Background Residents lack confidence in caring for transgender individuals. More exposure and practice throughout training is needed.

Objective To explore whether and how prior exposure to transgender health skills during medical school impacted competency with these skills during residency.

Methods In 2022, all 101 internal medicine residents at New York University Grossman School of Medicine participated in an objective structured clinical examination (OSCE) station as part of their annual formative assessment where they cared for a standardized patient (SP) who identified as transgender. Three SPs who were members of the transgender community were recruited through online and social media forums. Two resident groups (continuum vs noncontinuum) differed in their prior experiences with transgender OSCEs during medical school. We analyzed SPs’ ratings of resident performance using checklist data and SP open-ended feedback to compare performance between groups and resident post-OSCE evaluations to understand residents’ perceptions of the educational value of the case.

Results Residents with prior experience with transgender SPs (continuum) were more frequently recommended by SPs (88% [21 of 24] vs 70% [54 of 77]) to a family member or friend, were all rated professional (100% [24 of 24] vs 94% [72 of 94]) and scored better in pain information-gathering (92% vs 65%, mean summary score) and gender-affirming care skills (67% vs 52%, mean summary score). Noncontinuum residents lacked experience, missed opportunities to ask about gender identity, and needed work on demonstrating comfort and using proper language. Most residents completing a post-OSCE evaluation (80%, 41 of 51) rated the case as “very valuable.”

Conclusions Spaced practice and feedback through early exposure to transgender OSCEs were valuable for skill acquisition, giving continuum residents a learning advantage compared to noncontinuum residents.

Transgender patients (ie, individuals whose gender identity differs from their sex assigned at birth) face more barriers to care compared to their cisgender counterparts (ie, those whose gender identity aligns with their sex assigned at birth), including discrimination and postponement or refusal of care.1,2  Among these barriers are limited physician experience and training.3 

Educational activities exist to help clinicians gain comfort and skills in caring for transgender patients, but these vary in modalities and the type of learners these interventions target.3,4  Research suggests that longitudinal and integrated transgender health education improves learner skill and comfort, activates learners’ desire for more practice,2  and communicates that providing gender-affirming care is important and valued.5 

Few studies looked at the impact of longitudinal and integrated transgender health training across the undergraduate medical education (UME) to graduate medical education (GME) continuum.4  Currently, transgender health education in medical school curricula is limited. More than half of training programs accredited by the Liaison Committee on Medical Education reported having no LGBTQIA+ training in their curricula.6  On average, medical school curricula include an average of 5 hours of LGBTQIA+ health education, primarily focused on HIV, differences in sex development, and safe sex.2,6  Additionally, medical students do not get enough exposure to transgender patients: around 40% of students reported caring for no transgender patients, and those who did have prior experience cared for fewer than 5 transgender patients.7,8  Transgender health education at the GME level is also lacking, with only a few specialties publishing about transgender health education in both didactic and clinical settings.6  Most specialties report minimal to no transgender health education during residency, despite multiple studies finding that residents and fellows believe in the importance and value of learning comprehensive gender-affirming skills needed to care for transgender patients.6  This suggests there is an opportunity to include more transgender health training and exposure in medical school curricula and/or throughout training.

The aim of our study was to describe whether and how exposure to transgender health skills during medical school impacted trainees’ competency in this area during residency. We describe outcomes from an objective structured clinical examination (OSCE) station where residents were tasked with managing the care of a standardized patient (SP) who identified as transgender.

What Is Known

Improving care for patients who are transgender needs more attention in residency curricula. Spaced repetition and simulation are sound educational designs that would hold promise in this domain.

What Is New

Residents in an internal medicine program who had undergone a prior objective structured clinical examination with a transgender patient in medical school at the same university showed improved performance in the care of a simulated patient who is transgender.

Bottom Line

Spaced repetition, even years apart and in a simulated setting, shows promise for improving the care of transgender patients.

Setting and Participants

As part of their required annual formative assessment in 2022, New York University Grossman School of Medicine (NYUGSOM) residents in the internal medicine (IM) residency program participated in an OSCE where they rotated through multiple simulated clinical encounters with SPs. An OSCE station with an SP who identified as transgender was included with an aim of assessing how residents care for transgender patients. This case was developed by program leadership (R.E.G., a content expert on gender-affirming care, and S.Z., an expert in simulation), and reviewed by a member of the transgender community with lived experience who also served as an SP (C.L.).

