Trans education

[OmalleysAnatomy]

I am working on my list of schools and I was wondering if there are any schools that definitely teach or have an opportunity to learn about transgender medicine specifically. I am very interested in treating the trans community someday and am almost positive it's not taught everywhere.
I could go to every website individually, which I might do eventually, but am hoping you guys might be able to suggest a few for me to definitely not miss.
Thanks!

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[EZR]

http://www.amsa.org/gender/programreviews.cfm

Check that link out. The student reviews may clue you in on whether the schools include much about LGBT health in the curriculum. Some schools may have electives on LGBTQ health disparities (or an even more general class for health disparities) - but I feel like the core curriculum of any school will have very little focusing on the complexities of transgender health. Again, this sort of content will most likely be found in an elective.

ALSO very important. You want to look into schools that have clerkship sites or affiliated hospitals that have doctors that have a special interest in transgender needs (some hospitals even have "trans health centers"). In addition, if you're in an urban setting, more than likely there will be an LGBTQ community health center around that you could work with throughout your med-schooling.

Hope this helps!

 

[Doctor Strange]

A couple of weeks ago, we had Sexuality and Gender-based medicine week where we talked a lot about LGBT issues and sexual health. It wasn't en extensive module, but we definitely touched on it.

 

[OmalleysAnatomy]

Thanks! I'll definitely check out that link.

 

[DR MOM]

UCSF is awesome for trans health. Also, if you go to Harvard you can do some of your rotations at Fenway Health, which is an amazing clinic. Other Boston schools might also have connections. It's actually transgender awareness week right now, so you can check out great resources on Twitter if you follow the hashtag #transwk.

 

[styphon]

ALSO very important. You want to look into schools that have clerkship sites or affiliated hospitals that have doctors that have a special interest in transgender needs (some hospitals even have "trans health centers"). In addition, if you're in an urban setting, more than likely there will be an LGBTQ community health center around that you could work with throughout your med-schooling.

My med school did not offer much of anything for LGBT health in the first 2 years. But I would agree with the above statement, the city the medical school is in has multiple LGBT health clinics, one of which I know is receptive to medical students. So it is more than just looking at the med school - it is also about seeing what the community has in resources/clinics.

 

[OmalleysAnatomy]

I never thought about starting with trans clinics first then looking into med schools around them. I think that'll help narrow the search a lot.
Thanks everyone!

 

[Goro]

You'll have to do the detective work, but there are schools out there that I believe are required by state law to include such aspects in their Sexual Medicine curriculum.

True story: one of my students was on rotations and went to see a patient in hopsital. Student looked at chart and saw "Bill Jones" as patient's name.

So student goes up to patient and says "Hi, Mr Jones, I'm X, a medical student, and I'm here to do blah blah blah."

Except Mr Jones was actually Grace Jones, a post-op transseuxal.

Ms Jones did NOT take to kindly to my student's greeting and raised a huge ruckus.

The students are more careful to check charts and notes now.

I am working on my list of schools and I was wondering if there are any schools that definitely teach or have an opportunity to learn about transgender medicine specifically. I am very interested in treating the trans community someday and am almost positive it's not taught everywhere.
I could go to every website individually, which I might do eventually, but am hoping you guys might be able to suggest a few for me to definitely not miss.
Thanks!

 

[otterxavier]

Unfortunately, many schools that include LGBTQ health topics in their curricula don't necessarily give much attention to the T. (Even the concept of "LGBTQ health" glosses over the reality that transgender people have very different health needs than cisgender LGBQ people.)

There's a report from a few years ago called Project: Transgender: The Missing "T" in Medical Education that surveyed medical school deans and students -- they established that med students are generally much less equipped to deal with trans health issues than LGBQ health issues, but didn't discuss curricula at specific schools. (here and here)

A few schools that have clinics specifically focused on trans health:
- The Center of Excellence for Transgender Health at UCSF
- The Transgender Clinic at Dartmouth-Hitchcock
- The Comprehensive Gender Services Program at the University of Michigan
- The Center for Sexual Health at the University of Minnesota

The other thing you could do is contact doctors in the specific area of transgender medicine that you're interested in (surgeons, endocrinologists, gynecologists, primary care physicians -- there are a lot of ways in) and ask how they got their training and what they'd recommend for someone who's considering entering the field. There are a few good online directories of doctors who work with trans communities -- feel free to PM me if you want links to those resources 🙂

 

[Ellie Arroway]

As far as didactic stuff, it's a mixed bag. At my school (University of Washington) I am on the planning committee for a new trans health elective course that will get launched this spring. I know a third year that arranged an elective rotation at Fenway Health doing primarily trans care & HIV care, and I believe he also managed to finagle an elective surgery rotation with Marci Bowers, who does gender reassignment surgery. Often you have to make your own opportunities. If it's not there, build it.

