Gender Nonconforming Patients Research Articles

Safe and equitable inpatient care for transgender, nonbinary and gender-nonconforming patients.

Safe and equitable inpatient care for transgender, nonbinary and gender-nonconforming patients.

A Case Series of Transgender and Gender-Nonconforming Patients in a Pediatric Functional Neurologic Disorder Clinic.

Youth who identify as transgender and gender nonconforming (TGNC) are at increased risk of anxiety, depression, bullying, and loss of social and family support. These factors may increase the risk of developing functional neurologic disorder (FND). If the risk of FND is increased in TGNC youth, then identifying which youth are at increased risk, and the particular times when risk is increased, may allow for earlier diagnosis and treatment of FND. Better awareness of functional symptoms among clinicians who care for TGNC youth may prevent disruption of gender-affirming care if FND symptoms emerge. Patients diagnosed with FND who are TGNC may require different forms of intervention than other youth with FND. We present 4 cases from our multidisciplinary pediatric FND program of TGNC youth who developed FND. In all individuals for whom follow-up information was available, access to gender-affirming health care was associated with marked improvement or resolution of FND symptoms.

Intersectional Examination of Gender-Inclusive Care and Women’s Health

Transgender and gender-nonconforming people remain excluded from women’s health spaces, and nurses with expertise in women’s health best serve their needs when they seek sexual, reproductive, gynecologic, or obstetric care. However, commentary regarding the term “women” and exclusionary policies and behaviors in health care marginalize gender-nonconforming patients and contribute to health disparities. Therefore, the purpose of this article is twofold. First, we review terminology related to gender-nonconforming populations and their known health care needs; provide a brief historical overview of gender and health care; and describe the influence of White supremacist, misogynist, and heteronormative influences in women’s health care. Second, we generate a call to action and specifically discuss the responsibilities of nurses and nursing organizations to ensure the provision of gender-equitable and respectful care and generate clinical recommendations for the specialty.

Cancer screening and management in the transgender population: Review of literature and special considerations for gender affirmation surgery.

Literature focused on cancer screening and management is lacking in the transgender population. To action to increase contributions to the scientific literature that drives the creation of cancer screening and management protocols for transgender and gender nonconforming (TGNC) patients. We performed a systematic search of PubMed on January 5th, 2022, with the following terms: "TGNC", OR "transgender", OR "gender non-conforming", OR "gender nonbinary" AND "cancer screening", AND "breast cancer", AND "cervical cancer", AND "uterine cancer", AND "ovarian cancer", AND "prostate cancer", AND "testicular cancer", AND "surveillance", AND "follow-up", AND "management". 70 unique publications were used. The findings are discussed under "Screening" and "Management" categories. Screening: Current cancer screening recommendations default to cis-gender protocols. However, long-term gender-affirming hormone therapy and loss to follow-up from the gender-specific specialties contribute to a higher risk for cancer development and possible delayed detection. The only known screening guidelines made specifically for this population are from the American College of Radiology for breast cancer. Management: Prior to undergoing Gender Affirmation Surgery (GAS), discussion should address cancer screening and management in the organs remaining in situ. Cancer treatment in this population requires consideration for chemotherapy, radiation, surgery and/or reconstruction. Modification of hormone therapy is decided on a case-by-case basis. The use of prophylactic vs aesthetic techniques in surgery is still debated. When assessing transgender individuals for GAS, a discussion on the future oncologic risk of the sex-specific organs remaining in situ is essential. Cancer management in this population requires a multidisciplinary approach while the care should be highly individualized with considerations to social, medical, surgical and gender affirming surgery related specifications. Special considerations have to be made during planning for GAS as surgery will alter the anatomy and may render the organ difficult to sample for screening purposes. A discussion with the patient regarding the oncologic risk of remaining organs is imperative prior to GAS. Other special considerations to screening such as the conscious or unconscious will to unassociated with their remaining organs is also a key point to address. We currently lack high quality studies pertinent to the cancer topic in the gender affirmation literature. Further research is required to ensure more comprehensive and individualized care for this population.

Gender affirming top surgery in transmale vs. gender nonconforming patients: Does gender identity affect patient-reported outcomes?

Gender affirming top surgery in transmale vs. gender nonconforming patients: Does gender identity affect patient-reported outcomes?

Review of adult gender transition medications: mechanisms, efficacy measures, and pharmacogenomic considerations.

