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STUDENT CONTRIBUTION
Year : 2022 | Volume
: 35
| Issue : 1 | Page : 31-34
Educating for Quality Transgender Health Care: A Survey Study of Medical Students
Virginia H Dale, Ranmini Philomin
Department of Medicine and Life Sciences, Swansea University Medical School, Swansea, Sketty, UK
Correspondence Address:
Virginia H Dale
Swansea University Medical School, Swansea, Sketty, SA2 8QA
UK
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/efh.efh_508_20
Background: The worse health outcomes suffered by transgender patients is compounded by the lack of training that students receive on addressing the needs of this population. Medical students are future doctors, and in this role, they should be learning to provide care to all of their potential patients. Methods: This study uses pretest–posttest design to assess the impact of a teaching session on students' responses across three themes: understanding, education, and profession. Students and members of the public (n = 25) attended a 2-h teaching session covering important topics in relation to transgender health. Assessment was carried out using a six-question survey that gathered responses on a Likert scale. Results: Level of understanding showed a significant increase (P < 0.05), as did one of the questions associated with profession (comfort seeing a transgender patient for a gender issue). The questions on education showed no significant change with the majority of students believing in the importance of learning about transgender health care. Despite the teaching session, there was no increase in the comfort level of medical students' with seeing a transgender patient for a nongender issue. Discussion: Medical students are ready to be part of reducing the barriers to quality health care for transgender people. Education delivered with the help of the transgender community and specialist doctors can equip medical students with the understanding and level of education required to provide care to all of their patients.
Keywords: Education, LGBTQ+, medical student, transgender
Transgender people and the rest of the Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual, Non-binary, as well as other sexual and gender identities (LGBTQ+) community suffer worse health outcomes than the general population across a range of measures. LGBTQ+ people suffer from higher rates of substance abuse, anxiety and depression, HIV and sexually transmitted infections as well as decreased uptake of many screening programs.[1],[2] The reasons for this are multifactorial, but discrimination and ignorance are two contributing elements.
One of the driving factors for discrimination is ignorance. A quarter of patient-facing staff in the NHS is not confident in their ability to provide care for transgender patients.[3] One Canadian study found that anti-LGBT+ sentiment does not exist only within the health-care workforce but also among medical students, with just under a third of respondents saying that they had witnessed discriminatory behavior, often from their colleagues.[4]
To prevent the perpetuation of ignorance and discrimination, education is a potential solution. This study aims to examine the impact of an education session on medical students' comfort with their knowledge of and ability to address the health needs of transgender patients. The goal was to improve medical students' knowledge and therefore reducing their potential to be good health-care providers for all their patients.
MethodsIntervention population and design
Pretest–posttest design was used with a single cohort of subjects. A teaching session occurred at Swansea University in 2019. Attendance was optional and the medical students ranged from their first to final year. Three 20-min lectures were given, with time for questions. The presenters were a senior lecturer and researcher looking at inclusive care for older trans people, a senior medical doctor specializing in the provision of transgender health care, and a transgender activist. Topics discussed included the spectrum of gender identity, using pronouns, and a broad overview of experiences of transgender people across the age spectrum and life course.
Measures
A six-question survey with a focus on self-assessed knowledge and comfort with transgender issues was given to participants. Participants filled in the same survey before and after the teaching session. The survey used a five-point Likert scale [Figure 1] where 1 was strongly disagree and 5 was strongly agree with the survey statements.
The questions were designed to gather medical students' responses across several themes: understanding, education, and profession. To assess these themes, we asked subjects to respond with 1–5 (as above) to the statements in [Figure 2].
Statistical methods
Parametric testing was used to assess whether the intervention had an impact on the question answers. Due to the sample size being over 15, and the similar nonnormal distribution being likely across the questions, there is no major difference between using parametric or nonparametric analysis methods.[5] The means of the results were compared, and their statistical difference was compared using paired t-test analysis to identify significance (P ≤ 0.05 was used as the significance level).
ResultsOf the 25 attendees, 22 completed both the pre- and postlecture survey (88% response rate). However, only 18 of these were medical students, so the overall response rate for the relevant population is 72%. The means and standard deviations are found in [Table 1].
Table 1: Response means and standard deviation for pre. and postinterventionThe results of Q1 and Q2 showed responses that gave a picture of subjects self-assessed levels of understanding. Before the intervention, 61% were in agreement or strong agreement with the Q1 statement “I am comfortable with my understanding of what transgender means,” which moved to 83% after the intervention. Both Q1 and Q2 showed a significant increase (P < 0.05) in the value of the mean score, showing an increased level of self-evaluated understanding of transgender issues and health needs.