We compared performance on the case between 2 groups of residents: (1) residents who had trained at the same medical school (continuum residents) and had previously participated in an OSCE at NYUGSOM as part of their UME curriculum featuring a transgender SP with feedback; and (2) residents who attended different medical schools (noncontinuum residents) and who therefore did not participate in the NYUGSOM transgender OSCE. During their first year of medical school prior to clerkship training, continuum residents attended lectures on transgender health that involved education on barriers to care and gender-affirming hormone therapies, a conversation with a transgender community member, and a workshop on inclusive sexual history taking, followed by participation in an initial OSCE case with a transgender SP.

All NYU residents (continuum and noncontinuum) attended a similar lecture regarding transgender health with more detailed information about hormones and surgery, consistent with their level of training.

OSCE Scenario

The OSCE station involved caring for a 37-year-old transgender male patient who was admitted to the hospital for abdominal pain. Residents had 10 minutes to confirm the SP’s affirmed name and pronouns, evaluate the abdominal pain, complete a sexual history and relevant organ inventory, and identify the need for additional testing.

We recruited 3 transgender SPs through online and social media forums, and they were compensated as any other SP ($28/hour compensation). Each of the 3 SPs, who identified as transgender (and importantly had lived experiences to draw upon), received 3 hours of SP training on how to play the role of the patient, assess performance using the checklist, and give effective feedback. During the encounter, the SPs were instructed to act intimidated by clinicians and to not readily offer any information about their gender identity unless prompted. The SPs were to remain open with the residents if they said something awkward (and not openly offensive) and to express displeasure but remain cooperative if the resident made any overtly judgmental or offensive statements. Full resident and SP case instructions are available as online supplementary data.

Assessment

The SPs evaluated each resident’s performance using a checklist that rated residents on 5 domains: information gathering (4 items), relationship development (5 items), education and counseling (3 items), gender-affirming care skills (6 items), and case-specific abdominal pain information gathering (1 item), see Table 1. Items were rated on a behaviorally anchored “not done,” “partially done,” or “well done” (WD) scale. In addition, the SP gave each resident a global recommendation and professionalism rating, using 4-point scales. Our original communication checklist was developed through the Macy Initiative on Health Communication9  and adapted for this case to include assessment of case-specific skills in gendering-affirming care and abdominal pain information gathering. Our checklist has demonstrated internal consistency (Cronbach’s alphas 0.70-0.95), significant and positive association with similar student performance metrics,10-13  and sensitivity in capturing effects of interventions.14,15 

Table 1

2022 New York University Grossman School of Medicine Standardized Patient Assessment Checklist, With Reported Rating by the Standardized Patient for Each Item (N=101)

2022 New York University Grossman School of Medicine Standardized Patient Assessment Checklist, With Reported Rating by the Standardized Patient for Each Item (N=101)
2022 New York University Grossman School of Medicine Standardized Patient Assessment Checklist, With Reported Rating by the Standardized Patient for Each Item (N=101)

Following the case, residents received both written and verbal feedback from the SPs and debriefed with a faculty observer who had expertise in caring for transgender patients. Residents completed a post-OSCE evaluation where they rated whether the case was educationally valuable and shared their experience about their participation in the case.

Data Analysis

We used a mixed methods approach to explore the potential impact prior transgender health exposure and practice during medical school may have had on competency in providing gender-affirming care during residency.

Quantitative Analysis: We calculated summary scores (mean % WD) for each item and domain. Wilcoxon rank sum tests for nonparametric data were conducted to test for statistically significant differences in performance between the 2 resident types. All checklist data were analyzed using R Core Team (2021).16 

Qualitative Analysis: We analyzed SP open-ended feedback comments given to each resident using the framework method for content analysis.17  This method was chosen because we used domains and items assessed on our checklist as a guide for organizing the behavior codes but remained open to other themes that emerged from the SP’s feedback. Two authors (C.P.B. and J.A.W.) read through all SP comments to generate codes individually and then met regularly to discuss and jointly create a codebook. This codebook was shared with the entire study team who discussed the data and reached consensus on a final working code book. One author (C.P.B.) then applied codes to the SP comments. Comparisons were made between continuum and noncontinuum residents to identify potential differences in SP feedback about care provided.