Gender dysphoria is the imparity between a person's experienced gender and their birth-assigned gender. Gender transition is the process of adapting a person's sexual characteristics to match their experienced gender. The number of adults receiving sex hormone therapy for gender dysphoria is increasingly and these pharmacotherapies are increasing being prescribed in a general practice setting. The role of hormone therapy is to reverse or reduce physical sexual characteristics of the birth-assigned gender and enhance and build characteristics aligning to the expressed gender and these therapies apply to both transgender and gender nonconforming patients. Recognizing the options and interpreting the effects of gender transition therapies are fundamental to the discussion and treatment of gender dysphoria. This review summarizes pharmacodynamics, comparative dosing, adverse effects, monitoring, and potential pharmacogenetic influence of current pharmacotherapy. These include the use of 17-beta-estradiol, spironolactone, testosterone, GnRH agonists as well as adjunctive phosphodiesterase-5 inhibitors. The article also addresses gaps within the published literature including optimal routes of administration for individual patients, risks of malignancy and dosing reductions as transgender patients age.

Developing medical professionalism in care of gender nonconforming patients: Reflections of second-year medical students after a curricular experience with gender nonconforming people and allies

Introduction Negative healthcare experiences persist for gender nonconforming individuals. Clinician-related factors, including lack of comfort with gender nonconforming persons and unexamined personal biases, present barriers to equitable and affirming healthcare. We explored the effects of contact with gender nonconforming individuals in preclinical medical education through a structured curricular intervention designed to build medical and humanistic knowledge and stimulate the development of medical professionalism surrounding the care of gender nonconforming individuals. Methods A curricular module (didactic prework, time-synchronous online panel discussion, and post-event written reflection) was implemented in a second-year preclinical course in a large multi-campus Midwestern medical school. The module was based on pedagogical foundations of contact theory and reflective writing. Post-event written reflections were investigated using thematic analysis. Results Analysis of 355 written reflections revealed three major themes (moments of insight, topics of confusion, connections to professional identity formation) and eight sub-themes. The findings demonstrated emerging gender professionalism and the importance of contact in professional development. Discussion Contact with gender nonconforming people and the use of written reflections can encourage self-examination and foster professional identity formation among preclinical medical students. Modeling gender-affirming approaches may help counteract negative cultural messages about gender nonconforming people, aiding development of inclusive future physicians.

Transgender and Gender-Nonconforming Populations Experience Unique Challenges in Health Information Environment Developed for Heteronormative Audience

A Review of: Tenny, C. S., Surkan, K. J., Gerido, L. H., & Betts-Green, D. (2021). A crisis of erasure: Transgender and gender-nonconforming populations navigating breast cancer health information. The International Journal of Information, Diversity, & Inclusion, 5(4), 132–149. https://doi.org/10.33137/ijidi.v5i4.37406  Objective – To understand the lived experiences of transgender and gender-nonconforming populations in seeking health information about breast cancer. Design – Thematic literature review. Setting – Four English-language databases featuring clinical, patient engagement, and library and information sciences (LIS) research. Subjects – Twenty-one published articles. Methods – The researchers chose three concepts (trans, LGBTQ+, and breast cancer), identified related terms for each, and used these terms to conduct literature searches in four databases: PubMed, Web of Science, Library Literature & Information Science Full Text, and Library, Information, Science & Technology Abstracts. Search results were reviewed for relevance to the research objective. The researchers applied grounded theory to analyze the 21 selected articles through open, axial, and selective (thematic) coding. The qualitative research software NVivo was used to perform thematic analysis of each article, and a shared codebook was developed to ensure saturation of axial themes and consistency of coding amongst researchers. Main Results – Three overarching themes emerged from selective coding that exemplify experiences of transgender and gender-nonconforming persons seeking health information about breast cancer: access, erasure, and quality. Compared to their cisgender peers, these historically marginalized populations and their caregivers experience more difficulty accessing the already limited breast cancer information, healthcare, and support services suited to their needs. In particular, transgender and gender-nonconforming patients are often burdened with choosing between receiving health information and care designed for heteronormative persons and risking self-disclosure and possible discrimination by culturally incompetent health professionals. Conclusion – The researchers noted the alarmingly limited resources available for gender-nonconforming patients seeking information and support for health matters other than mental health or sexually transmitted diseases. The researchers also called for increased efforts by LIS curriculums and professionals to study and understand the needs of transgender and gender-nonconforming patrons, and to improve the quality and quantity of information resources specifically dedicated to these unique populations.