There was no statistically significant (P > 0.05) change in the responses to the “education” themed questions as a result of the intervention. Q3 had 78% of respondents strongly agree with the statement “I need more teaching on gender and transgender issues in medicine” both before and after the intervention. However, before the intervention, 50% agreed or strongly agreed with the Q4 statement, and after the intervention, this was 78%. While the difference between the before and after group's was not significant for either of these questions, the means were maintained at above the midpoint (3-neither agree nor disagree), meaning that education on transgender health care maintained its importance to the subjects.
The profession questions assessed responses from the subjects to do with seeing transgender patients in a professional health-care setting. Q5 before the intervention had 22% of respondents agreeing or strongly agreeing with the statement “I have enough knowledge to feel comfortable seeing a transgender person as a patient for a nongender-related issue.” After the education session, this became 44%. Q6, before education, had 28% of medical students agreeing or strongly agreeing with the Q6 statement, which increased to 61% after the intervention. Q6 showed a significant increase in the mean (P < 0.05) due to the educational intervention, as shown in [Figure 3].
DiscussionIn this study, the authors explored the impact of an educational session on medical students' self-reported understanding and ability to provide health care to transgender patients. This was done in an effort to increase the likelihood that they will provide appropriate and high-quality care to all of their patients in the future, which is a health and social justice issue. The students were assessed across three domains: education, understanding, and profession. Responders identified that there was a need for more education in this field, and that they were increasingly comfortable with their ability to provide health care to transgender patients. This study could provide the evidence required to persuade universities to make changes to their curriculum to ensure that future medical students are leaving with the tools to provide good health care for their transgender patients.
Our study showed that an education session can increase medical students' understanding of, and comfort at interacting professionally with transgender patients. There was a significant increase in understanding of what transgender means (Q1) and about the issues faced by transgender people (Q2). This is important as increasing understanding increases compassion. Compassion and empathy for minority groups have been shown to be predictors for reduced negative bias.[6] The results of this study are consistent with other studies which found that teaching sessions increased confidence in using and understanding correct terminology.[7] Understanding the issues as well as appropriate terminology is key in ensuring that future medical professionals are able to provide unbiased, culturally competent care.[8]
Our study findings that students have a desire for education about transgender health to be included in the curriculum are supported by the literature. Other studies have found that there is a desire for LGBTQ health care to be an essential module within each medical school.[4],[8] Several schools across the UK have taken the steps to imbed transgender health-care teaching sessions in their education program.[7],[9] The more contact that students can have with role models from the LGBT community, the more likely they are to have a lower negative bias, and therefore more likely to be better physicians.[10]
Medical schools should be creating doctors that will provide all their patients with high-quality care. Our study showed that one teaching session can increase medical students' knowledge and therefore comfort with seeing a transgender patient in relation to a gender issue. This finding of increased clinical comfort has been replicated across several studies.[7],[9] Interestingly, in our study, there was no statistically significant increase in knowledge comfort with seeing transgender patients for a nongender-related issue. This may be reflective of the students' comfort seeing patients in general, as the education session was not providing a treatment guide for any specific health conditions.
A statistically significant increase in the students' understanding of what transgender means highlighted the impact of a 2-h teaching session. Proving that changing perceptions are achievable with even the smallest addition to the curriculum. Ultimately, students should not feel unable to build rapport and provide appropriate health-care advice for the transgender community for both nongender and gender concerns. However, a study by Sekoni et al.[8] found that there is no evidence that educating medical students on transgender health issues translates into a change in professional practice.
Strengths and limitations
Key strengths of this study are its pretest–posttest design, its setting within undergraduate medical education, and its survey design allowing for a range of analysis to assess the impact of the educational session. There was also the strength of not collecting any personal details about participants; this increased the likelihood that the self-reported responses were accurate.
The study was already limited by the small sample size; demographics were deliberately excluded from the survey methodology to prevent identifiable information being shared. Swansea University medical school curriculum (at the time of the study) did not include any formal teaching on this, but with students being from many life and educational backgrounds, it is not possible to say whether this impacted the study results.
ConclusionThis study shows that medical students are ready to be part of reducing the barriers to quality health care for transgender people. There is the ability and desire to increase their understanding of the transgender community and their health needs. Medical students want transgender education to be integrated into the curriculum, and so that they can enter their chosen profession with the skills to provide excellent and culturally competent care to all their patients.
Acknowledgments
Many thanks to The Royal College of GPs (Wales) provided sponsorship to allow for food being provided at the educational event.
The authors would also like to thank Captain Burton, Dr. Quinney, and Dr. Dobbs for their educational lectures.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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