A Systematic and Practical Framework on Gender and Sexual Diverse (GSD) Health for Internal Medicine Residents

Internal medicine (IM) residents often lack the knowledge, comfort, and competency to care for gender and sexual diverse (GSD) patients, contributing to health disparities. We developed a practical, evidence-based framework providing residents with a systematic, stepwise approach to addressing GSD health needs.

The curriculum was implemented at an urban safety-net hospital for 46 IM residents. Two 2-hour sessions utilized a case-based, small-group, interactive scenario of a transgender woman requiring screening and treatment of sexually transmitted illnesses (STIs), pre-exposure prophylaxis (PrEP) prescription, and gender-affirming hormone therapy (GAHT) initiation. One-page handouts with step-by-step instructions were provided. Surveys evaluated knowledge, attitudes toward the importance of GSD care, and perceptions of confidence in performing specific skills related to GSD care. Wilcoxon signed-rank tests were used to compare pre- and postsession answers.

Residents' perceived confidence in providing GSD sexual health care and prescribing PrEP and GAHT increased after the sessions (p < .001). Attitudes regarding the importance of obtaining comprehensive sexual histories, discussing gender identity, assessing gender dysphoria, and offering GAHT for GSD patients also increased (p < .001). The median number of correct responses to five knowledge-based questions increased from 1 to 4 (p < .001).

This curriculum improved residents' perceptions of the importance of providing GSD care, as well as their knowledge and confidence in clinical skills related to STI screening and treatment, PrEP prescription, and GAHT initiation. This curriculum offers IM residents one of the first systematic frameworks, with immediately useable materials, to address GSD health.