Caring for transgender cancer patients: Shortcomings of medical education.

Abstract

11002 Background: Caring for transgender patients requires specific knowledge and skills. Medical schools spend less than 5 hours on average training for treatment of LGBT patients (Obedin-Maliver, JAMA, 306 (9), 971). This paper assesses the knowledge on the topic and skills of postgraduate Oncology students from Universidad del Salvador at the Observational Standard Clinical Examination (OSCE) 2019 (JCO 34 (15), Abstract e18150, 2017). Methods: At one of the stations of OSCE 2019, students had thirty minutes to complete a clinical record of a simulated transman patient with ovarian cancer stage IIIC. Based on the real case of Robert Eads, actors were trained with the documentary on his life “Southern Comfort”. Students were assessed on: A) knowledge of the transman condition, B) use of preferred gender pronoun by the patient, C) discontinuation of testosterone treatment, D) recommendation of genetic study, E) treatment of ovarian cancer according to NCCN guidelines, F) moral discomfort with LGBT patient care. All interviews were filmed or recorded by an observer. All films, recordings and clinical records were reviewed to rate the students' performance. Results: A total of 25 postgraduate Oncology students took the OSCE 2019. Assessment: A) 5/25 (20%) lacked knowledge of the transman condition, B) 3/25 (12%) did not use the patient's preferred gender pronoun, C) 17/25 (68%) discontinued testosterone, D) 23/25 (92%) requested genetic study, E) all students treated ovarian cancer according to NCCN guidelines, F) none expressed moral discomfort with LGBT patient care. Conclusions: 1) It is feasible to assess the knowledge and skills required for treatment of transgender patients in Oncology. 2) We found shortcomings of student's medical training regarding transgender patients: one in five did not understand the patient's condition, three did not use the patient´s preferred gender pronoun during the interview and more than half suspended the necessary hormone therapy for their condition. 3) This emphasizes the need to deepen our medical and communication skills in order to assist the transgender population and should be included in future ASCO-ASH milestones for specialty accreditation.