Background Transgender individuals face numerous health disparities and report negative experiences with health care providers related to their gender identity. Significant gaps in medical education regarding transgender health persist despite calls for increased sexual and gender minority content. The purpose of this student‐led study was to assess the effectiveness of a half‐day educational intervention on first‐ and second‐year medical students’ attitudes and knowledge of transgender health. Methods Students and faculty members collaborated to develop an educational session on transgender health. This content was presented to first‐ and second‐year medical students at Integrated Grand Rounds, a pedagogical method in which basic science and clinical faculty members co‐present didactic content interspersed between live patient interviews and student‐led small group discussions. Student participants (n = 138) completed voluntary 9‐item pre‐ and post‐session surveys assessing comfort with and knowledge of transgender medicine. Results Students’ comfort with and perceived knowledge about transgender patients increased significantly between pre‐ and post‐test. Students’ knowledge of transgender medicine standards of care also improved, though not all items reached significance. Discussion A half‐day educational intervention improved many facets of medical students’ attitudes and knowledge about transgender patients. The significant disparities in physical health, mental health and access to care currently experienced by transgender persons in the United States warrants the continued testing and refinement of educational interventions for future and practising providers.

Barriers to competent and safe healthcare disproportionately impact people who are marginalized because of their race, ethnicity, gender, or socioeconomic status. It is well documented that transgender patients in particular experience barriers to both accessing care and receiving high quality, non-discriminatory care (Hatzenbuehler & Pachankis, 2016; James et al., 2016; Rahman et al., 2019; Safer et al., 2016). This lack of access to culturally competent healthcare services contributes to health disparities that disproportionately impact the trans community. Literature on barriers to competent care for trans patients indicates that providers experience discomfort related to their ability to provide competent care (Safer et al., 2016). Many providers endorse a median of only five hours of trans healthcare training across their entire medical school curriculum (Hughto et al., 2015), and in some cases, as little as 45 minutes per year (Sawning et al., 2017). Primary care clinics should be the place in which general health and wellbeing are addressed for trans patients, as has been true for cisgender people. Primary care providers should be competent in assessing eligibility for Hormone Replacement Therapy (HRT) and surgery (Wylie et al., 2016), as well as providing necessary preventative care. Thus, this makes primary care the ideal setting for the proposed medical education implementation project. The current study aimed to develop and implement a training program for medical residents in primary care in rural South Central Appalachia. A six-stage development and implementation study is described. The intervention was evaluated for pedagogical outcomes including sustainability for future use, usefulness to residents, and accessibility. Evaluation of effectiveness included analyses of changes in providers’ self-reported competency, awareness of discriminatory experiences, and attitudes towards treating trans patients. There were no significant differences in pre-post competency scores (r=22, M=33.29[SD=5.96]; r=31, M=37.33[SD=1.02], SD=8.00) or in pre-post attitudes scores (r=15, M=32.76[SE=0.8], SD=4.69; r=13, M=34.7273[SE=1.00], SD=4.692). Accessibility and sustainability were measured qualitatively and included data such as resident attendance and ease of use of material for future behavioral health provider trainers. These outcomes were found to be satisfactory based on stakeholder feedback. Usefulness included three data points (satisfaction, helpfulness, value of training).

The Institute of Medicine report of 2011 defined Transgender Specific Health Needs as one of four priority research areas. While there is research asserting that health care providers (HCPs) do not have adequate training in providing competent care to transgender patients, there are no studies to date assessing HCPs' gender identity attitudes and their willingness to learn the Standards of Care (SOC) developed for this patient population. According to the Agency for Health Care Research and Quality, as of 2010, 52% of Nurse Practitioners (NPs) were practicing in primary care settings. As more than half of NPs practice in primary care and transgender patients often initially present their gender concerns to their primary care provider, this study focuses on the NP population. This study describes a sample of NPs' attitudes towards gender variance, as well as their perceived need and interest in learning the SOC as published by the World Professional Association for Transgender Health. Multi-state purposive sampling of NP professional organizations was conducted. Two conservative and two progressive states' professional organizations were included in the sample. The states were randomly assigned within both geopolitical groups to intervention or control with the use of a random numbers table. Comparisons between geopolitical groups and between control and intervention groups cannot be made due to low response rates of all states. The majority of this small sample of NPs agreed that they needed and wanted additional training in transgender health care. Future research with representative sample sizes is needed to better understand provider-sided barriers to caring for this marginalized patient population.

This study explores the experiences of gender nonconforming (GNC), transgender, and transsexual (trans) people in the search for a primary care provider in the United States. The current body of literature on transgender health often discusses HIV rates, substance use, mental health/suicide, and few studies have studies primary care seeking behaviors; this study seeks to provide new insight into the primary care (pcp) seeking behaviors of GNC and trans people. The primary theoretical perspectives utilized in this study were West and Zimmerman’s (1987) “Doing Gender” and the Health Beliefs Mode (Ayers et al., 2007; Connor and Norman, 2005; Green and Murphy, 2014). In order to explore the pcp seeking behaviors among GNC and trans individuals, I designed a 45 item survey. The survey was posted on-line on three separate “sub-reddits” between March and April of 2016 and was open to all individuals who self-identified as gender nonconforming, transgender, and/or transsexual. Of 96 responses, 68 were included. Although the sample is small, the results showed that structural barriers were significantly associated with having a PCP. Those with health insurance (p=.031) and those with at least one chronic illness (p=.037) were more likely to have a regular primary care provider. Descriptive findings support the role of socio-economic factors, geographic location, and past experiences of discrimination as predictors of primary care status.

Despite advancements in research on sexual morphology as well as increasing interdisciplinary theory on gender, medicine continues to perpetuate anti-transgender stigma in health care. Research on this topic has typically lacked perspectives from health professionals, who operate in and contribute to the environments in which patients seek care. In collaboration with Dallas non-profit Trans Pride Initiative, this study seeks to begin filling this research gap, relying on a sexual stigma framework created by Gregory Herek and applying it to anti-transgender (or gender) stigma to examine its manifestations in health care environments through narrative inquiry. The data from narrative interviews with health care professionals revealed themes of inadequate schooling on transgender competency models and health needs, difficulties in resisting gatekeeper practices while addressing mental health needs, a patient-as-expert approach amongst trans-affirming providers, and understanding of patient family dynamics as a catalyst for understanding stigma. Exploration of sexual identity prior to claiming gender identity, lacking language to explain gender experiences until encountering other LGBTQ+ (lesbian, gay, bisexual, transgender, queer) people, and religious trauma as restrictive to gender exploration during childhood emerged as themes amongst transgender and gender diverse participant interviews. The practical implications of these themes present issues for institutional, social, and legal change due to the pervasiveness of sexual dimorphism (and subsequent gender binary) as a means of structuring medicine, social organization, and legal systems, respectively. Still, critical gender engagement with health professionals pre- and post- licensure has the potential for profound impacts beyond addressing anti-trans stigma in health care.

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