1) Transgender medicine is an emerging but poorly understood part of a complete medical education. Most US/Canadian schools offer no didactic on the topic.
2) No conflicts of interest.
3) Multiple studies suggest that transgender people comprise about .6% of the population, or about 1/200 people. However, many practicing physicians and current trainees report a paucity of education on the topic, leading to poor quality of care. Nearly a quarter of transgender people have avoided seeking healthcare for fear of receiving poor care from a physician, and approximately the same number report having to teach their provider basic aspects of medical gender transition or pre- and post-surgical anatomy.
4) Understand baseline trans competence of UM medical students. Understand attitudes toward transgender health, preferences for curricular interventions.
5) I surveyed my class regarding knowledge base, attitudes, and curricular preferences. With an 88% response rate, I uncovered significant knowledge gaps and unanimous preference for further didactic and clinical education. I presented this to our curriculum Dean and a lecture was added to the reproductive sequence. Following this, I repeated the study with the same survey on graduating M4s (whom had completed undergraduate medical education) and M1s pre and post the lecture regarding transgender medicine. I found that one didactic lecture improved objective knowledge, confidence with physical exam skills, self-assessed knowledge of psychosocial disparities relative to pre-lecture M1s and also relative to graduating M4s.
6) Our didactic curriculum was transitioning from 2 to 1 years, so adding didactic content is difficult in light of the need to reduce the number of lectures. It is also important to present transgender medicine as non-negotiable clinical training without conflating it with a disease process that needs to be "medicated". As with all curricular research, reliance on "self assessed" competence is a limitation (as people can overestimate their confidence, famously with things at which they are incompetent via the Dunning-Kruger effect), however the use of an objective knowledge measure served to balance this limitation. Finally, while these metrics suggest positive momentum in the arena of transgender health competence, they should not be conflated with evidence that our students have evidence of clinical savvy in the arena of gender transition, merely that they have the basic knowledge enabling them to advance further if further opportunities are presented.
7) Initially, I had planned to (and obtained funding) to consult the local transgender community on their opinions on our curriculum, but it proved difficult to ethically recruit and conduct this within time and monetary constraints.