Health History Skills for Interprofessional Learners in Transgender and Nonbinary Populations

Abstract

Introduction: Transgender and nonbinary peoplehave been identified as vulnerable and clinically underserved and experience health disparities. Lack of health care provider knowledge about transgender and gender diverse populations is a barrier to care, impacting health outcomes. The aim of this project was to develop, implement, and evaluate a simulation learning activity for midwifery and women's health nurse practitioner students and obstetrics and gynecology residents to interact with transgender and nonbinary individuals, with the goal of enhancing health history taking comfort and skills.Methods: A partnership was formed among University faculty and simulation educators, a community clinic providing gender-affirming care, and members of transgender and gender diverse populations who served as patient-teachers. Two cases frequently encountered in clinics providing care to transgender individuals were developed for the simulation. Learners were divided into interprofessional groups of 3 and completed one of 2 case scenarios with a patient-teacher. Learners and patient-teachers debriefed after the simulation to discuss and reflect on the experience.Results: Thirty-three learners participated in the simulation, 12 midwifery students, 16 women's health nurse practitioner students and 5 obstetrics and gynecology residents. Significant differences were observed for all comfort and skills questions, showing increased perceived comfort and skills from pre-to postsimulation. There were no significant differences in attitude responses.Discussion: We successfully created and implemented a new sexual and reproductive history taking skills simulation in partnership with community clinic staff and transgender and nonbinary persons. The session was well received by learners and patient-teachers. Learners demonstrated significant improvements in comfort and skills in history taking in this setting and provided favorable feedback about the experience. This simulation can serve as a guide to others providing education to future midwives, women's health nurse practitioners, and obstetrician-gynecologists.

Transgender health content in medical education: a theory-guided systematic review of current training practices and implementation barriers & facilitators

“…As noted above, students’ prior exposure to related educational content was supported through vertically and horizontally scaffolding learning throughout medical curricula (Park & Safer, 2018 ). This scaffolding required institutional/faculty buy-in and dedication of time and resources (Gibson et al, 2020 ; Ruud et al, 2021 ; Vance et al, 2017 , 2018 , 2020 , 2021 ). Support across medical schools and academic institutions was in turn shaped by organizational culture and the broader sociopolitical climate (Biro et al, 2021 ; Eriksson & Safer, 2016 ; Gibson et al, 2020 ; Rosendale & Josephson, 2017 ; Safer & Pearce, 2013 ; Sawning et al, 2017 ).…”

Bringing Gender-Affirming Care to Primary Care

“…The gender of the SP matched the gender of the case study used. The PI provided a 15-min prebriefing to participants, discussing the process and best practices in simulation methodology 18. Subjects were given a Standardized Patient Encounter Checklist so that they were aware of best practices for this exercise and then given 30 minutes to review the simulated health record and conduct a focused history on their assigned SP.…”

Implementing a Transgender and Gender-Diverse Standardized Patient Simulation in Advanced Health Assessment

“…In addition, a case outside of gender-affirming hormone or surgical care was specifically chosen to highlight the diverse needs of this population. A pre/posttest project design was used with a 12-item survey that was adapted with permission to assess students' comfort, skills, and attitudes in caring for the TGD population 4. Two nonbinary individuals were recruited and trained to be SPs.…”

“…A pre/posttest project design was used with a 12-item survey that was adapted with permission to assess students' comfort, skills, and attitudes in caring for the TGD population. 4 Two nonbinary individuals were recruited and trained to be SPs. This project was implemented as a mandatory requirement for doctor of nursing practice students enrolled in advanced health assessment (AHA).…”