The Last Taboo? Teaching skills for clinical consultations with sex/gender diverse people in medical education
Canty, JB and Gray, L, The Last Taboo? Teaching skills for clinical consultations with sex/gender diverse people in medical education, 4th ANZPATH Biennial Conference Australian and New Zealand Transgender Health Finding a New Narrative, 30 September - 1 October, The Pullman (2017) [Conference Extract]
Sex/gender diverse and sexuality diverse populations experience worse outcomes compared with the general population across a range of physical and mental health indicators and experience significant barriers to equitable health care. Significant among these barriers is lack of cultural competence among health care practitioners when engaging with LGBTIQ people. Research undertaken in Australia indicates that LGBTIQ people will avoid disclosure of their sexuality or gender identity from health professionals for fear of discrimination. There is a body of evidence suggesting that experiences are likely to be consistent in Aotearoa New Zealand. Therapeutic alliance is well recognised as integral to improved health outcomes and so this identified problem in doctor-patient interactions recommends explicit inclusion of health issues for sex/gender people in the curriculum for medical education. Representation of sex/gender diversity in the medical education curriculum remains highly variable and a specific gap appears to be transgender health. Similar variability has been identified in Australian and New Zealand medical curricula through recent surveys of medical schools and students undertaken by the Australian Medical Students Association and Otago University Medical Students Association. The OUMSA survey responses indicated students felt least equipped in terms of knowledge or skill to provide effective health care to sex/gender diverse people and wanted more teaching on clinical knowledge and skills. Given the medical input required for physical transition, this gap presents a major concern for sex/gender diverse communities and health professionals alike. Where education initiatives health care with sex/gender diverse people in medical education have been trialled and evaluated, these tend to focus on addressing knowledge gaps and presentation of people’s lived experiences, often through guest speakers or panels. Feedback on such sessions indicated that medical students wanted opportunity to practice skills, even as they valued the topic exposure. With this in mind, we developed a pilot session focused on ‘taboo’ topics with cultural competence as our model. This work has evolved out of the ‘Talking about Overweight and Obese (TabOO) teaching sessions, which utilised overweight and obesity as the exemplar for teaching skills for addressing sensitive topics in clinical consultations to senior undergraduate medical students. The opportunity arose to expand the focus of this session to consider other potentially sensitive topics that can emerge in clinicial consultations. Thus TaBOO became Taboo Topics and the session has drawn upon weight and substance use alongside sexuality and sex/gender diversity to explore cultural competence and skills in clinical conversations. In this presentation, we discuss a skills-focused approach to teaching medical students about sex/gender diverse health within a primary health care and general practice rotation. We will address the cultural competence pedagogical approach applied in the session and its location within the broader medical curriculum. The session format integrates OSCE-format role-play scenarios with knowledge input focused on clinical skills. Student and colleague review of these sessions over three years have offered an opportunity to identify key strengths in this approach. These evaluations have reinforced the value and importance of taking a skills-focused approach to promote engagement and increase student confidence for undertaking clinical consultations with these populations as a step towards reducing barriers to health care. We address the advantages that this offers to medical education as a component of improving health outcomes for sex and gender diverse people, the limitations associated with reliance on stand-alone sessions, and challenges for integrating sex and gender diversity across the medical curriculum.
gender diverse populations, medical education, LGBTIQ health, therapeutic alliance