 

[otterxavier]

As far as didactic stuff, it's a mixed bag. At my school (University of Washington) I am on the planning committee for a new trans health elective course that will get launched this spring. I know a third year that arranged an elective rotation at Fenway Health doing primarily trans care & HIV care, and I believe he also managed to finagle an elective surgery rotation with Marci Bowers, who does gender reassignment surgery. Often you have to make your own opportunities. If it's not there, build it.

That is fantastic -- and congrats on getting the course launched! Are other schools creating electives in trans health, or is UW the first that you know of?

 

[otterxavier]

There's also this:

Safer has recently piloted a transgender medicine component to the pathophysiology curriculum for medical school students at BUSM. According to pre- and post-course surveys published this summer in the journal Endocrine Practice, there was a 67 percent improvement among students enrolled in his course regarding their confidence with transgender medicine.

Safer is working to develop comprehensive transgender medicine training curricula for medical students, physician trainees, teaching physicians and other health care professionals. to address the specific biological distinctions of the patient group and evidence-based treatment paradigms derived from that biology. This training programwould increase access to safe care for transgender patients.

 

[DR MOM]

There's also this:

That is awesome! I got a really good vibe from BU when I interviewed.

 

[RoseHelene]

I am working on my list of schools and I was wondering if there are any schools that definitely teach or have an opportunity to learn about transgender medicine specifically. I am very interested in treating the trans community someday and am almost positive it's not taught everywhere.
I could go to every website individually, which I might do eventually, but am hoping you guys might be able to suggest a few for me to definitely not miss.
Thanks!

First: Thank you for being interested in treating trans communities. There's such a desperate need for competent health care providers it breaks my heart. Gender and sexual minorities are the underserved communities I'm focused in.

But I really highly doubt you'll get much trans medicine education in medical school. As I recall the average # of hours for LGBT issues in general is 4. I would bet that the majority of that time is spent on LGB issues like HIV prevention/treatment in MSM, taking sexual histories, knowing what health issues to screen for (obesity, substance use, depression/anxiety) and the like. Trans people are <1% of the general population - logically, why would the school spend lots of time on it given its complexities? I happen to disagree with minimizing trans issues but I do see logic.

I think your best bets include...

• Self-teaching. It's what I started out with. Read the protocols, join in discussions with both trans and medical communities, and read the research!
• Finding a mentor as a pre-med. For me this was by volunteering with a trans health program that happened to be near me. It was really super helpful to have a good grasp on trans medicine when I started.
• Doing a rotation (or two, or three) in the field.
• Arranging materials and talks at your school, wherever you go.
• Attending conferences. The National Transgender Health Summit, Philly Trans Health, Gender Expansion Conference, and Gender Spectrum all spring to mind and I'm sure there are others. WPATH's tends to be out of the country so I don't generally recommend them.

As others have mentioned, you can start with looking for clinics and narrow down that way. Any school in the Los Angeles area, for example, is at least somewhat close to Children's Hospital Los Angeles which has a trans youth program. Anywhere in the San Francisco Bay Area is close to half a dozen programs, not even including Dr. Bowers and Dr Crane who are nearby.

If I can help you at all, either with learning trans medicine or finding clinics/hospitals/programs, or...heck anything else, send me a PM.

 

[darkjedi]

Philadelphia has a large LGBTQ+ community and so there has been a movement to try and include more information and education about the population in our curriculum at Penn. In the past few years, it seems we have made some pretty big strides as far as making sure that we as students are aware of the issues surrounding the community.

Since it's such a 'recent' thing, and being how jam packed med school is already of information. Don't expect the curriculum to spend more than a few days on LGBT issues during preclinicals at any school. That said, med schools everywhere could benefit from passionate people who are willing to improve the curriculum in these fields.

