Improving Residents’ Competency in Caring for Transgender Individuals Through Development of a Curriculum

Objectives: Several recent publications have described the lack of education in transgender health care among providers across all levels of medical training. Here we describe a QI project that developed and implemented a transgender health care curriculum for the University of Massachusetts Medical School-Baystate Medical Center (UMass-Baystate) pediatric and combined internal medicine-pediatrics residency programs. Methods: We designed a curriculum for the UMass-Baystate pediatric (9 residents/yr) and med-peds (8 residents/yr) residency programs. The curriculum included grand rounds presentations on transgender health care, didactic sessions integrated into the residents’ protected educational time throughout the academic year, and a panel discussion with non-binary and transgender individuals from the community. The didactic sessions included a mixture of lectures, role- playing, and case-based discussion. The curriculum development was guided by a curriculum design specialist and adapted each year based on feedback. Residents’ self- reported comfort and competency level were assessed through a survey at baseline and at the end of each year. Results: Ninety-eight percent (42/43) completed the baseline survey. Forty percent (17/42) had received no formal training in medical school, and 21% (9/42) had never taken care of a transgender patient. At baseline, 62% felt a little less comfortable and 50% felt somewhat competent, 2.4% very competent caring for transgender individuals compared to cisgender individuals. After three years, 25% felt a little less comfortable and 44% felt somewhat competent, 19% felt very competent caring for transgender individuals compared ot cisgender individuals. The community panel was very well received. Free text comments regarding the curriculum included “very helpful,” “loved the panel,” “clinically relevant.” Conclusions: This QI initiative served as the groundwork for the development of a formal curriculum to enhance medical education among residents in caring for transgender individuals. After three years, residents felt more comfortable and competent in caring for transgender individuals as compared to the baseline survey. We will continue to adapt the curriculum as it continues. The curriculum has expanded to include the pediatric nurses and the UMass medical students.