Possible Solutions of Transgender Health Disparities Issue

As the literature suggests, there is a dire need for radical change within medical education programs and practices. In order to address the issue of transgender health disparities, medical training and awareness must be improved upon. There is ample evidence indicating that the medical training programs in the U.S. are not even incorporating LGBTQ health cirriculum -- much less trans-specific curriculum -- and if this training is included, it often amounts to less than a full eight-hour work day. It should go without saying that a one-time lecture about LGBTQ health is entirely insufficient and will not prepare medical students to adequately advocate or care for their LGBTQ patients. A productive step towards addressing this issue would be the creation of national standard that requires accreditation boards and educational institutions to include more comprehensive LGBTQ health education both in their curricula and residency programs (Dubin, Nolan, Streed, Greene, Radix & Morrison, 2018). With the help of the NASW and social workers all over the world, this goal might be achieved.

One way that social workers can help is to advocate for curricula that offers more unique and individuated courses that focus specifically on LGB health care, transgender health care, the LGB community, and the transgender community (Dubin, Nolan, Streed, Greene, Radix & Morrison, 2018). Gender identity and sexual orientation are not synonymous; however, they often do get lumped together, and this can easily lead to both confusion and over-generalization. By separating the transgender population from the LGBTQ umbrella, students can better understand gender-based inequities within the collective LGBTQ community and the health care system. In other words, health care and its outcomes can look entirely different between FTM, MTF and non-binary individuals, thus warranting the individuation of these topics. Furthermore, by including courses that focus on the history, development, and the dynamics of the LGB and transgender communities, training programs can increase students’ awareness and general understanding of this unique population. In doing this, students are encouraged to look at the ‘full picture’ rather than something as arbitrary as reproductive organs, for example.

General education courses that pertain to the LGB and transgender communities can be taught through a broader, social work lense rather than solely medical. If social workers and institutions can encourage students to see LGBTQ individuals through a humanistic perspective instead of a medical perspective, we could see a radical shift in health outcomes for this community. Through challenging a perspective that views transgender individuals as a ‘medical anomaly’, to instead viewing them as simply human, institutions would be supporting an environment of acceptance and compassion. One way to put this idea into action would be to establish a custom of introduction and open discussions in the classroom. For example, on the first day of class instructors could set an example by introducing themselves, share their gender-identity, and share their preferred pronoun, then ask that all students follow their example (Wagaman, Shelton & Carter, 2018). This practice would encourage respect, trust, and inclusivity, and it could be duplicated throughout the course to acknowledge and support the fluidity of identity and gender.

Another idea could be to incorporate discussions and activities around identifying privilege in social work and medical classrooms (Wagaman,, Shelton & Carter, 2018). For instance, the instructor could pose questions like, “What is it like to be able to walk into any environment and not have someone call you another name or use the opposite gender pronoun?”, “What is it like to walk into any doctor’s office and feel fairly confident that you will be treated with dignity and respect?”, “How would you feel - after checking ‘male’ on your intake form - having to explain to your doctor that you are in need of a pap smear, how would you go about that discussion?”, etc. Questions like these require a student to check their privilege and step into the shoes of a transgender patient; this may increase student’s ability to empathize with their clients, and therefore increase the likelihood that clients will receive unbiased, gender-appropriate treatment (Wagaman,, Shelton & Carter, 2018).

Finally, social work and medical training could be improved to focus more heavily on direct patient-client interactions (Lytle, Vaughan, Rodriguez & Shmerler, 2014). In general, repeated exposure to and repetition of a particular practice amounts to increased understanding, level of comfort, and skill; this is how we learn and develop better practices. It goes without saying that a provider who worked with a dozen transgender patients during training/residency would be more comfortable and adept working with the population than one who had zero exposure. One way to ensure students receive this exposure would be to require one (or more) of their clinical rotations to occur at a LGBTQ-specific, or trans-specific, health care center. Not only would this create an opportunity to work with LGBTQ clients in a medical fashion, but students would also be immersed into a unique culture and environment that they may not otherwise be exposed to in a traditional medical setting (Lytle, Vaughan, Rodriguez & Shmerler, 2014).