Educating Women's Healthcare Providers on Transgender and Gender Non-Binary Care

Transgender and gender non-binary (TGNB) individuals experience significantly greater disparities related to healthcare access than their cisgender-identifying with the gender to which one was assigned at birth- counterparts (James, Rankin, Keisling, Mottet, & Anafi, 2016). The minority stress model posits these individuals experience extrinsic and intrinsic stressors which affect overall health outcomes (Frost, Lehavot, & Meyer, 2013). Though providers may not be able to impact the intrinsic stressors experienced by their patients, it is possible to minimize extrinsic factors by educating themselves on culturally appropriate care. When these patients have to educate their providers they are less likely to return for follow up (Jaffee, Shires, & Stroumsa, 2016). Purpose Nurse Practitioners and Midwives are supported and encouraged to seek out additional opportunities for education on gender affirming care ("NPWH Position Statement," 2018; American College of Nurse Midwives [ACNM], 2012). Safer et al. (2016) data demonstrates TGNB individuals do not seek out healthcare because there are insufficient providers who are educated to their needs. With rapidly changing vocabulary and pronoun use providers may feel ill-equipped to handle a basic introduction, let alone the intricacies of hormone therapy and primary care (Chipkin & Kim, 2017). Lack of TGNB curricula in medicine has been identified as a primary cause of undereducated healthcare providers (Korpaisarn & Safer, 2018). Current estimates indicate 0.58% (1,397,150) of the adult population in the United States self-identify as transgender; 0.7% (150,000) of the US adolescent population; and 0.36% (7,200) of the adult population in the state of Utah (Flores, Herman, Gates, & Brown, 2016). Although underreported these numbers represent a clinically significant portion of the population with unique healthcare needs. Methods A needs assessment survey (NAS) was emailed to the clinic director of a midwifery practice in Salt Lake City, Utah. The NAS was comprised of questions focused on assessing provider willingness to learn, motivation for learning, and areas of interest within transgender healthcare. Providers were not compensated for their time or participation in the NAS. It took approximately two minutes to complete and there was a 95% (n=19) completion rate. Providers were invited to complete the free online education module Clinical Care for Transgender and Gender Nonconforming Patients (Cassidy-Brinn, Ellis, McGuinness, & Deutsch, 2015). The online education module was created by Cardea Services which is a company dedicated to research and online training for adult learners (Cardea Services Website, 2019). A focus group was held with providers to gather feedback on the module, identify previous trans-specific education, assess attitudes towards care of TGNB individuals, and identify future areas for improvement. Findings Common themes from the focus group in addition to needs assessment data showed interest (n=16, 84.2%) in receiving education but limited time to pursue it. They desired improvements to their electronic medical record listing preferred pronouns adjacent to preferred name as well as an expanded gender marker, such as MTF of FTM, rather than male or female (where applicable). Time was spent during the focus group addressing the importance of educating graduate students through didactic and simulation-based learning. Previous research has called for addressing gaps in education identifying that LGBTQ individuals do not seek out care from providers who are not educated in caring for them (Safer et al., 2016).