The same process was repeated when analyzing the resident responses on the post-OSCE evaluation to identify main themes between and across the 2 groups. Analyses of SP open-ended feedback and resident responses were carried out using Dedoose (Version 9.0.54).18 

We ensured trustworthiness of our results by having an interdisciplinary team of both clinicians and nonclinician educational researchers within and outside of NYUGSOM who varied in their levels of expertise in transgender health education.19  This helped to ensure our interpretations were free from biases and reflected the authentic experiences of the SPs and residents.

This project qualified as an educational quality improvement project through NYUGSOM’s Institutional Review Board, and therefore resident consent was not required for participation in this project.

A total of 101 residents participated in the case (continuum [n=24], noncontinuum [n=77]). See Table 2 for breakdown by postgraduate year (PGY) and SP rater.

Table 2

Number of Residents who Participated in the OSCE Case Overall and Within Each Learner Type (Continuum vs. Noncontinuum), by Postgraduate Year and Standardized Patient Rater

Number of Residents who Participated in the OSCE Case Overall and Within Each Learner Type (Continuum vs. Noncontinuum), by Postgraduate Year and Standardized Patient Rater
Number of Residents who Participated in the OSCE Case Overall and Within Each Learner Type (Continuum vs. Noncontinuum), by Postgraduate Year and Standardized Patient Rater

Resident Performance on Case

Continuum and noncontinuum residents performed similarly in 4 of 5 domains, with significant differences in the abdominal pain information gathering domain (92% vs 65%, P<.01, 95% CI 0.11-0.43). Continuum residents were more frequently recommended or highly recommended compared to noncontinuum residents (88% [21 of 24] vs 70% [54 of 77] WD, P<.05, 95% CI 0.98-31.79) and were all rated mostly professional or completely professional (100% [24 of 24] vs 94% [72 of 77] WD, P<.05, 95% CI 1.35-12.50) by the SP. Continuum residents’ summary scores were better overall in the gender-affirming care skills domain, compared to noncontinuum residents, though differences were not statistically significant. See Table 3 for full results.

Table 3

Differences in Performance Between Continuum and Noncontinuum Residents as Rated by Standardized Patient Using 2022 New York University Grossman School of Medicine Assessment Checklist

Differences in Performance Between Continuum and Noncontinuum Residents as Rated by Standardized Patient Using 2022 New York University Grossman School of Medicine Assessment Checklist
Differences in Performance Between Continuum and Noncontinuum Residents as Rated by Standardized Patient Using 2022 New York University Grossman School of Medicine Assessment Checklist

SP Open-Ended Feedback Comments

Feedback comments from the SPs revealed notable differences between continuum and noncontinuum residents when it came to areas of improvement, including need for more experience and better skills in fostering SP comfort, asking about gender identity, and using gender-affirming language (see Table 4 of SP-reported areas of improvement).

Table 4

Areas for Improvement in Providing Gender-Affirming Care as Perceived by Standardized Patients (SPs) and Given as Feedback to Residents

Areas for Improvement in Providing Gender-Affirming Care as Perceived by Standardized Patients (SPs) and Given as Feedback to Residents
Areas for Improvement in Providing Gender-Affirming Care as Perceived by Standardized Patients (SPs) and Given as Feedback to Residents

Resident Lack of Experience

The SPs noted when residents demonstrated a clear lack of experience with transgender patients, and this occurred exclusively with noncontinuum residents. Residents’ lack of experience was noted as a barrier to obtaining relevant clinical information related to the patient’s gender identity needed to address the abdominal pain.

“Clearly less experienced with the trans stuff, in a way that meant not getting all the clinically relevant information…The real issue was lack of training/experience and not being able to get past that to provide the care needed for the patient.” (SP1)

SP Discomfort

Though uncommon, SPs described encounters that made them feel uncomfortable, which happened only with noncontinuum residents who exhibited awkwardness and nervous nonverbal communication.

“Seemed very uncomfortable—not making eye contact, constantly looking down at papers…the palpable discomfort definitely made it an overall challenging experience as the patient.” (SP1)

Missed Opportunities to Ask About Gender Identity

Only noncontinuum residents avoided talking about patient’s gender identity, which the SPs hypothesized was due to residents’ lack of experience and fear of causing discomfort.

“Didn’t seem to know how to deal with me as a trans patient and didn’t ask many relevant questions. Didn’t talk about gender and sexuality and sexual practices at all.” (SP3)

“Skipped over sexual history completely, didn’t actually confirm whether I was trans…Felt like inexperience with trans-care meant avoiding questions for fear of causing discomfort.” (SP1)

Need for Proper Language

When it came to specific skills, most noncontinuum residents received feedback about needing to use more inclusive/affirming language and preferred terminology when talking with transgender patients.

