Should medical schools require transgender health education?
Medical schools around the country are trying to implement instruction in transgender care into their curriculum. Infectious Diseases in Children asked Katherine L. Margo, MD, emeritus associate professor of family medicine and community health at the University of Pennsylvania Perelman School of Medicine, if transgender health education should be required in medical school curricula.
Given the 1 million to 1.4 million transgender people in the United States, most physicians will have transgender patients at some point as part of their practice. Until recently, this situation often caused consternation and embarrassment for both the patient and the physician. I have had transgender patients tell me that a particular specialist “doesn’t take care of people like me.” This lack of knowledge and comfort is changing with more and more publicity about transgender people through social media, TV and movies. In addition, millennials are much more fluid in their understanding and expression of gender, and most medical students I encounter now have had a friend or acquaintance who is transgender or gender nonbinary.
Medical students and residents are asking for more curricula about how to care for transgender patients. Given the vulnerability and poor access to health care with resultant poor outcomes in this population, the learners are right. Just as all students learn about hepatitis C, HIV and other infections, they all need to understand how to assess the increased risk for these infections in this population. A study in JAMA in 2011 showed that 5 was the mean number of LGBT-related content hours among 150 medical schools that completed a survey. Quality of the instruction was variable, much of it rated as poor. A more recent article in Teaching and Learning in Medicine showed that students rated their LGBT education as “fair.” They felt the least prepared in their knowledge of transgender care. In a study published in 2014 in the American Journal of Public Health, we showed after implementing curriculum in a family medicine clerkship that 2 hours or less of focused lectures on transgender care improved their competency. A 2018 review showed that educational interventions to incorporate more transgender health improved attitudes and knowledge but tended to be single interventions.
Transgender health care needs to be included as an integral part of the medical student curriculum in an ongoing manner and not only be relegated to an elective for those with a special interest. Asking students to participate in creating that curriculum has made it more creative and useful. Doctor-patient relationship strategies for these patients should be addressed. Courses that discuss psychosocial issues should address transgender patients’ common mental health issues resulting from, in many cases, bias, rejection by families and bullying. Everyone should know that 41% of transgender women of color have attempted suicide. Sexuality and reproductive health in this population present unique challenges. Like so many lesbian and gay couples, many couples with one or two transgender people want to have children. The rate of HIV infection in transwomen is high, requiring a thorough knowledge of pre-exposure prophylaxis and special fertilization methods. Hormone treatment is straightforward and should be taught as part of a primary care curriculum. Special cancer screening needs should be included. Educating health care providers to take good care of this group is overdue and needs to be prioritized.
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Disclosure: Margo reports no relevant financial disclosures.