Educating for equity: implementing trans-affirmative competencies in physiology curriculum

Despite legal protections under the Transgender Persons (Protection of Rights) Act, 2019, Indian medical curricula lack trans-affirmative competencies, skills essential for providing respectful, evidence-based care to transgender and gender-diverse individuals. This pilot curriculum development study aimed to longitudinally embed trans-affirmative competencies into the first-year physiology curriculum across theory, practical, ethics, and early clinical exposure (ECE) sessions. Conducted at a public medical school in Delhi, the study involved 170 first-year MBBS students over 11 mo (August 2023-June 2024). Using Kern's six-step approach to curriculum development, we adapted and aligned 16 trans-affirmative competencies with the five roles of the Indian medical graduate: clinician, leader, professional, communicator, and lifelong learner. These were delivered across 1,005 min (16 h 45 min), primarily during ethics (48%) and ECE (36%) sessions. Health humanities tools, such as trigger films, Theater of the Oppressed, lived experiences sessions, thinking ethics, storytelling, and poetry, were used to foster empathy and engage learners with complex socioethical issues. Feedback from all 11 facilitators (100% response rate) indicated unanimous support for the appropriateness and effectiveness of the competencies. Student feedback (92.3% response rate, n = 157) showed that 69.0% found the addition relevant to learning and 80.6% deemed it essential for future practice. This study demonstrates the feasibility of integrating trans-affirmative competencies without disrupting core curricula. It provides a replicable model for incorporating gender-inclusive medical education and highlights the transformative potential of humanities-based pedagogy in fostering inclusive, rights-based health care.NEW & NOTEWORTHY This pilot study is the first in India to longitudinally integrate trans-affirmative competencies into the MBBS physiology curriculum using a mixed-methods approach. Delivered over 11 mo, it demonstrated that nearly 17 h of gender-inclusive education can be embedded without disrupting existing teaching schedules. Using health humanities tools like poetry, trigger films, and Theater of the Oppressed, the curriculum enhanced student engagement and empathy. The study offers a scalable model for incorporating transgender health into early medical education, bridging curricular gaps and aligning with legal and professional mandates for inclusive health care.