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Bias may affect providers’ knowledge of trans health

According to a study, increased hours of education related to caring for transgender patients may not correlate to more competent care.

Photo by Sharon McCutcheon from Unsplash.com

As it is, transgender people already face many barriers in accessing health care, from dealing with issues with intake forms that use non-inclusive language, to challenges finding providers who are knowledgeable about transgender-specific health issues.

But a Michigan Medicine-led study is suggesting that more training may not be the answer to improving competent care, since this study found that more hours of education in the field was not associated with improved knowledge of transgender care among physicians and other providers.

Published in the journal Medical Education, the study found that nearly half of providers said they had cared for a transgender patient, but as many had received no training on the topic. What distinguished knowledgeable providers from those who were less so, however, appeared to have little to do with their medical education.

Transphobia, or a prejudice against people who are transgender, was the only predictor of provider knowledge.

“We were surprised to find that more hours of education about transgender health didn’t correlate with a higher level of knowledge about this topic among providers,” said lead author Daphna Stroumsa, M.D., MPH, an obstetrician gynecologist at University of Michigan’s Von Voigtlander Woman’s Hospital and a National Clinician Scholar at the U-M Institute for Healthcare Policy and Innovation.

“Transgender and gender diverse individuals often face discrimination in health care settings and many are unable to find competent, knowledgeable and culturally-appropriate health care,” Stroumsa added. “Lack of provider knowledge is a significant barrier, but our findings suggest that simply increasing training may not be the solution.

Because of this, “medical education may need to address transphobia and implicit bias in order to improve the quality of care transgender patients receive,” Stroumsa said.

Researchers surveyed 389 attending physicians, advanced practitioners and residents from the departments of internal medicine, family medicine and obstetrics and gynecology in a large urban health system.

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It is worth noting that the study did not evaluate the content or format of the education providers were exposed to; but it is still likely that educational efforts that address unconscious bias would be more effective. Stroumsa noted that even in educational programs that address transgender health, the topic is usually presented as a separate section of provider education, rather than as an integral part of general medical education and training – a distinction which may further fuel “othering” of transgender patients.

Many providers – especially those traditionally considered “women’s health” professionals – likely need to be better prepared to care for transgender patients, Stroumsa said.

People who identify as transgender and non-binary may require many of the services provided by Ob/Gyns and other “women’s healthcare” providers, including prenatal and fertility care, cervical cancer screening, menstrual cycle management, as well as gender transition-related care (i.e. hormone therapy), and other routine Ob-Gyn care.

“We obviously have a lot of work to do in improving health outcomes for gender diverse people,” Stroumsa said. “We need to take a close look at our healthcare environments, practices and approaches to medical education. These are just beginning steps in reducing wide health disparities. Creating a safe, knowledgeable, trustworthy care environment will help us expand the care we provide to a broader more diverse patient population.”

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