The transgender community in Colorado faces significant disparities, especially around mental health. However, a transgender-inclusive provider is associated with improved mental and physical health and health behaviors. Further population-level research and provider education on transgender health should to be incorporated into national efforts to eliminate health disparities.

This sexual history taking module engages medical students in discussion and practice with standardized patients in taking an inclusive (orientation-and gender-neutral) sexual history. An inclusive sexual history is critical to providing comprehensive patient care and an environment supportive of lesbian, gay, bisexual, and transgender (LGBT) patients. This case was developed for first-and second-year medical students who have had basic communication skills training. This session was designed to be delivered in one 40-minute large-group session followed by three 1hour-long small-group sessions (with one third of the class participating in each session) with standardized patients. Four students per group is optimal. Faculty training should take approximately 30 minutes prior to the session as well as participation in the large-group session. The materials associated with this publication include guidelines for faculty facilitators and students to prepare them for the large-group discussion and small-group practice sessions with standardized patients. Also included are four standardized patient cases, a slide presentation using an audience response system for the large-group session, and an evaluation form. The average response to "Overall, this session was effective in improving my sexual history taking skills" has been out of 5. Our communication needs assessment has shown a statistically significant improvement in those reporting increased importance, confidence, and performance of a sexual history between the first and second year of medical school (before and after the curriculum). In addition, students reported performing more components of the sexual history after the session. This sexual history taking module has been incorporated into our Foundations of Doctoring communications curriculum and has been rated as highly effective by learners. Performing an inclusive sexual history is critical to providing comprehensive patient care as well as providing an environment supportive of LGBT patients. Educational Objectives By the end of this module, the learner will be able to: 1. Describe the rationale and steps for performing a gender-and orientation-neutral sexual history. 2. Recognize the breadth of expression of sexuality and gender identity. 3. Practice performing a gender-and orientation-neutral sexual history.

Despite increased media attention to transgender/gender non-binary people, access to care remains a major health disparity. Several multidisciplinary gender clinics involve children/adolescents seeing multiple providers during the same visit. However, adult transgender clinics are more primary care-based with navigators guiding patients across specialties. Few adult multidisciplinary clinics exist where providers care for transgender patients during a single visit. We know of no published models of care housed within the endocrine clinic, which can serve as a gender-inclusive space where providers/staff have expertise in hormone physiology. Our Integrated Transgender Program launched in September 2017 to provide culturally responsive, multidisciplinary care to transgender adults within a single endocrine clinic visit. School of Medicine faculty in endocrinology, psychiatry, gynecology, internal medicine, and plastic/reconstructive surgery, provide care in this now biweekly collaboration. We also do provider/staff education to increase knowledge within our community. From September 2017 to October 2018, we had 180 visits with 70 unique patients. Visits were with: endocrinology (n=90), psychiatry (44), internal medicine (20), gynecology (18), plastic surgery (8). The 70 patients self-identified as: transwoman (31), transman (29), non-binary (3), transmasculine (3), male (2), female (1), genderqueer (1). Patient ages varied: 18-24 yrs (18), 25-44 yrs (38), 45-64 yrs (11), 65+ yrs (3). Our patients were 70% White, non-Hispanic and came from around our state and beyond. Type of insurance included: commercial (33), Medicaid (11), Medicare (7), self-pay (5), Tricare (4), other (10). In our first 9 months, we saw 13 patients overdue for cervical cancer screening and 11 (85%) underwent testing in our clinic, higher than the 34% screening rate of transmen we previously reported at our institution. Adult transgender/gender non-binary patients benefit from streamlined patient-centered care from a multidisciplinary team. Our endocrine clinic serves as a centralized, gender-inclusive space to improve access to care, particularly services that traditionally come with gender-specific waiting areas. Bringing the specialties into one clinic may allow for familiarity among our younger cohort who may have experienced multidisciplinary pediatric gender clinics. Many patients are younger/middle aged but routine maintenance exams across the lifespan are integral to supportive health care. Not all patients identify as transwomen or transmen. Awareness of non-binary identity or those still congruent with their sex assigned at birth is also important. Patient feedback has been positive, but we plan to conduct formal satisfaction surveys and develop a community advisory board to further assess needs. Supported by: University of Colorado Diversity & Inclusive Excellence Grant