Incorporating Gender-Affirming Care in Health Professions Curricula

Without adequate training, many healthcare providers feel unprepared to support and care for trans and gender diverse individuals — a population that already faces greater barriers to accessing care, experiences an increased burden of disease with a significantly greater incidence of behavioral health issues, and has disproportionately higher rates of suicide.

We recently had the opportunity to chat with the Director of LGBTQ and Gender Justice Learning at Yale’s School of Nursing, Nathan Levitt FNP-BC, MSN, RN, BSN, MA and Kognito’s Head of Product, Healthcare Gurnek Singh to discuss how clinicians can better serve their trans and gender diverse patients. Keep reading for a brief summary, or watch the full webinar on-demand on our website.

What are best practices for gender-affirming care?

Caring for a gender-diverse individual, someone who is transgender, who identifies as a different gender than the one assigned at birth, or someone who identifies as neither gender or both, isn’t different from caring for any other patient. It’s more about affirming who they are, establishing trust, and having the awareness and expertise to provide the care that is relevant to who they are.

1. Include gender-diverse options on your patient forms and EHR system
2. Know and record preferred pronouns, and ask every patient for their preferred pronouns (rather than making assumptions)
3. Ask for and use preferred terms for body parts
4. Use gender-neutral terms until you know patient preferences
5. Explain why you’re asking questions surrounding sexuality or gender identity as it relates to their diagnosis or care
6. Post signs and symbols in public spaces that affirm all patients are welcome in your practice

For more detailed guidance related to specific types of care, reference the Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People from the University of California, San Francisco.

For further guidance, check out the resources shared by our presenters:

1. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People
2. National LGBTQIA+ Health Education Center
3. World Professional Association for Transgender Health
4. GLMA: Health Professionals Advancing LGBTQ Equality

Using gender-neutral language in healthcare settings

Any patient may identify as gender diverse, and we wouldn’t know without asking. That’s why you shouldn’t make assumptions, and make it a standard practice to ask all patients for their preferred pronouns. Until that has been established, using gender-neutral language can help you provide sensitive care to all patients.

For example, instead of using “Ma’am,” “Miss” or “Mr.”, you can simply use the patient’s name or ask them what name they’d like you to use. You can also use their full name or simply refer to them as “client” or “patient” when speaking to colleagues about them.

When referencing body parts, use non-gendered language such as “chest,” “top,” or “pelvic area.”

“Sometimes people use ‘sir’ and ‘ma’am’ as a way to be polite, but it can be really offensive to trans and gender diverse individuals that don’t identify with that gender,” Levitt said during the webinar.

“When I walk into a room with a patient, I will say, ‘My name is Nathan. I’ll be your nurse practitioner today. I use he/him pronouns. What name and pronouns would you like to go by today?”

Transitional phrasing and the importance of effective communication

Transitional phrasing lets a person know what to expect next during the course of your visit. It helps them understand when questions are medically relevant and why their answers are important to their care.

1. Let the person know why you need to ask a question, and clarify that you ask it of all your patients.
2. Reassure the person that they are in control of their healthcare, even if you need to share some difficult information.
3. Explain the purpose and ask for permission before touching any part of someone’s body.
4. “To make sure I’m recommending the right exams and tests for you, can I ask a few questions about your anatomy?”
5. “I ask all my patients about their sexual health. Would it be OK if I ask you a few questions to collect history?”
6. “Is it okay for me to touch your arm as part of my exam?”

Using effective communication strategies such as transitional phrasing can help develop and strengthen the patient-provider relationship — which we know can lead to better patient outcomes and improved adherence.

How to facilitate gender-affirming care training at your institution

Healthcare education has a critical role to play in eliminating health disparities. The skills emphasized by gender-affirming care practices improve provider competence to deliver care to diverse individuals.

Unfortunately, educational institutions have traditionally lacked adequate training, and many healthcare providers don’t know how to provide sensitive care to their diverse patients. Our new gender-affirming care course (joining our chronic disease management suite later this year!) uses the power of virtual simulation to effectively train clinicians and students in three essential learning objectives:

1. Understand gender-neutral language, and the importance of honoring patients’ pronouns and identity without making assumptions.
2. Apply transitional phrasing to ensure all questions are medically relevant and patients understand why their answers are important to their care.
3. Know when and how to apologize when mistakes are made to reassure the patient they are receiving compassionate care.

We consulted with subject matter experts, including the co-presenter of this webinar — Nathan Levitt FNP-BC, MSN, RN, BSN, MA, Director of LGBTQ and Gender Justice Learning at Yale’s School of Nursing — to develop this simulation.

Levitt said he thinks the role-play nature of the simulation is powerful because it allows learners to practice realistic scenarios in a safe environment.

“You can see, ‘Oh, I really messed up with some of that language,’ or ‘I can see this isn’t going in the right direction,’ and get some feedback afterward. I think those opportunities where students or practicing clinicians can really practice in the most realistic way that’s not harming trans patients and that’s not traumatizing trans patients really helps more than, you know, words on a screen,” he said.

Gender-affirming care is compassionate care. By building knowledge and skills, clinicians can better support their gender diverse patients.

“A lack of adequate training leaves many healthcare providers feeling unprepared to support and care for trans and gender diverse individuals, exacerbating health disparities compared to cis-gender people,” Head of Product Gurnek Singh said. “The current climate and the proliferation of anti-transgender policies really demands our best efforts to combat these challenges and advocate on behalf of our transgender patients and neighbors.”

Watch the webinar and a live demo on demand

Hear the full discussion and see an exclusive demo of our new gender-affirming care simulation. Access the webinar recording and presentation slides at kognito.com.