Abstract
Transgender persons face many barriers to accessing health care, including identifying a knowledgeable physician. Medical schools have made curricular changes addressing cultural competence in transgender medicine, but changes are inadequate to graduate physicians competent in gender-affirming health care. The aim of this study was to assess the current state of education on the comprehensive health care of transgender patients, including gender-affirming health care (GAH) strategies (hormone therapy, surgical interventions) in US and Canadian family medicine clerkships (FM clerkships) in addition to the beliefs and actions of the directors making those curricular decisions. Questions regarding transgender education within FM clerkships were included in the 2018 Council of Academic Family Medicine's Educational Research Alliance (CERA) survey of family medicine clerkship directors. The online survey was distributed via email invitation to 128 US and 16 Canadian FM clerkship directors between June 21, 2018 and August 4, 2018. Seventy-two percent (68/94) of FM clerkship directors agreed transgender health care should be a required part of the medical school curriculum. Sixty-six percent report active advocacy within their institutions for increased curricular time devoted to transgender health care. Fifty-six percent (53/94) treat transgender patients in their own clinical practice, but just 26% agreed they were comfortable teaching transgender health care to medicals students. While the presence of transgender patients within the clinical practice did not have a significant impact on FM clerkship directors' comfort teaching this subject, having transgender friends or acquaintances did. FM clerkships are primed for inclusion of comprehensive transgender and GAH education in their curriculum. Increasing comfort of FM clerkship directors in teaching this subject area by providing accessible curriculum may encourage further uptake of this content into FM clerkships.
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