Increasing Inclusivity and Reducing Reactance During Provider-Patient Interactions.

Significant health disparities exist for trans and gender-nonconforming patients, in part caused by a reduced likelihood of seeking health care due to experienced discrimination in health care settings. Increasing inclusivity in patient-provider interactions can decrease barriers to care seeking for these patients, but such advice to providers must be simple to implement and account for potential backlash among certain patient subgroups. In 3 studies, we use online samples to experimentally test patient reactions to 2 methods of provider inclusivity signaling: verbal sharing of the provider's pronouns and request for the patient's pronouns (a method frequently suggested in the literature) and the provider wearing a pin indicating their pronouns without verbal sharing or requesting that the patient share their pronouns. Study 1 finds that political orientation significantly moderated the effect of pronoun request on patient satisfaction with the visit, P = .003; satisfaction with the doctor, P = .003; and willingness to return to the provider, P = .007, with politically liberal participants being more satisfied and more likely to return when pronouns were requested and politically conservative participants less satisfied and less likely to return. Study 2 replicated these findings and demonstrated that such backlash among conservative participants did not occur when inclusivity was indicated via the provider wearing a pin indicating their pronouns. Study 3 showed that while pronoun pins may be subtle enough to not cause backlash, they are noticed by the target community and increase satisfaction and willingness to return among participants who identify as trans, nonbinary, and genderqueer. These studies were hypothetical scenario studies run online rather than field studies. These results suggest that recommendations for increasing inclusivity should account for potential negative impacts on the practice from more politically conservative patients and that more subtle methods of indicating an inclusive health care environment are likely to be more implementable for practitioners in the field while still positively affecting the target population. Increasing inclusivity in health care settings by verbally sharing and requesting pronouns can cause backlash and aggression among politically conservative patients.More subtle methods of inclusivity signaling such as providers wearing pins sharing their own pronouns do not have this type of backlash effect and increase satisfaction and willingness to return among non-cisgender patients.Recommendations for increasing inclusivity in health care settings should consider negative reactions from other patient subgroups to ensure recommendations are those providers are likely to be willing and able to implement long term.

115. Automated Identification of Transgender and Gender Non-conforming patients from Electronic Health Record Data

115. Automated Identification of Transgender and Gender Non-conforming patients from Electronic Health Record Data

ODP415 Inclusion Health Clinic: Gender-Affirming Hormone Therapy & Surgery Booklet and Review of Efficacy in Patient-Provider Encounters

Abstract While gender-inclusive health has been a growing field, comprehensive information on the topic has lacked for both patients and providers. The "Inclusion Health Clinic (IHC) Gender-Affirming Hormone Therapy & Surgery" booklet, modelled after other Froedtert Health resources and created using guidelines from Endocrine Society, University of California, San Francisco, and World Professional Association for Transgender Health (WPATH), was introduced to IHC on April 28, 2021. Its goal was to facilitate patient-provider relationships through sharing clinical knowledge and practice preferences with patients as well as to assist providers in communicating concepts to individuals seeking advice and care. Booklet efficacy was analyzed through anonymous surveys self-selected among transgender and gender-nonconforming patients seen at Inclusion Health Clinic. Regardless of gender identity or new patient status, 100% of survey respondents found the booklet useful in generating a productive conversation. For numerical questions, averages for all data sets were above 4. 0/5. 0: ease of navigation was rated highest (4.75 +/- .24), followed by scope of care (4.25 +/- .34), and lastly the booklet's utility in explaining concepts (4.15 +/- .36). For qualitative responses, respondents found the most value in pages related to hormone therapy and surgery. Data from the survey was primarily used to improve the booklet; this revision is projected to be distributed to IHC in Spring 2022. The aspiration is for the booklet to evolve as care for the LGBTQ+ population advances, and that it will continue to serve as a relevant and useful source of information on gender-affirming health needs. Presentation: No date and time listed

