Simulation Bridges LGBTQ+ Educational Gaps in Gynecologic Care: Menstrual Suppression for a Gender and Sexually Diverse Patient

Date of Review: April, 2025

This educational initiative consisting of a lecture and standardized patient simulation, from MedEdPortal, aims to improve gender and sexually diverse gynecologic care among OB/GYN residents. The curriculum was designed as a single 4-hour session for OB/GYN residents of all postgraduate year levels. The interdisciplinary team that created the curriculum included members of the LGBTQ+ community, and the standardized patient identified as a non-binary, pansexual individual. Trainees receive a 40 minute didactic lecture on affirming language, clinical considerations, and communication strategies for sexually and gender diverse patients. They then are divided into small groups to participate in a standardized patient simulation with a focus on menstrual suppression. During the simulation, two residents co-lead the patient session while two residents and two faculty observe and assess the interaction using a checklist of skills. Directly after the simulation, each small group participates in a 40 minute debrief and is provided with materials to guide future encounters with gender and sexually diverse patients. This interactive, experiential modality is well suited for this topic and allows learners to practice skills that can be directly applied to clinical care. Small groups of 3-4 residents at a time are important to creating safety for debriefing and discussion (the curriculum was delivered to a total of 11 OBGYN residents), so larger programs seeking to adapt this curriculum should consider how to space out sessions to accommodate this. Importantly, to increase authenticity and avoid reinforcing biases, the standardized patient identified as a member of the gender and sexually diverse community. In addition, the faculty facilitators also identified as LGBTQ+ and included a health service psychologist with expertise in working with this population. Institutions should consider how to recruit faculty and standardized patients from the LGBTQ+ community and allot appropriate time and support to do so. The authors also highlight the importance of providing support to the standardized patients, who will likely encounter misgendering and bias over the course of the simulation. While the curriculum was intended for OB/GYN residents, the lecture and case could be easily edited to focus more generally on taking a patient-centered social and sexual history, which would be valuable for trainees from a range of specialties including pediatrics, family medicine, and internal medicine. –Emma Anselin, MD, NCEAS

Corresponding Author’s Email:

cking79@jhmi.edu

Institution:

Johns Hopkins

Where was the Curriculum Implemented:

Baltimore, Maryland

Relevant Specialty:

OBGYN/Womens Health

Outcomes that Have Been Reported for the Curriculum:

Learner Satisfaction or reaction

Self-reported learner attitude

Self-reported learner knowledge

Measured learner behavior in simulated setting

Outcome and Study Design:

Pre/Post

Level of Learner Assessment

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

Demonstration of skill in a controlled environment (OSCE, Simulation)