Trans standardised patients can help bridge gap in care

By acting out scenarios commonly seen in the clinic, real-life transgender actors can help medical residents learn to provide care that is more sensitive to people with different gender identities, suggests a recent study.

The results indicated that good communication skills helped some residents overcome their lack of transgender-specific clinical acumen and that going through this scenario training with a transgender actress helped them to shed preconceptions and be better prepared for the clinic.

Lead study author Richard E. Greene from NYU Langone Medical Center said, "The opportunity to interact with a transgender patient in a low-stake setting during medical training increased trainees' comfort during future real-world outpatient encounters."

Greene added that even those who had baseline knowledge of care for transgender patients before the study found that learning in this safe, simulated way added value in helping them provide more sensitive care for transgender patients.

The authors designed the current study after many conversations with transgender patients who reported feeling discomfort, discrimination, and insensitivity in health care settings.

To study the problem, the research team employed a common teaching strategy that uses a "standardised patient," an average person trained to consistently portray a patient in a certain medical situation.

Each trainee in a class interviews the patient, seeking to determine the person's medical needs, communicate options and offer reassurance.

A transgender actress/standardised patient, who acted out a common outpatient scenario, rated the 23 internal medicine residents on their ability to communicate and to leave the patient satisfied with the interaction.

In the specific clinical scenario used in the study, the transgender actress was taking the anti-androgen hormone, spironolactone, for reducing masculinisation, along with the feminising hormone estradiol.

She also came in for hypertension and had dangerously high blood levels of potassium, a condition known as hyperkalemia. The patient then expressed the desire to undergo an orchiectomy, a procedure for removing the testicles.

The average scores using a newly designed behavioural measure achieved by the residents were 89 percent for overall communication and 85 percent for satisfaction.

The residents were tasked with exploring and respecting the patient's treatment goals, given her hormonal transition hormone therapy and to make a plan for managing her hypertension and hyperkalemia.

This study is published online in the Journal of Graduate Medical Education.

-ANI