“Some work could be done about using less gendered language and affirming gender identity…improvement on language and communication would be helpful.” (SP2)

Resident Post-OSCE Evaluations

Fifty-one residents completed the resident post-OSCE evaluations (continuum [n=14], noncontinuum [n=37]). We found no clear differences in experience or perceived value of the case between continuum and noncontinuum residents. Most residents across the 2 groups (80%, 41 of 51) rated the case to be “very valuable,” attributing it to the opportunity to practice skills in a safe space.

A Safe Space to Practice With Transgender Patients

Many residents identified the opportunity to practice with transgender patients and discuss their care in a safe space, with feedback from the SP, to be helpful.

“Really appreciated the opportunity to practice appropriate terminology, alleviate some of my anxiety, and gain some experience discussing common medical issues with a trans patient in such a supportive environment.” (Noncontinuum resident)

Opportunity to Practice Nongendered Language

Several residents mentioned how practicing using nongendered, patient-centered language was especially helpful in improving skills and comfort.

“Extremely helpful in being familiarized with accepted and acceptable terminologies used during this select and often emotionally charged exchange.” (Noncontinuum resident)

“Just great opportunity to ask questions about gender, identity, organ inventory and practice using nongendered language.” (Continuum resident)

Lack of Prior Exposure With Transgender Patients

Residents across both groups described having few prior clinical encounters with transgender patients and described how the case increased their comfort and preparation for caring for transgender patients.

“We have talked about how to respect trans patients a fair amount but have not had many opportunities to treat them, this was a good learning experience to become more comfortable.” (Noncontinuum resident)

“Really good to have a safe space to practice this as I have had very little experience caring for trans patients. This will make me more comfortable and confident in the future.” (Continuum resident)

Enthusiasm for the Future

A few residents described a sense of humility and enthusiasm about continuing to learn more about and practice caring for transgender patients in the future.

“I still need help likely in working up this situation medically but will feel much more comfortable and more prepared to effectively work with a patient who may be transgender. I think there will need to be more practice, but I look forward to that.” (Noncontinuum resident)

Our findings suggest that continuum residents may have had a learning advantage due to their previous participation in a transgender OSCE during medical school. Continuum residents, compared to noncontinuum residents, exhibited better performance on the domains of case-specific information gathering, gender-affirming care skills, and global ratings. Furthermore, continuum residents’ greater experience and comfort in this area was highlighted by the fact that their noncontinuum counterparts exclusively received SP feedback about their lack of experience and comfort.

The fact that continuum residents performed better on several domains that they were similarly assessed in during medical school and exhibited greater confidence and competence in caring for a transgender SP demonstrates the durability of their skills and their ability to generalize learning from a previous exposure to this new encounter. This advantage aligns with the concept of distributed practice where learning becomes more durable when opportunities for practice are spaced out over time (compared to massed together during a short period of time) and new learning encounters build upon previous learning.5,6,20-25  These findings suggest that trainees benefit from repeated exposures to and practice with transgender health skills over time as it promotes retrieval, consolidation, and competency in providing affirming care to transgender patients.

Residents across both groups did not score as high on the gender-affirming care skills item “made SP feel welcome and comfortable as a trans-identified patient” (continuum=71% [17 of 24] vs noncontinuum=58% [45 of 77]), which identifies a curricular gap. One area that may address this gap is the use of nongendered terms, preferred terminology, and inclusive/affirming language, which was frequently identified as a challenge by SPs and residents. Currently, transgender health topics covered in UME and GME curricula focus little on interpersonal skills, such as affirming patients and use of language.6  Experiential learning opportunities, such as OSCEs, with transgender patients within UME and GME curricula is one strategy for providing trainees with valuable exposure to transgender patients, practice with inclusive and affirming language and interpersonal skills, and feedback about their performance from individuals who identify as transgender or nonbinary.2,26-28  Most medical schools and residencies have SPs, but including members of the transgender community with lived experiences in the development and implementation of transgender OSCEs is imperative.

