"Progress in Medicine Is Slower To Happen": Qualitative Insights Into How Trans and Gender Nonconforming Medical Students Navigate Cisnormative Medical Cultures at Canadian Training Programs. (6th August 2019)

• Record Type: Journal Article
• Authors: Butler, Kat; Yak, Adryen; Veltman, Albina
• Is Part Of: Academic medicine. Volume 95:Number 1(2020)
• Publication Date: 2019-08-06
• Subjects: Medical education -- Periodicals; Medical policy -- Periodicals; Medical personnel -- Periodicals; Periodicals; 610.711
• DOI: 10.1097/ACM.0000000000002933
• Languages: English
• ISSNs: 1040-2446

Abstract

Abstract : Purpose: Trans and gender nonconforming (TGNC) people face significant health disparities compared to their cisgender (non-trans) counterparts. Physician-level factors play a role in these disparities, and increasing the participation of individuals from sexuality and gender minority (SGM) communities in medical training has been proposed as one way of addressing this issue, however very little is known about the experiences of current TGNC medical students. This study aimed to understand the experiences of TGNC medical students in Canada. Method: Between April 2017 and April 2018, seven TGNC participants either currently enrolled in or recently graduated from a Canadian medical school completed audio-recorded semi-structured interviews. Interviewers asked about experiences with admissions; academic, clinical, and social environments; and interactions with administration. The authors analyzed interviews using a constructivist grounded theory approach. Results: The authors developed five overarching themes: navigating cisnormative medical culture; balancing authenticity, professionalism, and safety; negotiating privilege and power differentials; advocating for patients and curricular change; and seeking mentorship in improving access and quality of care to TGNC patients. This article focuses on the first theme, with associated subthemes of culture and context, interactions with classmates, curriculum, policy and administration, and gendered spaces. Conclusions: The results of this study delineate heterogeneous experiences of medical cultures with a shared underlying pattern of erasure of TGNC people as both patients and clinicians. Findings were largely consistent with previously published recommendations for improving academic medical institutional climates for SGM people, though the need for access to appropriate gendered spaces beyond washrooms was highlighted.