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TGNC, and training did not correlate with provider comfort caring for transgender patients, suggesting that prior training may have inadequately prepared the providers.27,28 This is significant as OBGYN providers play a crucial role in the long-term medical and surgical care of these patients. Among female pelvic medicine and reconstructive surgeons, a hybrid between OBGYN and urology surgical specialties, Chang et al found that most fellows had no experience with transgender patients (26% with outpatient exposure, 16% with inpatient exposure) and 70% of fellows had no transgender health didactics during fellowship.29 Only 33% of fellows at institutions where GAS was not performed felt comfortable performing genderaffirming hysterectomy with salpingo-oopherectomy, as opposed to the 88% of fellows at institution where GAS was performed.29 Despite the lack of exposure, Grimstad et al found that 82% of American OBGYN residency program directors felt that transgender health objectives were important and 96% favored the addition of a transgender component in their curriculum.30 This was reiterated by Mehta et al who found that 60% of providers desired further training in LGB-TGNC health.28 Similar to other surgical specialties, OBGYN residents feel only “somewhat” prepared to care for this marginalized population, despite strongly agreeing that education in transgender care is important, and highlighting the need for a more developed formal curricula.31 This request for increased education is supported by The American College of Obstetricians and Gynecologists, who echoed the need for transgender education in response to a landmark study that detailed disparities affecting this community.32 Yet, current curricula lack sufficient transgender education. A follow-up survey performed by Vinekar et al found that 31 out of 61 responding American residency programs currently offered transgender health education and 24 programs planned to introduce educational didactics in the preceding year.33 However, only 20 programs offered clinical training for transgender patients and only five introduced surgical techniques for GAS. Current research may not fully elucidate a true understanding of the current transgender education for OBGYN, as response rates were overall much lower among OBGYN providers, program directors, and residents when compared to other specialties. Discussion Training in transgender health for surgical residents is neither standardized nor uniform and the current exposure during residency does not sufficiently prepare all residents to care for this marginalized population.15,18,26,30,31,33 The Accreditation Council for Graduate Medical Education (ACGME) at this time has no case log requirements or mandated education related to transgender health and GAS.34 As a result, a surgical trainee’s experience varies significantly across surgical specialty, geographical region, and individual program. Specialties such as otolaryngology, OMS, and OBGYN report less exposure when compared to plastic surgery and urology (►Fig. 2).14–35 Residents from different specialties reported significantly different comfort levels when caring for transgender patients.22,28,31 Recently, an emphasis has been placed on the multidisciplinary and holistic approach to transgender health.35 It is therefore imperative that surgical residents in all specialties that perform GAS receive adequate education and exposure related to transgender care. Standardizing training with competency-based guidelines will prepare surgical residents uniformly to care for transgender patients undergoing GAS. The majority of residents and program directors in surgical specialties encourage transgender health education during residency.15,18,26,30,31,33 However, not all surgical residents felt that transgender health was an important component of a residency curriculum.14,18,25,26,36 Multiple studies have demonstrated that residents and providers with prior education in transgender health were more likely to desire further training.15,28 As programs commit to implementing and expanding transgender education in upcoming curriculums, we anticipate the relative emphasis on transgender health in surgical education will propagate and become considered a foundational component of surgical training.14,18,20,26,33,36 Through standardization of training and increased support for transgender health education, programs will be better suited to adequately train residents in GAS. While transgender health education during surgical residency continues to evolve, there has been a simultaneous increase in GAS fellowship opportunities and a demand for fellowship-trained surgeons.19,37,38 Despite program directors disagreeing on the need for fellowship training in GAS, multiple studies have shown that most residents in plastic surgery, urology, otolaryngology, and OMS support fellowship training.14,15,20,21,25,26 Fellowship opportunities will further prepare trainees to master the technically challenging GAS, and better care for these patients in a variety of clinical settings. Additional training is also supported by patients, as it has been shown to alleviate stress in patients undergoing these life-changing surgeries.39 Limitations and the Development of New Transgender-Health Curricula Our
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