Promoting transgender healthcare competency: simulation scenario for medical students

Medical professionals, from trainees to practicing clinicians, often lack adequate preparation to provide care and understand the health needs of transgender and gender diverse (TGD) people, as documented worldwide. As a result, many medical trainees feel unprepared to deliver competent and affirming care to TGD patients. To address this educational gap, this study implemented a simulation-based learning activity as an initial exposure to TGD healthcare. We aimed to assess medical students' attitudes and performance in a transgender healthcare simulation scenario.

We designed and evaluated a simulated scenario for the care of a transgender man with delayed menstruation, with the aim of training Obstetrics and Gynecology (OB/GYN) clerkship students in caring for TGD patients. The simulation and cross-sectional data collection took place in a university hospital located in the northeast of Brazil. From January to June 2023, the OB/GYN clerkship medical students were invited to run a simulated scenario and completed a brief quantitative, survey-based evaluation using a simplified "Scale of Satisfaction with Simulated Clinical Experiences".

Overall, many students reported limited prior experience in caring for transgender and gender diverse patients. For instance, only a small proportion had received formal instruction or had curricular content addressing the distinction between gender identity and sex assigned at birth during their undergraduate program. Similarly, many students acknowledged that sexual orientation may influence the care patients receive. The scenario simulated a consultation for a trans man with secondary amenorrhea, with two trans men participating as standardized patients. Of the 25 undergraduate students taking part, most students demonstrated behavior free from biases or assumptions about patients' identities, although 44% reported difficulty using the patient's chosen name and pronouns due to lack of training, and 60% found it challenging to provide counseling on health promotion and prevention. During debriefing, students expressed discomfort discussing sexual practices and limited knowledge about referral pathways for TGD care services. In general, students found certain aspects of the simulation challenging primarily due to limited prior training, with specific examples described above. Students generally responded positively to the simulation, indicating engagement and willingness to learn.

Simulation-based learning on transgender healthcare is an effective educational tool for medical students with limited prior exposure to TGD topics. Although students faced challenges, particularly in using correct pronouns, discussing sexual practices, and providing preventive counseling, they demonstrated engagement and receptivity to the scenario. These findings suggest that realistic simulation scenarios can enhance cultural competence and prepare students to provide affirming care to TGD individuals, regardless of prior experience learning about and working with this community.