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Training in Transgender Patient Care - A National Survey of Plastic Surgery and Urology Residents and Residency Directors
Shane D. Morrison, MD, MS1, H. Jonathan Chong, MD1, Geolani W. Dy, MD1, Nate C. Osbun, MD1, Stelios C. Wilson, MD2, David W. Grant, MD, MSc3, Sarah K. Holt, PhD1, Jens U. Berli, MD4, Nicholas B. Vedder, MD, FACS1, Mathew Sorensen, MD, MS1, Byron Joyner, MD1, Jeffrey B. Friedrich, MD, FACS1.
1University of Washington, Seattle, WA, USA, 2New York University, New York, NY, USA, 3Washington University in St. Louis, St. Louis, MO, USA, 4Oregon Health and Sciences University, Portland, OR, USA.

PurposeGender dysphoria is estimated to occur in up to 0.9% of the United States population. With increasing awareness and decreasing stigma surrounding transgender issues, it is predicted more patients will begin to seek medical and surgical transition. We sought to characterize transgender-related educational content provided in United States plastic and urologic surgery residencies, predictors of having transgender-specific curricula, and trainee perceptions of transgender patient care.
MethodsProgram directors (PD) from 219 United States ACGME-accredited plastic surgery (91) and urology (128) programs, and residents at greater than 20 representative urology and plastic surgery programs were asked to complete a web-based survey between November 2015 and March 2016. Respondents were queried on the extent didactic and clinical hours dedicated to transgender-related curricular content, types of clinical exposure available, and perceptions regarding the importance of transgender-specific education.
ResultsOne hundred and fifty-four (70.3%) PDs responded, and 145 (66.2%) completed the questionnaire. Three hundred and twenty-two plastic surgery residents or fellows responded to the survey (80% response rate) and 294 urology residents or fellows responded to the survey (73% response rate). PDs reported a median of 1 didactic hour (interquartile range [IQR], 2 hours), and 2 clinical hours (IQR, 10) dedicated to transgender content. Of 71 plastic surgery and 74 urology PD respondents, 18.3% and 41.9% provided no didactic exposure; and 33.3% and 29.7% provided no clinical exposure, respectively. 64% of plastic surgery trainees had education on or direct exposure to transgender care during residency. Overall, the majority of respondents believed that training in gender-confirming surgery is important and 72% endorsed the necessity of gender-confirming surgery fellowship training opportunities. 54% of urology trainees reported exposure to transgender patient care. Most urology trainees (77%) felt gender-confirming surgical training should be offered in fellowships.
ConclusionsThe median reported time dedicated to transgender education was minimal across US plastic surgery and urology programs, though highly variable. The majority of PDs endorse transgender-focused education as important, yet there were significant regional differences in attitudes. The majority of trainees endorsed the importance of residency and fellowship training in gender-confirming surgery, and had exposure to transgender patient care. In order to better serve the transgender population, formal fellowship training in gender-confirming surgery should be considered.


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