 

[Gauss44]

I hope trans education becomes widespread because I've heard a lot of transgender people complain about not being able to find adequate healthcare, especially when it involves endocrine disorders and specific body parts. I've heard the same from some intersex people which may be another topic.

I wish that the healthcare centers that specialize in LGBTQ (and those that don't) would define "transgender" too or be more specific when they ask about it. It seems that there are many different definitions floating around. It's never clear what someone means when they say, "transgender." I don't know if they mean a person who's gender identity doesn't match their assigned sex at birth, a person with GID, or something else.

Insurance companies* are coming around, major corporations* are coming around, it's time for doctors to come around to support human rights for everyone as well. Just my opinion!

*Page 9 lists companies offering Transgender Inclusive Health Insurance Policies: http://www.hrc.org/resources/entry/transgender-inclusive-benefits-for-employees-and-dependents

 

[WaylonS]

From my experience at conferences, all the Philly schools, NYU, JHU, Tulane, and USC have well organized LGBT med students groups and offer courses on LGBT health and/or have pushed their schools to integrate more LGBT issues into the curriculum. Specifically, these courses/curriculum changes include addressing health issues and disparities within the trans community.

BTW, there are more schools with LGBT groups than are listed on the AMSA website

 

[vagabondrunning]

UCSF is awesome for trans health. Also, if you go to Harvard you can do some of your rotations at Fenway Health, which is an amazing clinic. Other Boston schools might also have connections. It's actually transgender awareness week right now, so you can check out great resources on Twitter if you follow the hashtag #transwk.

If you're in Boston, check out Boston Healthcare for the Homeless, too, if you go to Boston University SOM. They directly address LGBTQ issues. I was really impressed when I went on a tour of that facility.

 

[DermViser]

You'll have to do the detective work, but there are schools out there that I believe are required by state law to include such aspects in their Sexual Medicine curriculum.

True story: one of my students was on rotations and went to see a patient in hopsital. Student looked at chart and saw "Bill Jones" as patient's name.

So student goes up to patient and says "Hi, Mr Jones, I'm X, a medical student, and I'm here to do blah blah blah."

Except Mr Jones was actually Grace Jones, a post-op transseuxal.

Ms Jones did NOT take to kindly to my student's greeting and raised a huge ruckus.

The students are more careful to check charts and notes now.

Then maybe your label on the patient's chart should have been clearer.

 

[Goro]

Well, yeah...except, I'm not clinical faculty.

Then maybe your label on the patient's chart should have been clearer.

 

[Gauss44]

Then maybe your label on the patient's chart should have been clearer.

Another way to phrase that without the Mr./Mrs./Ms./Miss part would be to walk in the room and say the patient's name in a neutral tone like you were checking the waiting area for a patient, "Bill Jones?" (pause) Bill Jones: "Yes, hi." Dr.: "My name is Dr. Smith, what brings you here today?"

IMO, guessing at someone's gender can be awkward or even insulting - the alternative is to give a gender free greeting. It's always possible to just say a person's name in a professional tone without Mr./Mrs./Ms./Miss. Using the whole name is more accurate too in case there's several "Mr. Jones'" (and a Ms. Jones that gets called Mr. Jones) and you have the wrong one.

Addressing people by the wrong gender repeatedly is likely to make someone mad even if they don't correct you. Some people get tired of correcting others about their gender because what comes next (for some people) are comments like, "Wow, you sure look like a guy/girl because (unwelcome analysis here)." A multitude of endocrine disorders, intersex conditions, cultural factors, and gender factors can impact appearance.

Since this is a pre-med discussion, I might mention that wrong assumptions about gender can also lead to wrong assumptions about age, fitness, sanity, etc. For example, I know someone who has a gender ambiguous appearance due to an endocrine disorder. In this particular case (not in every case), when people think he's female, they assume he's 50 years old or more. When they assume he's male, they think he's in his 20's. It's a perspective thing that strongly impacts how different age and gender groups treat this person, how his behavior is interpreted (odd versus fine, etc.). Imagine someone who you assume is 50 talking about going to medical school in 5 years.

For these reasons, I also believe that it is important that doctors are trained to ask about an individual's gender and sex in appropriate ways. If relevant to treatment, a doctor might as specifically about what parts a person has, if they are taking any hormones, if they have a history of endocrine disorders, and what pronoun a patient prefers. Insurance does NOT always accurately indicate someone's gender identity or physical sex as many of you probably already know!