Approaching Trans Healthcare Competency: The Implementation of Trans Health Education for Medical Providers in Appalachia

Barriers to competent and safe healthcare disproportionately impact people who are marginalized because of their race, ethnicity, gender, or socioeconomic status. It is well documented that transgender patients in particular experience barriers to both accessing care and receiving high quality, non-discriminatory care (Hatzenbuehler & Pachankis, 2016; James et al., 2016; Rahman et al., 2019; Safer et al., 2016). This lack of access to culturally competent healthcare services contributes to health disparities that disproportionately impact the trans community. Literature on barriers to competent care for trans patients indicates that providers experience discomfort related to their ability to provide competent care (Safer et al., 2016). Many providers endorse a median of only five hours of trans healthcare training across their entire medical school curriculum (Hughto et al., 2015), and in some cases, as little as 45 minutes per year (Sawning et al., 2017). Primary care clinics should be the place in which general health and wellbeing are addressed for trans patients, as has been true for cisgender people. Primary care providers should be competent in assessing eligibility for Hormone Replacement Therapy (HRT) and surgery (Wylie et al., 2016), as well as providing necessary preventative care. Thus, this makes primary care the ideal setting for the proposed medical education implementation project. The current study aimed to develop and implement a training program for medical residents in primary care in rural South Central Appalachia. A six-stage development and implementation study is described. The intervention was evaluated for pedagogical outcomes including sustainability for future use, usefulness to residents, and accessibility. Evaluation of effectiveness included analyses of changes in providers’ self-reported competency, awareness of discriminatory experiences, and attitudes towards treating trans patients. There were no significant differences in pre-post competency scores (r=22, M=33.29[SD=5.96]; r=31, M=37.33[SD=1.02], SD=8.00) or in pre-post attitudes scores (r=15, M=32.76[SE=0.8], SD=4.69; r=13, M=34.7273[SE=1.00], SD=4.692). Accessibility and sustainability were measured qualitatively and included data such as resident attendance and ease of use of material for future behavioral health provider trainers. These outcomes were found to be satisfactory based on stakeholder feedback. Usefulness included three data points (satisfaction, helpfulness, value of training)