Transgender Health Emergencies: A Simulation on Ruptured Ectopic Pregnancy in a Transgender Man

Ruptured ectopic pregnancy is a rare emergency that occurs when an embryo implants and grows outside of the uterus. Despite testosterone use, transgender men with female reproductive anatomy remain at risk for ectopic pregnancy.

This 1-hour-long simulation featured a 28-year-old transgender man with ruptured ectopic pregnancy who presented to the emergency department following a syncopal episode with abdominal pain. Learners completed a history and physical examination, ordered and interpreted laboratory and imaging studies, stabilized the patient, and consulted for definitive management. Each session included a prebriefing, the simulation case, debriefing, and postsimulation survey.

Fifteen medical students participated in the simulation, conducted twice during a dedicated simulation day. Learners agreed that this simulation raised their index of suspicion for gynecological emergencies in transgender patients and taught them how to diagnose and manage ruptured ectopic pregnancy. Level of confidence in diagnosing and managing ruptured ectopic pregnancy after the simulation was between fairly and completely confident. Learners also indicated that they were more comfortable communicating with transgender patients and had a better understanding of the concept of premature closure and how biases and assumptions affect care.

This novel simulation allows medical students to practice diagnosing and managing a life-threatening gynecological emergency under unique circumstances while honing their communication skills.