Embedded Files
identify as transgender.1,2 The term transgender describes those whose gender identity differs from their sex assigned at birth and/or does not confirm to the conventional gender binary, including gender nonbinary, gender nonconforming, gender queer, and gender diverse.3 Transgender patients have previously experienced significant levels of discrimination within health care settings.4–6 However, recent advocacy efforts and expanded insurance coverage has decreased stigma and improved access to health care for this patient population. As transgender health care utilization continues to increase, so too will the requested number of gender-affirming surgeries (GAS).7 Therefore, it is pivotal that surgical residents are properly trained to care for transgender patients in both clinical and surgical settings. As per the World Professional Association for Transgender Health (WPATH), treatment of gender dysphoria involves psychiatric,medical, and surgicalinterventions.Multiple studies have already assessed the current undergraduate medical education related to transgender health.8 A well-cited 2011 study by Obedin-Maliver et al discovered that the median time devoted to lesbian, gay, bisexual, and transgender (LBGT) content in undergraduate medical education was only 5 hours across 4 years of school.9 This was further supported by Dubin et al, who performed a systematic review of the current literature related to medical student and resident transgender health awareness and found that education in these curriculums was often limited to one-time attitude and awarenessbased interventions.10 These studies established the limited transgender health exposure in medical school curriculums. Recently, there has been an increase in literature describing transgender-specific education for surgical training programs. However, no literature has summarized our current understanding of the postgraduate training in surgical residency related to transgender health. Multiple surgical specialties have already begun participating in GAS, including plastic surgery, urology, otolaryngology, oral and maxillofacial surgery (OMS), and obstetrics and gynecology (OBGYN). Yet, no formal curriculum or training requirements exist for surgical residents preparing to care for transgender patients. The aim of this systematic review is to better understand the surgical trainee’s education and training with respect to transgender health and GAS. Methods Literature Search This systematic review adhered to the standards of the Cochrane Handbook of Systematic Reviews of Interventions and was written in the format provided by the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) statement.11–13 (►Fig. 1). On December 04, 2020, we performed a comprehensive and reproducible electronic search for studies regarding GAS postgraduate training in PubMed, Elsevier Embase, and Wiley Cochrane Central Register of Controlled Trials. See Appendix 1 for the comprehensive search strategies. Eligibility Screening The retrieved hits were screened and reviewed by two independent reviewers, based on the title and abstract and using predefined inclusion and exclusion criteria. A third reviewer was asked to adjudicate in the case where consensus could not be reached among initial reviewers. An additional assessment was performed, based on the full-text versions of all selected records and those with insufficient information in the title and abstract. Studies were included if they addressed transgender health education related to a surgical or procedural specialty. Reasons for exclusion included irrelevant outcomes, inability to acquire full text, abstract only publications, secondary sources (reviews, commentaries, letters to the editor), and publications without English translation. Results The electronic search yielded a total of 186 unique hits. Screening of the title and abstract led to the inclusion of 33 studies for secondary evaluation. Screening of the citations, references, and related articles of the 33 reviewedmanuscripts yielded two additional papers. Fifteen original studies were ultimately includedin the systematic review. Fourteen of these were survey-based studies among various surgical specialties such as plastic surgery, urology, otolaryngology, OMS, dermatology, and OBGYN. One manuscript included in this review implemented a trainingmodule consisting of both didactic and cadaveric dissection. Notable primary outcomes included trainee exposure with respect to transgender care, program director and resident perceptions and attitudes of transgender care, and currently established transgender health curriculums. Secondary outcomes included geographical region, comfortability caring for this patient population, and beliefs regarding gender-affirming surgical fellowships. All of the publications were from North America. Current Training for Surgical Residents in Transgender Health Initial surveys among American plastic surgery and urology residents revealed that surgical trainee exposure to GAS is highly variable (►Table 1). Morrison et al surveyed 322 plastic surgery residents and fellows from 21 training programs and found that approximately 65% had received education or had direct patient exposure to transgender patients during residency.14 Dy et al found that among 289
Google Sites
Report abuse