8944 Outcomes Among Patients Undergoing Gender-Affirming Hysterectomy from 2010-2020: A NSQIP Analysis

<h3>Study Objective</h3> We utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, to study reoperation rates after benign hysterectomy in transgender and gender nonconforming (TGNC) patients. <h3>Design</h3> Demographic data and surgical outcomes between 2010-2020 were abstracted from the ACS NSQIP database. <h3>Setting</h3> ACS NSQIP Database. <h3>Patients or Participants</h3> Current Procedural Terminology (CPT) codes were used to identify patients who underwent hysterectomy for non-oncologic indications. ICD-9/10 codes were used to identify patients with gender dysphoria. 445,997 hysterectomies were performed between 2010-2020, of which 2,011 (0.45%) were for TGNC patients. <h3>Interventions</h3> Associations between gender dysphoria and unplanned re-operation were examined using propensity score-adjusted logistic regression. Propensity scores were calculated using the variables of: Age, race, BMI, ethnicity, hypertension requiring medication, and diabetes. <h3>Measurements and Main Results</h3> The percent of hysterectomies for TGNC patients increased between 2010-2020 (21 (1.0%) to 379 (18.6%), p< 0.01). TGNC Patients were younger (mean age 35.6 vs. 49.5), less likely to use anti-hypertensive medications (12.7 % vs. 29.7%), and less likely to have diabetes (4.4% vs. 9.7%), compared to non-TGNC patients, p< 0.001. Body mass index was similar between groups (28.3 IQR [24.2, 33.4] vs. 29.9 IQR [25.5, 35.7]). The risk of reoperation in this cohort was low overall (6,600 (1.5%)), and similar between groups (6,568 (1.5%) vs. 32 (1.6%), p = 0.747). A propensity-score adjusted linear regression demonstrated no increased risk of reoperation for cisgender compared to gender diverse patients (aOR 1.01 95%CI [0.99-1.01]). <h3>Conclusion</h3> Benign hysterectomy carries a low overall risk of reoperation. There was no difference in reoperation among TGNC patients, even when controlling for differences in health status. Hysterectomy continues to be a safe, medically necessary procedure for TGNC patients.

Do patients want clinicians to ask about social needs and include this information in their medical record?

BackgroundSocial needs screening in primary care may be valuable for addressing non-medical health-related factors, such as housing insecurity, that interfere with optimal medical care. Yet it is unclear if patients welcome such screening and how comfortable they are having this information included in electronic health records (EHR).ObjectiveTo assess patient attitudes toward inclusion of social needs information in the EHR and key correlates, such as sociodemographic status, self-rated health, and trust in health care.Design, participants, and main measuresIn a cross-sectional survey of patients attending a primary care clinic for annual or employment exams, 218/560 (38%) consented and completed a web survey or personal interview between 8/20/20-8/23/21. Patients provided social needs information using the Accountable Care Communities Screening Tool. For the primary outcome, patients were asked, “Would you be comfortable having these kinds of needs included in your health record (also known as your medical record or chart)?”AnalysesRegression models were estimated to assess correlates of patient comfort with including social needs information in medical records.Key resultsThe median age was 45, 68.8% were female, and 78% were white. Median income was $75,000 and 84% reported education beyond high school. 85% of patients reported they were very or somewhat comfortable with questions about social needs, including patients reporting social needs. Social need ranged from 5.5% (utilities) to 26.6% (housing), and nonwhite and gender-nonconforming patients reported greater need. 20% reported “some” or “complete” discomfort with social needs information included in the EHR. Adjusting for age, gender, race, education, trust, and self-rated health, each additional reported social need significantly increased discomfort with the EHR for documenting social needs.ConclusionsPeople with greater social needs were more wary of having this information placed in the EHR. This is a concerning finding, since one rationale for collecting social need data is to use this information (presumably in the EHR) for addressing needs.

Sports Medicine Physicians Comfort and Competence in Caring for Transgender and Gender Nonconforming Patients and Athletes.

The purpose of this study was to explore primary care sports medicine physicians' comfort, competence, education, and scope of training in caring for transgender and gender nonconforming (TGNC) patients/athletes. Mixed-methods, cross-sectional survey. Online. In total, 4300 e-mails were successfully sent with 252 eligible responses received from the American Medical Society for Sports Medicine members. Previous relationships with TGNC persons; previous relationships with TGNC patients/athletes; frequency of care for TGNC patients/athletes. The participants completed a 38-item tool used to assess perceived comfort and competence treating TGNC patients/athletes. Physicians defined "transgender" and described their thoughts on unfair competitive advantage of transgender athletes. Most participants had worked with a TGNC patient (70.2%, n = 177), but far fewer worked with a TGNC athlete (n = 26.6%, n = 67). Among the participants who provided a definition of transgender (n = 183), only 28.4% (n = 52) of participants were able to correctly define the term, whereas most were able to partially (57.9%, n = 106) characterize the term. The most common mechanisms identified for learning about TGNC patients were reading peer-reviewed journal articles (44.8%, n = 113) and CME (41.3%, n = 104). Those with previous TGNC friend/family, patient, and athlete relationships had a significantly different level of comfort and competence treating TGNC patients/athletes. Previous care relationships with TGNC strongly influences comfort and perceived competence of primary care sports medicine physicians. Training, from unbiased peer-reviewed sources of data, is critical to improve care for TGNC patients/athletes.

