Athletic Trainers' Competence, Education, and Perceptions Regarding Transgender Student-Athlete Patient Care

Abstract

Context Transgender student-athletes are increasingly participating in sport, requiring athletic trainer (AT) preparedness to care for their needs. Objective To measure ATs' (1) perceived definition of transgender, (2) comfort and competence working with transgender student-athletes, (3) sources of education, (4) perceived legal concerns, and (5) perception of competitive advantage. Design Cross-sectional study. Setting Mixed-methods survey. Patients or Other Participants Collegiate or university ATs (n = 5537) received an email invitation to participate; the data of 667 ATs were included in the analysis. Main Outcome Measure(s) A multipart 43-item questionnaire addressing the primary objectives of the study, with other factors that were explored in relation to these objectives to uncover potential influences on their responses. We calculated descriptive statistics, and for open-ended responses, we used the consensual qualitative research tradition. Results About half (48.1%, n = 321) of the participants agreed they were competent in treating transgender patients, but only 36.0% (n = 240) believed they were competent in practicing collaboratively with an endocrinologist in the drug-screening processes. Fewer than half (45.6%, n = 304) of participants felt they were competent in using appropriate terminology relating to transgender patients. The ATs disagreed when asked if they were competent regarding counseling transgender patients about the effects of hormone replacement therapy on sport participation (48.1%, n = 321) or on mental health concerns (40.3%, n = 269). Participants learned most frequently from media outlets (35.2%, n = 235) or personal experiences with family, friends, or themselves (33.7%, n = 225), yet 35.1% (n = 243) received no education in caring for transgender patients. Many ATs (41.2%, n = 278) believed that transgender female student-athletes had a competitive advantage. In contrast, 6.6% (n = 44) of participants indicated that transgender male student-athletes had a competitive advantage. Conclusions Although collegiate ATs generally felt competent in treating transgender patients, they did not feel capable of addressing specific aspects of transgender patients' health care needs. Regardless of the resulting perceived unfair advantage, ATs must be aware of the regulations and therapeutic effects associated with hormone-related therapy for transgender student-athletes.

Program Directors' and Athletic Training Students' Educational Experiences Regarding Patient-Centered Care and Transgender Patient Care

“…34 In this same study, half of the respondents reported feeling comfortable caring for transgender patients, and about half felt competent in their ability to care for transgender versus cisgender patients. 34 A lack of comfortable and competent athletic trainers who can deliver high-quality, PCC to transgender patients is doing a disservice to the transgender population and the athletic training profession. 35 With this current lack of knowledge, it is imperative that the profession works not only to address credentialed athletic trainers' lack of knowledge but also current athletic training students' knowledge on transgender patient care.…”

“…Therefore, equal treatment will not suffice if the goal is to eliminate health disparities, and transgender patients face both health and health care disparities. 34 By working toward equity, athletic trainers will expand access to health care, a PCC principle. 30 In a comparison between athletic training practice and primary care, Green and Sauers 47 report successful primary care delivery outcomes, and one outcome is equity of care.…”

“…7 By educating students on the subject, it could improve transgender care and address inequities. 31,34 Part of why the transgender population face health inequities is because transgender health care education is sometimes not included in health care students' curricula. 18 In 1 study on medical students, 74% of participants reported they had 2 hours of education or less regarding transgender patients, and authors of another study found medical schools spent 5 hours total on LGBTQþ health.…”

“…32 Unfortunately, the literature identifies that athletic trainers lack the general knowledge, comfort, and competence in specific topics needed to care for transgender patients. 33,34 In a study about athletic trainers working in the collegiate setting, only 28.8% of the respondents stated they had formal education about transgender patient needs. 34 In this same study, half of the respondents reported feeling comfortable caring for transgender patients, and about half felt competent in their ability to care for transgender versus cisgender patients.…”

“…33,34 In a study about athletic trainers working in the collegiate setting, only 28.8% of the respondents stated they had formal education about transgender patient needs. 34 In this same study, half of the respondents reported feeling comfortable caring for transgender patients, and about half felt competent in their ability to care for transgender versus cisgender patients. 34 A lack of comfortable and competent athletic trainers who can deliver high-quality, PCC to transgender patients is doing a disservice to the transgender population and the athletic training profession.…”