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Transgender health care lacks multidisciplinary training
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As more transgender patients seek accessible and affordable health care, nonhormonal aspects of transgender care remain underemphasized in endocrinology fellowship programs, according to an analysis of survey data.
“Providers and trainees in endocrinology need to become competent in transgender health care,” Caroline Davidge-Pitts, MBChB, of the division of diabetes, metabolism and nutrition at Mayo Clinic, told Endocrine Today. “Our research suggests an education deficit in endocrinology fellowship programs, and physicians in practice have low confidence in nonhormonal topics. We have identified barriers to education, which can provide a platform for improved curriculum development in training programs and better provider exposure to transgender health topics.”
Davidge-Pitts and colleagues administered an anonymous web-based survey to 104 endocrinology fellowship directors and 6,992 U.S. members of the Endocrine Society (8% pediatric endocrinologists); 54 program directors and 411 health care providers responded. The survey, in two parts, assessed the status of transgender health care in U.S. endocrinology fellowship training programs, as well as the knowledge and practice of transgender health among practicing clinicians with an interest in endocrinology (questions were designed with a five-point Likert scale).
Among the 54 responding program directors, 35 reported providing dedicated teaching on transgender health topics — 37% were in the Northeast; 32% in the Southeast; 20% in the Midwest; 11% in the Southwest; none were in the Northwest. Endocrine faculty members provided most of the education (97.2%); all provided education regarding hormone therapy. However, researchers noted that only 22 programs provided comprehensive transgender-orientated sexual and social history taking, whereas 14 programs provided education on systemic physical examination and 13 provided education on psychosocial and legal issues. Providers cited a lack of faculty interest or experience, lack of training resources or a lack of funding as perceived barriers to providing such education, according to researchers.
Among 411 responding Endocrine Society members, 79.8% reported treating a transgender patient during their career, and 55% reported treating more than five patients per year; however, 80.6% of those members reported never receiving training on the care of a transgender patient. Among those who reported receiving training, 58% reported receiving education during their endocrinology fellowship, and 52.7% received education at meetings. Very little education occurred during medical school or internal medicine residency (4% and 6.7%, respectively), the researchers wrote.
“The awareness of transgender health care issues has increased, leading to improved coverage of both hormonal and nonhormonal therapies,” Davidge-Pitts said. “In endocrinology practices, there is an increased demand for providers who are competent in these areas. We need to educate our current and future endocrinologists to ensure that the needs of our transgender patients are met.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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The survey results are not surprising. Multidisciplinary transgender care was not part of previous training programs, but that is changing.
Fellows in training should be at least aware of available guidelines and be able to provide culturally sensitive and diverse care not only to transgender people, but to anyone. Some of the programs have responded, and they are starting to add this curriculum to their programs.
At Emory, we employ simulations in our program, including a simulated patient who is transgender. This is a way for fellows to get feedback from the faculty and the simulated patient, plus their own personal feedback when they review the recording of the encounter. The Endocrine Society is also in the process of updating its transgender guidelines. In addition, there are now several national conferences being held on transgender care. The first conference of the United States chapter of the World Professional Association for Transgender Health (WPATH) will be held in the U.S. in a few weeks (February 2-5), and many faculty will be attending that meeting. It’s really exciting to have U.S. providers getting together and sharing best practices on transgender care. These things, together, help to facilitate changes.
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