Missed opportunities: are residents prepared to care for transgender patients? A study of family medicine, psychiatry, endocrinology, and urology residents

Abstract

Background: The transgender (trans) population faces multiple barriers in accessing health care, with knowledge deficits of health care providers contributing substantially. Trans patients report having to teach health care professionals about their own health needs. We compared perceptions of trans-care education and training across family medicine, psychiatry, endocrinology, and urology residency training programs at the University of Toronto.

Methods: We surveyed residents to assess their perceptions of and attitudes towards trans-care, exposure to trans patients, knowledge of trans-specific clinical care, and the state of trans-care education within their training. We used Likert scale data to identify patterns across residency programs. We collected open-ended responses to further explain quantitative findings where appropriate.

Results: Of 556 residents approached, 319 participated (response rate = 57.4%). Nearly all endocrinology and psychiatry residents agreed that trans-care falls within their scope of practice, while only 71% and 50% of family medicine and urology residents did, respectively. Though participants were at different stages of their postgraduate training when surveyed, only 17% of all participants predicted they would feel competent to provide specialty-specific trans-care by the end of their residency and only 12% felt that their training was adequate to care for this population.

Conclusion: Though the study revealed a willingness to serve this population, there was a lack of clinical exposure and trans-related teaching within postgraduate curricula resulting in feelings of unpreparedness to meet the health care needs of this underserved population.

Figure 1

Recognition, interest, and self-proclaimed competency and adequacy of education? with respect to transgender related care. Participants in Endocrinology (E), Urology (U), Family Medicine (F), and Psychiatry (P) either strongly disagreed, disagreed, felt neutral about, agreed, or strongly agreed to each Likert scale statement, and responses were collapsed for more optimal interpretation. Residents were asked the extent to which they: believe transgender-related medical therapy should be within their scope of practice [Recognition]; would like to incorporate transgender care into their future practice [Interest]. Residents were also asked if by the end of their residency, they believe they will be able to competently prescribe hormone therapy (E,F), perform gender affirming surgery or deal with complications arising from such procedures (U), and competently assess for and give counseling on gender dysphoria (P) [Competency]. Lastly, they were asked whether they think teaching around treatment and management of the transgender population is adequate in their current curriculum [Adequacy of Education].

Figure 2

Perception of and attitudes regarding transgender related clinical practice. Residents were asked the extent to which they believe: the benefits of transgender hormone therapy outweigh its risks [Hormone Therapy Benefits]; the benefits of gender affirming surgery outweigh its risks [Gender Affirming Surgery Benefits]; hormone therapy should be fully government funded [Hormone Therapy Funding]; breast augmentation for trans women and chest contouring for trans men should be fully government funded [Tops Surgery Funding]; and gender affirming surgery should be fully government funded [Bottom Surgery Funding]. Endocrinology (E), Urology (U), Family Medicine (F), and Psychiatry (P).