Simulation for Mental Health Care Providers Treating Transgender Veterans: A Practice Improvement Project

Background: Transgender patients, including transgender veterans, face structural and personal discrimination in every level of society. The same discrimination is well documented in healthcare settings despite policies and education in universities and employment settings that encourage cultural competency and equity in treatment for all patients. This is evidence of inadequate educational and professional training and exposure to work with this patient population. Methods: This practice improvement project included a brief educational lecture and simulation which was designed, piloted, and implemented to improve mental health provider knowledge and comfort working with transgender veterans. Survey data were collected before and after the simulation. Debriefing was completed with trained experts after each simulation scenario. Results: Four, racially diverse, mental health professionals participated in this simulation. In a survey with a score range of 25-100 points, knowledge and comfort scores improved from 73.17 (SD=12.56) to 83.61 (SD=10.75). Survey data showed simulation to be educational (EPQ avg = 4.1/ 5), well designed (SDS avg = 4.08 /5), and satisfactory (SSCL avg = 3.9/ 5). Conclusion: This project helped participants feel more comfortable and knowledgeable working with transgender veterans by providing instruction on best practices, then encouraging the use of these practices in a safe, non-judgmental environment - simulation. Prior to simulation, participants all felt underprepared to take a complete sexual history, a standard element of initial assessments. Designing standardized patients to include unique demographics are helpful in improving cultural sensitivity training while practicing universal skills like taking a sexual history.