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Assessing the Role of Pronoun Competency Training in the Expansion of Transgender and Gender Diverse Curriculum in Undergraduate Medical Education
Morgan, R. [1]
Buckley, S. [1]
Scotten, M. [1]

Journal: Journal of Osteopathic Medicine Date: 2024/12, 124(12):Pages: A112-A113. doi: Subito , type of study: pretest posttest design

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2024-2000/html)

Keywords:

curriculum [291]
gender diverse [1]
medical students [647]
osteopathic medicine [2025]
pretest posttest design [217]
pronouns [1]
transgender [8]
undergraduate medical education [78]
USA [1656]

Abstract:

Context: Individuals who hold sexual or gender minority (SGM) identities are often subject to discrimination at the hands of providers, with 56% of sexual minority-identified patients and 70% of gender minority-identified patients reporting at least one incident of healthcare-based discrimination in their lifetime (1-3). Studies have found that many providers admit to discomfort and a general lack of willingness to discuss relevant topics or perform routine screening tests on SGM patients (1, 2, 4). These barriers, discrimination, and incompetencies lead to significant adverse health outcomes for this community (2,5,6,7). This population often reports feelings of fear, shame, and general unease when seeking medical care (2,3,5). Because of this, SGM individuals are more likely to avoid seeking out preventative medicine, routine follow-up, and acute healthcare than their heterosexual and cisgender counterparts (2,5,6,7). Resulting disparities in health outcomes are especially obvious in sexual health, mental health, and routine cancer screenings (2,5,6,7). The prevalence of this inequity is due in part to the lack of provider knowledge about SGM identities and their specific healthcare needs (1,2,4,8). This knowledge deficit among the provider population is present and pervasive at all levels of experience due to a lack of adequate education in SGM healthcare topics during undergraduate and graduate training programs (1,2,4,8). A growing number of educational approaches have been implemented in undergraduate medical education to advance students’ competency in this area (9-12). Modalities used and studied include didactic lectures, panels, seminars, group work, case-based learning, and standardized patient encounters (9-12). Many of these educational interventions have shown significant short-term improvements in knowledge, comfort, and attitudes; however, there is a notable lack of long-term efficacy data 9,10. The study team is not aware of any studies that have looked specifically at the role of pronoun competency training in education for undergraduate medical students. Objective: To identify current self-perceived knowledge gaps about gender identity, gender pronouns, and health disparities that can be addressed by future curriculum. Methods: The New York Institute of Technology College of Osteopathic Medicine introduced a mandatory, student-lead pronoun competency training into the 2023-24 first-year Doctor Patient Relations coursework to enhance didactic curriculum on SGM health needs. A pre-test/post-test design was used to assess student comfort, perceived knowledge, and inclusive behaviors before and after watching the lecture. Five Likert-type responses were collected pre- and post-lecture to gauge comfort using proper pronouns, understanding of SGM definitions—including a specific question about the terms cis/transgender—, awareness of barriers to care for SGM patients, and initial and future willingness to engage in inclusive behaviors. Two open-ended questions were asked post-lecture to allow for free-response answers from students on key knowledge outcomes and areas of knowledge gaps or further questions. Any response that included at least one pair of pre-/post-test answers OR at least one free-response answer was analyzed; 481 responses were included in the final analysis. The student’s paired t-test was used to assess pre- to post-lecture change of Likert data. Qualitative analysis was used to categorize key knowledge outcomes and knowledge gaps and questions. Results: Analysis showed no significant difference between any of the pre-lecture Likert scores of students at the New York campus versus the Arkansas campus. Results further showed that there was significant improvement in Likert scores for all five Likert-type questions at a. Conclusion: As the population of transgender and gender diverse people grows—now said to be anywhere between 0.39% and 2.7% of the total adult population in the U.S. and up to 5.1% in those under 30 years old—the need for inclusive and comprehensive care becomes exponentially more important12,13. This analysis will contribute valuable information regarding the initial knowledge level of incoming first year osteopathic medical students. The results will also provide guidance on where future iterations of curriculum can improve students’ understanding of SGM health needs and develop their interpersonal communication skills to be inclusive of patients and peers of diverse gender identities.

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