the transgender community in St. Louis and the Transgender Health Collaborative at Saint Louis University. This project was funded by an Inclusive Practice Grant from the Saint Louis University Reinert Center for Transformative Teaching and Learning.
References
Supplementary Material
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