Overall, our results suggest the following steps forward for transgender health education: (1) Introducing transgender health training early in medical education can provide trainees with learning advantages that may improve their skill and comfort with caring for transgender patients; (2) Skills acquisition around how to build rapport, affirm patients, and use appropriate language is an important and desired area of improvement; and (3) Experiential opportunities (OSCEs or patient-as-teacher forums) should be incorporated within UME and/or GME curricula so trainees can interact and practice with and receive feedback from transgender patients to improve their gender-affirming care skills.

One limitation is that we did not collect data on noncontinuum residents’ prior transgender health experiences. Our findings indicated that regardless of noncontinuum residents’ prior experiences (or lack thereof) in their respective medical schools, continuum residents exhibited better performance that may be attributed to our medical school’s transgender health curriculum. We also did not look at residents’ prior experiences with real transgender patients; therefore, their performance on this case may not reflect their care in actual practice. Third, differences in ratings among 3 different SPs may be a confounding factor. However, each SP saw a fairly equal distribution of continuum vs noncontinuum residents; the pattern in which continuum residents performed better in specific domains persisted when we looked within individual SP’s ratings; and all SPs consistently identified the same areas of improvement, giving us confidence in our results. Lastly, other factors, such as training in a large American city with a sizeable population of transgender individuals, may explain the differences between groups, limiting the generalizability of our results to other training programs.

Future research should look at whether integrating transgender OSCEs across the UME-to-GME continuum improves trainees’ interactions with transgender patients beyond the simulated environment.

Our data demonstrate that exposure and the opportunity to practice clinical interactions with a transgender-identified SP during medical school is associated with better performance in caring for transgender SPs during residency.

The authors would like to thank the following for their participation and for ensuring a successful OSCE: the residents, standardized patients, and NYSIM, a public and private partnership of NYULH and City University of New York.

