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. 2024 May 20;19(5):e0301603.
doi: 10.1371/journal.pone.0301603. eCollection 2024.

Transgender health objectives of training for adult Endocrinology and Metabolism programs: Outcomes of a modified-Delphi study

Tehmina Ahmad  1   2 , Leighton Schreyer  3 , Raymond Fung  1   4 , Catherine Yu  1   5
Affiliations

Transgender health objectives of training for adult Endocrinology and Metabolism programs: Outcomes of a modified-Delphi study

Tehmina Ahmad et al. PLoS One. .

Abstract

Background: Transgender people encounter significant barriers when seeking timely, high-quality healthcare, resulting in unmet medical needs with increased rates of diabetes, asthma, chronic obstructive pulmonary disease, and HIV. The paucity of postgraduate medical education to invest in standardization of transgender health training sustains these barriers, leaving physicians feeling unprepared and averse to provide transgender health care. Closing this education gap and improving transgender healthcare necessitates the development of consensus-built transgender health objectives of training (THOOT), particularly in Adult Endocrinology and Metabolism Residency programs.

Methods: We conducted a two-round modified-Delphi process involving a nationally representative panel of experts, including Adult Endocrinology and Metabolism program directors, physician content experts, residents, and transgender community members, to identify THOOT for inclusion in Canadian Endocrinology and Metabolism Residency programs. Participants used a 5-point Likert scale to assess THOOT importance for curricular inclusion, with opportunities for written feedback. Data was collected through Qualtrics and analyzed after each round.

Findings: In the first Delphi round, panelists reviewed and rated 81 literature extracted THOOT, achieving consensus on all objectives. Following panelists' feedback, 5 THOOT were added, 9 removed, 34 consolidated into 12 objectives, and 47 were rephrased or retained. In the second Delphi round, panelists assessed 55 THOOT. Consensus was established for 8 THOOT. Program directors' post-Delphi feedback further consolidated objectives to arrive at 4 THOOT for curriculum inclusion.

Conclusions: To our knowledge, this is the first time a consensus-based approach has been used to establish THOOT for any subspecialty postgraduate medicine program across Canada or the United States. Our results lay the foundation towards health equity and social justice in transgender health medical education, offering a blueprint for future innovations.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Overview of modified-Delphi process.
Delphi rounds developing transgender health objectives of training.
Fig 2
Fig 2. Example of graphically synthesized distribution score for each THOT.
From Survey 1 the majority response is indicated by height of the shaded grey histogram, and the individual’s initial response indicated by the red box.
Fig 3
Fig 3. Final consensus-based list of transgender health objectives of training.
For incorporation into Adult Canadian Endocrinology and Metabolism Residency programs.
Fig 4
Fig 4
a. Panelists responses regarding number of hours transgender health content should be included in the curriculum. b. Panelists favoured educational strategy for which transgender health topics should be delivered.
See this image and copyright information in PMC

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