Transgender patient care a priority in MD, PA and PA online degree programs
A woman who was assigned to a man at birth is diagnosed with prostate cancer. This was a recent clinical training exercise from the Yale Online Medical Assistant (PA Online) program involving standardized patients who are transgender women. At Yale School of Medicine (YSM), the Medicine, Online PA, and Physician Associate (PA) programs incorporate curriculum content to train students to care for transgender and non-binary patients competently and compassionately. . Importantly, the programs are committed to ongoing program evaluation and reviews.
YSM began the process of meaningfully including this content into its medicine curriculum in 2014, as part of a larger collaborative effort between students and faculty to assess and augment content related to sexual minority medicine. and gender (SGM). This involved a careful review of the program to determine what was and was not covered, based on nationally established competencies provided by the Association of American Medical Colleges. Teachers were provided with tips and resources to incorporate missing content into the curriculum. A key principle was to develop unified intersectional learning activities focused on the experiences and needs of all patients in order to respond to the multifaceted nature of patient identities and healthcare concerns.
Relevant content is now incorporated into a number of pre-internship courses and several internships, such as an Ob-Gyn shared decision-making workshop using a case study of a man assigned to a woman at birth with cancer. cervix.
Medical students can participate in an elective course in family and transgender medicine at a clinic in Oneonta, New York, where YSM alumni Carolyn Wolf-Gould, MD 90 and Christopher Wolf-Gould, MD 90 serve as preceptors. Michael Solotke, MD-MBA ’21, spent two weeks seeing only transgender and non-binary pediatric and adult patients during the elective internship. Because these patients are among the most underserved in our health care system, he explains, “it was extremely valuable to my education to have the chance to learn in an environment that centers their needs. Solotke praises the Wolf-Goulds as truly exceptional preceptors who “modeled the way of providing structurally informed, evidence-based, humble, and community engaged care.”
Travel restrictions during the COVID-19 pandemic highlighted that an equivalent opportunity does not yet exist in New Haven, although the Pediatric Gender Program has created a temporary opportunity for students to participate in an elective course in transgender medicine. and not binary.
The YSM Dean’s Council for LGBTQI + Affairs was born out of the 2014 Medicine Curriculum Review. Since its inception in 2015, it has included representatives from the MD, PA and PA online programs, as well as nursing schools. and Yale Public Health. It focuses not only on curriculum, but also on a range of lesbian, gay, bisexual, transgender, intersex and Queer + (LGBTQI +) issues, as well as organizing ‘events. In January 2021, the Council established an official Education / Curriculum Working Group to provide curriculum advice to Dean Nancy J. Brown, MD, CNH Long Professor of Internal Medicine, and to other education officials.
In 2020, the MD program added a four-year thread on health equity (HET) to its curriculum, with the goal that by 2023, 50% of the program integrates health equity in a way. significant. Associate Dean of Studies Michael Schwartz, PhD, predicts that as strong content related to the appropriate and meaningful care and treatment of transgender and non-binary patients is integrated into the HET, students will benefit from even greater exposure. to this important facet of health care. delivery.
As of September 2020, the Physician Assistant Education Accreditation Review Board required accredited PA programs to prepare their graduates to provide CMS patient care. (There is no equivalent accreditation requirement yet for medical schools.) Both YSM PA programs met this requirement prior to its adoption. Diane Bruessow, PA Online faculty member, PA-C, DFAAPA credits PA Online program director James Van Rhee, MS, PA-C for including the topic in the program when Yale hosted its first class in January 2018.
Transgender health materials are integrated throughout the PA Online Patient Assessment course. For example, the Musculoskeletal System program includes a discussion of how sex steroids, especially estrogen, influence bone health, and how this relates to puberty suppression and hormone therapy. When studying the pulmonary system, PA Online students learn about the pulmonary risks associated with certain thoracic bonding techniques – a non-medical / surgical alternative to high-level surgery that transmasculine individuals can engage in to create a breast. male presentation.
During the Multi-Institutional Virtual Interprofessional Education (VIPE) program, PA Online students work on clinical cases in small interprofessional groups. In one scenario, the patient is a young transgender woman of color who has a musculoskeletal problem and the abuse is discovered. Additionally, many PA Online students participate in the SGM Health Program Virtual Clinical Elective Course, designed to help students understand and apply the scientific constructs of sexual orientation and identity and expression. gender in patient assessment and clinical decision-making.
Bruessow, who has expertise in transgender and non-binary medicine, has spent the last year writing chapters on transgender health for medical textbooks, with the goal of enabling other programs to teach this content as well.
Likewise, the PA program has material integrated into its didactic and clinical program. Throughout the first year, content is devoted to treatment and care approaches, including hormonal therapies, implicit bias, gynecological care, psychiatric impact, diversity and inclusion. In addition, students take a course on Gender-based youth health care, and participate in a session on LGBTQ health disparities, focusing on identifying the main barriers to accessing health care and health disparities and risk factors experienced by this community. Students learn how to provide primary care to LGBTQ patients, including developing a clinically inclusive and empathetic approach to providing optimal medical care.
During their shared medical decision-making sessions with standardized patients, PA students have a case with a transgender man making decisions about having children with his partner. They can also participate in clinical placements at the Nathan Smith Clinic in New Haven, which supports patients, including transgender and non-binary people, who are HIV positive. Clinical electives are available at the Yale Gender Interdisciplinary Program and the Walter – Whitman Clinic in Washington, DC, both with a focus on transgender and non-binary health care.
Jessica Illuzzi, MD, MS, Associate Dean of Education, Professor of Obstetrics, Gynecology and Reproductive Sciences, says it’s critical that students are trained to care for transgender and non-binary people in order to to ensure that this segment of the population receives the care they need. and deserve in a supportive, understanding and inclusive environment. “It is essential to recognize and minimize biases in the care of our patients. It is at the heart of our mission and, therefore, of our program.