An Effective Gender-Affirming Care and Hormone Prescribing Standardized Patient Case for Residents

Date of Review: May, 2024

This standardized patient case, from MedEd Portal, introduces resident learners to concepts in gender-affirming care including informed consent for hormone prescription. The case was developed with input from members of the local transgender community through an anonymous survey and a focus group. The learning objectives and evaluation measures were directly based on community priorities that emerged from this process. The case addresses communication skills relevant to gender-affirming care, including how to take an appropriate history, barriers to accessing care for transgender patients, and some specific medical knowledge relevant to hormone prescription. The use of a standardized patient format is appropriate as it allows for real-time feedback on knowledge, communication, and listening skills. Implementing this case would require trained standardized patients and an existing simulation center. The authors also acknowledge that ideally transgender standardized patients would be hired to portray this case. Implementation would also require content experts to train the standardized patients and faculty observers, ensure that the language used in the case is up to date (given ongoing changes in language and culture in the transgender community), and to provide real-time guidance to residents on current guidelines for hormone prescription. This could be offered as a standalone case within a resident curriculum or even medical student curriculum, though it would help prepare trainees to fully engage in the material if they had prior didactics on gender affirming care. Of note, the resident participants at this institution had high levels of pre-existing intent to provide gender-affirming care and positive attitudes about the role of transition-related care in primary care. If participants at other institutions had a wider spectrum of pre-existing intent and attitudes, then it would be important to build in more time in the beginning and end for debriefing and processing of the material, including careful consideration of establishing safety for participants who themselves identify as transgender or gender expansive. –Emma Anselin, MD, NCEAS

Corresponding Author’s Email:

cantone@ohsu.edu

Institution:

Oregon Health & Science University School of Medicine

Where was the Curriculum Implemented:

Oregon

Clinical specialty:

Family and Community Medicine

Outcomes that Have Been Reported for the Curriculum:

Self-reported learner attitude

Self-reported learner knowledge

Outcome and Study Design:

Pre/Post

Level of Learner Assessment

Appreciation of content/attitude assessment (self-reflection, blogging with rubric)

Knowledge Acquisition (MCQ, IRAT, GRAT)