Cytology and LGBT+ health: establishing inclusive cancer screening programs.

There are substantial disparities in cancer screening for sexual minorities and gender non-conforming patients. In additional to patients having trauma due to negative experiences with the healthcare system, disparities may be heightened due to heteronormative and cisnormative design of screening programs and electronic medical record systems. Furthermore, there are morphologic challenges specific to certain specimen types from the LGBT + population, such as anal cytology samples, cervical cytology from transgender men taking testosterone, and neovaginal cytology samples. Men who have sex with men are at increased risk for anal cancer compared with the general population. While early detection of anal dysplasia decreases the risk of invasive carcinoma, screening programs are not widespread. Cervical cancer screening may be psychologically and physically challenging for transgender men and non-binary patients. The use of exogenous testosterone therapy causes atrophic changes in cervical cytology samples which mimic high-grade dysplasia. The rate of unsatisfactory samples are also increased in this population. Although HPV driven cancers have been reported in patients with neovaginas, there are currently no guidelines about appropriate screening for transgender women and intersex patients who have neovaginas. Cytopathologists can optimize the health of LGBT + patients in many ways including advocating for inclusive screening guidelines, validating self-collection for HPV and cytology samples, updating requisition forms to better capture the spectrum of gender expression, and recognizing the morphologic changes in cytology samples due to exogenous hormone use.

Safe spaces that matter: Material semiotics, affective bodies and queer readings of clinical spaces in Winnipeg, Canada

Communities that claim “2SLGBTQ+” (Two Spirit, Lesbian, Gay, Bisexual, Trans, and Queer plus) identities experience profound inequities within healthcare settings. In response, scholars and advocates have engaged in conversations about creating “safe space,” for them. These “safe spaces” are said to be produced through the display of objects such as pride flag stickers and queer inclusive posters, as well as through “queer friendly” staff trained to meet the healthcare needs associated with 2SLGBTQ ​+ ​people. Such literature, however, often underplays the dynamic heteronormative spacialities of the clinic, and in particular the ways in which gender and/or sexual nonconforming patients negotiate feelings of safety within unequal social fields that assemble an array of human and non-human actors that present in medical space. Drawing on a qualitative study with 42 people identifying as queer and lesbian women and non-binary people living in a mid-sized Canadian city, we employ material semiotics to think through the networked effects of human and non-human entanglements that participants narrate as “safe” or “unsafe.” We argue that current understandings of “safe space” flatten the complex and textured interactions and affective dispositions emergent between queer patients and the clinical environment, and develop the concept of safe spaces that matter – sites of complex bodily and spatial engagements which are highly productive in rendering multiple accounts of the body as either legible in its (hetero)normativity or pathological in its alterity and unreadability. As such, a more spatially embodied and contingent picture of “clinical care” comes into view which, we maintain, is necessary in creating spaces that are truly open to the multiplicity of nonconforming embodiments which present themselves daily in medical space.

Effective and Affirming Communication with Transgender and Gender Nonconforming Patients

Bias is an important but often misunderstood factor in our learning. Too often, when faced with a novel or uncomfortable situation or set of facts, we fall back on what feels comfortable or familiar to us or adopt a stance of “neutrality.” In this instance, neutrality indicates deference to the status quo and an assumption of heteronormative and cisgender identities. Unfortunately, in medical education, this stance can effectively erase or make invisible those patients that do have unique needs, and for whom an awareness of minority identities can make the difference between affirming and competent care, or merely adequate care, or, at worst, stigmatizing care. In this roundtable discussion, we will explore methods by which clinicians and practitioners can utilize more inclusive, non‐stigmatizing, and exploratory language to create more effective, affirming, and inclusive learning environments. Critical to this practice is the knowledge and exploration of our biases and how they affect our assumptions and interactions, and what we can do to help moderate their potential influence, both in education and in practice.

