•  
  •  
 

Abstract

Introduction: Roughly half of ATP program directors include education on transgender health care in their programs, and even fewer report having the competence to do so. However, professional-level accreditation standards (56, 57, and DEI 2) require that programs have faculty with contemporary expertise to educate students on these outcomes. Current research suggests a comprehensive transgender and sexual health curriculum, including safe-zone training, traditional lecture, lab, and project-based instruction, was partially effective at changing students’ attitudes toward transgender patients but did not improve sexual health care delivery during a standardized patient encounter. The purpose of this project was to evaluate the effectiveness of instructional design and delivery in changing student attitudes toward transgender patients at a regional-comprehensive, midwestern University ATP. Instructional delivery included both active and passive strategies (readings, discussion, lecture, and problem-based learning) with a focus on destigmatization, health and healthcare inequities, gender-affirming care, and regulations related to sports participation. Methods: We used three measures to assess student attitudes, knowledge, and practical application. The validated Attitudes Toward Transgender Patients (ATTP) tool (10-item, 3 primary constructs (clinician education, transgender sport participation, and clinician comfort) was used immediately before the class discussion, immediately after the lecture, and 4 weeks later to evaluate student attitudes (n=8). A content-validated cognitive knowledge assessment (total score of 25 points; multiple-choice and multi-choice questions) was used immediately after the lecture and 4 weeks later. Finally, we used a problem-based learning case to evaluate the students’ ability to apply knowledge within 1 week of the lecture. We used descriptive statistics to characterize student performance. We used a repeated measures ANOVA to compare pre-, post-, and post-post attitudes for each item and each construct of the ATTP tool (clinician education, transgender sport participation, clinician comfort). We also used a paired t-test to evaluate knowledge after the lecture (post) and at the 4-week follow-up (post-post). Results: We did not identify significant differences across each of the ATTP subscales over time, but did identify two items where student attitudes improved at some point in learning. Their attitude about the importance “to receive training on transgender issues” significantly improved from pre-test to post-test (p=0.033), but not at any other time comparison. The attitude about feeling “safer treating a transgender patient in a group setting” at the post-post testing was significantly lower than the scores at the pre (p=0.009) and post-test times (p=0.004), indicating more clinician comfort. Student construct scores were slightly elevated (Table 1) compared to previous uses of the ATTP in professional and postprofessional students, suggesting higher levels of potential discord in learning about, permissibility to participate, and discomfort working with transgender athletes. Knowledge scores demonstrated below-desired outcomes relative to gender-affirming care and transgender athlete participation in sport (mean=17.9/25 points ± 5.4; 71.6%), which did not change over time (mean=17.1/25 points ± 2.7; 68.5%). An analysis of problem-based learning performance indicated a superficial appreciation for the needs of transgender athletes considering participation throughout the transition. Translation to Practice: After completing the learning activities and assessments, faculty engaged in a root cause analysis to evaluate the effectiveness of the instructional design and delivery (Figure 1). We summarized the minimal changes in attitude and below expectation results in learner performance. We identified the productive and inhibiting features for each of the four approaches to instruction and postulated the additional tactics necessary to reinforce and extend improved attitudes and increase knowledge. Consistent with previous research, strategies that contextualize theoretical knowledge, including interpersonal interactions that yield transformational learning, will be prioritized. We plan to use contemporary media and a “teaching” standardized patient encounter to humanize transgender athletes to meet the desired knowledge and attitude outcomes and expectations.

Download

Share

COinS