Transgender health objectives of training for adult Endocrinology and Metabolism programs: Outcomes of a modified-Delphi study

• Published in: PloS one 2024-05, Vol.19 (5), p.e0301603-e0301603
• Main Authors: Ahmad, Tehmina, Schreyer, Leighton, Fung, Raymond, Yu, Catherine
• Format: Article
• Language: English
• Subjects: Adult; Adults; Asthma; Biology and Life Sciences; Canada; Chronic obstructive pulmonary disease; Community; Curricula; Curriculum; Delphi method; Delphi Technique; Diabetes mellitus; Education; Endocrinology; Endocrinology - education; Feedback; Female; Graduate medical education; Graduate studies; Health aspects; Health care; Health care reform; Health education; Humans; Inclusion; Internal medicine; Internship and Residency; Lung diseases; Lung diseases, Obstructive; Male; Medical education; Medical electronics; Medical personnel; Medicine and Health Sciences; Metabolism; Methods; Objectives; People and Places; Physicians; Physiological aspects; Postgraduate medical education; Research and Analysis Methods; Social aspects; Social networks; Social Sciences; Standardization; Study and teaching; Teaching methods; Training; Transgender people; Transgender Persons; Variance analysis
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0301603

Transgender people encounter significant barriers when seeking timely, high-quality healthcare, resulting in unmet medical needs with increased rates of diabetes, asthma, chronic obstructive pulmonary disease, and HIV. The paucity of postgraduate medical education to invest in standardization of transgender health training sustains these barriers, leaving physicians feeling unprepared and averse to provide transgender health care. Closing this education gap and improving transgender healthcare necessitates the development of consensus-built transgender health objectives of training (THOOT), particularly in Adult Endocrinology and Metabolism Residency programs. We conducted a two-round modified-Delphi process involving a nationally representative panel of experts, including Adult Endocrinology and Metabolism program directors, physician content experts, residents, and transgender community members, to identify THOOT for inclusion in Canadian Endocrinology and Metabolism Residency programs. Participants used a 5-point Likert scale to assess THOOT importance for curricular inclusion, with opportunities for written feedback. Data was collected through Qualtrics and analyzed after each round. In the first Delphi round, panelists reviewed and rated 81 literature extracted THOOT, achieving consensus on all objectives. Following panelists' feedback, 5 THOOT were added, 9 removed, 34 consolidated into 12 objectives, and 47 were rephrased or retained. In the second Delphi round, panelists assessed 55 THOOT. Consensus was established for 8 THOOT. Program directors' post-Delphi feedback further consolidated objectives to arrive at 4 THOOT for curriculum inclusion. To our knowledge, this is the first time a consensus-based approach has been used to establish THOOT for any subspecialty postgraduate medicine program across Canada or the United States. Our results lay the foundation towards health equity and social justice in transgender health medical education, offering a blueprint for future innovations.