Dual X-Ray Absorptiometry Scan Procedural Variants in the Transgender Population

Transgender and gender non-conforming (TGNC) individuals face numerous barriers to healthcare, which contribute to many health disparities. TGNC persons must initially receive a diagnosis of gender incongruence, previously known as gender dysphoria [1], in order to begin the management of their incongruence with the help of medical interventions such as surgical procedures, and/or hormone replacement therapy (HRT). Despite the expanding use of hormone replacement therapies, the long-term outcomes of HRT on bone health and metabolism, are still relatively unknown. To explore HRT's effects on bone health via measuring bone mineral density, dual-energy x-ray absorptiometry, or DXA, scan has been labeled the gold standard [2]. By using bone densitometry, health care providers are able monitor bone health over time, as well as provide a diagnosis of osteoporosis by using T- and Z-scores. 1. Moser, C., ICD-11 and Gender Incongruence: Language is Important. Arch Sex Behav, 2017. 46: p. 2515-2516. 2. Punda, M. and S. Grazio, [Bone densitometry–the gold standard for diagnosis of osteoporosis]. Reumatizam, 2014. 61(2): p. 70-4. This study's purpose was to analyze what sex and gender was used to calculate T-score and Z-score for individuals who identify as TGNC in the authors’ hospital system. A retrospective chart review was utilized to determine how DXA technicians and physicians are recording, scoring, and reading DXA scans for the TGNC population. The qualitative data was determined as "correct" or "incorrect" based on positions provided from the International Society of Clinical Densitometry (ISCD). 13 DXA scans results were obtained between 11 transgender and gender non-conforming patients. In total, 24 T-scores and Z-scores of the 13 DXA were reviewed and scored. Based off ISCD positions, 58% of the T-score and Z-scores were calculated incorrectly. Like DXA scans, many current healthcare standards and protocols are based on a patient's sex or gender, which may cause confusion amongst healthcare personnel who have not received proper training regarding the TGNC population. This was seen in our present study evaluating standards for bone densitometry in the TGNC population at TUKHS. Ultimately, access to appropriate training regarding gender identity and future research looking to determine HRT's effects on BMD in the TGNC population in the United States is needed to help correct this healthcare disparity.

Listening to Transgender Patients and Their Providers in Non-Metropolitan Spaces: Needs, Gaps, and Patient-Provider Discrepancies.

Trans and gender non-conforming (TGNC) patients need better care; providers need TGNC focused medical trainings. TGNC health conferences can help, yet these events occur mostly in urban centers. Meanwhile, patients in non-metropolitan areas often face significant discrimination and notably poor access to TGNC care. This study explores the ongoing needs of TGNC patients and their providers following a one-day TGNC health conference in a small town in the American Midwest. Exploratory semi-structured interviews were used to gather in-depth information from TGNC conference attendees (N = 25). Theme analysis methods were used to identify areas of need for future trainings. Providers reported that they needed more exposure to TGNC patients, judgement-free opportunities to learn the basics about TGNC care, and ongoing trainings integrated into their medical school and ongoing education credits. Patients needed better access to care, more informed providers, and safer clinics. They cited lack of specialty care (e.g., mental health, surgery) as particularly problematic in a non-metropolitan setting. TGNC patients, and their providers in non-metropolitan areas, urgently need support. Patients lack specialized care and often possess greater knowledge than their health care teams; providers, in these areas, lack opportunities to work with patients and stay up to date on treatments.

Implicit Bias and Caring for Diverse Populations: Pediatric Trainee Attitudes and Gaps in Training.

The objective of this study was to determine the attitudes, skill level, and preferred educational interventions of pediatric residents related to implicit bias and caring for diverse patient populations. A cross-sectional survey of pediatric residents at a single, large urban residency program was utilized. Surveys were completed by 88 (55%) residents who were 69% female and 35% non-White or mixed race. Almost all residents felt that it was very or extremely important to receive training on health disparities, diverse patient populations, and implicit bias. Self-assessment of skill level revealed that residents felt confident in areas often covered by cultural competency curricula, such as interpreter use, but were less confident in other areas. The top 3 areas identified for further training included implicit bias, working with transgender and gender nonconforming patients, and weight bias. For the majority of diversity and bias-related skills, prior training was significantly correlated with higher skill level (P < .05).