1. 
Safer
JD,
Tangprichaa
V.
Care of the transgender patient
.
Ann Intern Med
.
2019
;
171
(
1
):
ITC1
-
ITC16
.
2. 
Greene
RE,
Blasdel
G,
Cook
TE,
Gillespie
C.
How do OSCE cases activate learners about transgender health?
Acad Med
.
2020
;
95
(
suppl 12 Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments
):
156
-
162
.
3. 
Nolan
IT,
Blasdel
G,
Dubin
SN,
Goetz
LG,
Greene
RE,
Morrison
SD.
Current state of transgender medical education in the United States and Canada: update to a scoping review
.
J Med Educ Curric Dev
.
2020
;
7
:
2382120520934813
.
4. 
Cooper
RL,
Ramesh
A,
Radix
AE,
et al.
Affirming and inclusive care training for medical students and residents to reduce health disparities experienced by sexual and gender minorities: a systematic review
.
Transgend Health
.
2023
;
8
(
4
):
307
-
327
.
5. 
Kang
SHK.
Spaced repetition promotes efficient and effective learning
.
Policy Insights Behav Brain Sci
.
2016
;
3
(
1
):
12
-
19
.
6. 
Dubin
SN,
Nolan
IT,
Streed
CG
Jr,
Greene
RE,
Radix
AE,
Morrison
SD.
Transgender health care: improving medical students’ and residents’ training and awareness
.
Adv Med Educ Pract
.
2018
;
9
:
377
-
391
.
7. 
Honigberg
MC,
Eshel
N,
Luskin
MR,
Shaykevich
S,
Lipsitz
SR,
Katz
JT.
Curricular time, patient exposure, and comfort caring for lesbian, gay, bisexual, and transgender patients among recent medical graduates
.
LGBT Health
.
2017
;
4
(
3
):
237
-
239
.
8. 
Petrey
LN,
Noonan
EJ,
Weingartner
LA.
Gender diverse representation in patient simulation: a scoping review
.
Acad Med
.
2022
;
97
(
suppl 11
):
107
-
116
.
9. 
Yedidia
MJ,
Gillespie
CC,
Kachur
E,
et al.
Effect of communications training on medical student performance
.
JAMA
.
2003
;
290
(
9
):
1157
-
1165
.
10. 
Tewksbury
LR,
Gillespie
C,
Paik
S,
Richter
RA,
Kalet
AL.
Quality and quantity of patient contact correlates with performance on a clinical skills exam. Abstract presented at: Council on Medical Student Education in Pediatrics conference;
2007
;
Toronto, Ontario, Canada
.
11. 
Tewksbury
LR,
Gillespie
C,
Richter
RA,
Kalet
AL.
Medical students with the lowest performance on a clinical skills exam poorly self-assess ability
. Abstract presented at: Proceedings of the Pediatric Academic Societies Meeting;
2006
;
San Francisco, California, USA
.
12. 
Tewksbury
LR,
Gillespie
C,
Richter
RA,
Kalet
AL.
The validity of a comprehensive clinical skills exam
.
Oral presentation at: Society of General Internal Medicine National Annual Meeting
;
April 26-29, 2006
;
Los Angeles, California, USA
.
13. 
Tewksbury
LR,
Richter
RA,
Gillespie
C,
Chase
J,
Kalet
AL.
Communication skills are highly correlated with history content: findings of a comprehensive clinical skills examination for medical students
. Abstract presented at: Proceedings of the Pediatric Academic Societies Meeting;
May 14-17, 2005
;
Washington, DC, USA
.
14. 
Hochberg
MS,
Kalet
A,
Zabar
S,
Kachur
E,
Gillespie
C,
Berman
RS.
Can professionalism be taught? Encouraging evidence
.
Am J Surg
.
2010
;
199
(
1
):
86
-
93
.
15. 
Stevens
DL,
King
D,
Laponis
R,
et al.
Medical students retain pain assessment and management skills long after an experiential curriculum: a controlled study
.
Pain
.
2009
;
145
(
3
):
319
-
324
.
16. 
R
.
The R Project for Statistical Computing
.
Accessed February 12, 2024. https://www.r-project.org/
17. 
Ritchie
J
, ed.
Qualitative Research Practice: A Guide for Social Science Students and Researchers
. 2nd ed. Sage;
2014
.
18. 
Dedoose
.
Accessed February 12, 2024. https://www.dedoose.com/
19. 
Elo
S,
Kääriäinen
M,
Kanste
O,
Pölkki
T,
Utriainen
K,
Kyngäs
H.
Qualitative content analysis: a focus on trustworthiness
.
SAGE Open
.
2014
;
4
(
1
):
2158244014522633
.
20. 
Cepeda
NJ,
Coburn
N,
Rohrer
D,
Wixted
JT,
Mozer
MC,
Pashler
H.
Optimizing distributed practice: theoretical analysis and practical implications
.
Exp Psychol
.
2009
;
56
(
4
):
236
-
246
.
21. 
Dunlosky
J,
Rawson
KA,
Marsh
EJ,
Nathan
MJ,
Willingham
DT.
Improving students’ learning with effective learning techniques: promising directions from cognitive and educational psychology
.
Psychol Sci Public Interest
.
2013
;
14
(
1
):
4
-
58
.
22. 
Cepeda
NJ,
Pashler
H,
Vul
E,
Wixted
JT,
Rohrer
D.
Distributed practice in verbal recall tasks: a review and quantitative synthesis
.
Psychol Bull
.
2006
;
132
(
3
):
354
-
380
.
23. 
Gordon
K.
Class results with spaced and unspaced memorizing
.
J Exp Psychol
.
1925
;
8
(
5
):
337
-
343
.
24. 
Carpenter
SK.
Testing enhances the transfer of learning
.
Curr Dir Psychol Sci
.
2012
;
21
(
5
):
279
-
283
.
25. 
Kapler
IV,
Weston
T,
Wiseheart
M.
Spacing in a simulated undergraduate classroom: long-term benefits for factual and higher-level learning
.
Learn Instr
.
2015
;
36
:
38
-
45
.
26. 
Obedin-Maliver
J,
Goldsmith
ES,
Stewart
L,
et al.
Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education
.
JAMA
.
2011
;
306
(
9
):
971
-
977
.
27. 
Mayfield
JJ,
Ball
EM,
Tillery
KA,
et al.
Beyond men, women, or both: a comprehensive, LGBTQ-inclusive, implicit-bias-aware, standardized-patient-based sexual history taking curriculum
.
MedEdPORTAL
.
2017
;
13
:
10634
.
28. 
Underman
K,
Giffort
D,
Hyderi
A,
Hirshfield
LE.
Transgender health: a standardized patient case for advanced clerkship students
.
MedEdPORTAL
.
2016
;
12
:
10518
.

The online supplementary data contains the full resident and standardized patient case instructions.

Funding: The authors report no external funding source for this study.

Conflict of interest: The authors declare they have no competing interests.

This work was previously presented as a poster at the Society of General Internal Medicine Annual Meeting, May 10-13, 2023, Aurora, Colorado, USA.

Supplementary data