Endres, Paul

Papanagnou, Dimitrios

Ziring, Deborah

Jefferson Digital Commons

Thomas Jefferson University Jefferson Digital Commons Student Papers & Posters Student Works 9-28-2022 Medical Student Sensitivity Training on the Differences in Sex Development Paul Endres Deborah Ziring Dimitrios Papanagnou Follow this and additional works at: https://jdc.jefferson.edu/student_papers  Part of the Gender and Sexuality Commons, and the Medical Education Commons Let us know how access to this document benefits you This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Student Papers & Posters by an authorized administrator of the Jefferson Digital Commons. For more information, please contact: JeffersonDigitalCommons@jefferson.edu. International Journal of Medical Education. 2022;13:259-260                                                                                                                                                            letter ISSN: 2042-6372  DOI: 10.5116/ijme.631e.e8fd 259 © 2022 Paul Endres et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use of work provided the original work is properly cited. http://creativecommons.org/licenses/by/3.0 Medical student sensitivity training on the  differences in sex development  Paul Endres1, Deborah Ziring1, Dimitrios Papanagnou2  1Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA 2Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA  Correspondence: Paul Endres, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA Email: pje002@students.jefferson.edu Accepted: September 12, 2022  To the Editor LGBTQ+ health concerns have become increasingly preva-lent in medical education. However, intersex individuals and their respective healthcare needs are frequently lumped into this category and not appropriately represented as standalone content in standard curricula. Intersex education is typically taught in conjunction with disorders of sexual de-velopment – an outdated and stigmatized term. The authors, who represent medical student and faculty educator stake-holders, aimed to develop a discrete intersex educational pi-lot training session to better inform how conversations sup-porting intersex individuals can be facilitated in undergraduate medical education.  Over the last decade, medical schools have rightfully ex-panded curricular content to educate students on LGBTQ+ health concerns, prompting students to ask for patient pro-nouns and take a more holistic sex history with sensitivity.1, 2 The care of intersex individuals, however, is frequently con-solidated into standard LGBTQ+ training and, as a result, is not appropriately represented in medical education curricula as a standalone curricular topic.3 Specifically, intersex educa-tion is frequently taught in conjunction with disorders of sex development (DSD) - an outdated and stigmatized term. This approach minimizes the intersex experience and does not address the current controversy surrounding DSDs, which are now more commonly described as differences in sex development, to de-stigmatize and de-pathologize inter-sex bodies.4 The authors suggest a more intentional approach to intersex education in order to train clinicians to provide patient-centered, trauma-informed care for this subset of the patient population and address their respective healthcare needs. While the actual incidence rate of differences in sex de-velopment remains unclear, it is estimated to be 1 in 4,500-5,500.5 Currently, the Intersex Society of North America re-ports there is a total of 1 in 100 people whose bodies differ from standard male and female.6 In the medical education literature, being an intersex individual is presented as part of the LGBTQ community. In terms of education and training materials available to the community, when searching inter-sex in the medical education literature available online, there is a paucity of resources available to guide the medical edu-cation community – and most of which pertain to general LGBTQ+ education. The education community requires standalone educational materials and training resources fo-cusing on intersex education. To this effect, there is a need to reframe the care of the intersex community that respects this unique community's individuality while using appropriate language in order to create a safe space that allows intersex patients to feel supported and empowered as they interact with healthcare providers.  At our institution, our student-run LGBTQ affinity group (referred to as JeffLGBTQ of the Sidney Kimmel Med-ical College at Thomas Jefferson University in Philadelphia, Pennsylvania, United States of America) was prompted to re-spond to this educational gap and advocate for additional training opportunities. JeffLGBTQ is well known at our in-stitution for providing informative and educational sessions surrounding a number of different genders and sexual mi-nority topics. Pre-clinical medical students, in particular, felt that the intersex community was marginalized in lectures surrounding DSD and intersexuality. Students felt that the content was not fully encompassing the history of intersex individuals and that the language was outdated. By engaging with intersex individuals, intersex advocates, and faculty stakeholders in the medical school, JeffLGBTQ organized an educational session entitled Intersex 101, to help educate stu-dents on the history, language, and concerns of people living with intersex conditions. Knowing the history of intersex medical care, in turn, has the potential to prepare them to be more patient-centered and take a trauma-informed ap-proach to serve this population. A trauma-informed ap-proach focuses on safety, empowerment, collaboration, and Endres et al.  Training on the differences in sex development 260 support. This model shifts the lens of care from "what is wrong with you?" to one that is more aligned with "what has happened to you?" This shift is critical as many of these indi-viduals may have experienced traumatic medical care.     This session was designed to complement content in our undergraduate medical education curriculum as a standalone extracurricular offering. It was open to all mem-bers of our institution's community, including students, res-idents, and faculty. No previous training was required to at-tend. The invited facilitator was a urologist and intersex advocate with expansive knowledge serving the intersex community from her work with interACT. InterACT is the world's largest intersex advocacy organization, which advo-cates for the human rights of children born with intersex traits. To encourage attendance, the session was delivered re-motely over Zoom. We were also fortunate to have the in-sight of another member of interACT who identifies as an intersex individual to provide their experiences of their med-ical care. The session emphasized four topics to our learners – empathy, engagement, language, and education. First and foremost, we aimed to discuss the experiences of individuals living with differences in sexual development. We stressed the power of language as the words we use as health providers are powerful. By using the word difference, in lieu of disorder, we are creating a space that does not stig-matize an individual while still being accurate to the condi-tion they are living with.  The session was attended by medi-cal students, residents, and faculty. Clinical faculty asked insightful questions surrounding the intersex experience and how to best inform their practice of medicine, with specific regards to obstetrics, gynecology, and urology. Medical stu-dents engaged with the invited intersex panelist, who was able to speak personally about their lived intersex experience. One faculty member specifically shared that she appreciated how "patient-driven care can reorient us to our patient's goals for their anatomy and how we can help them meet those needs." Despite our advertising and the high level of engage-ment in our attendees, attendance for this voluntary session was low – especially when considering our medical student body of approximately 1100 students. Sessions such as these should not be voluntary; instead, they should be part of a for-mal curriculum.  It is important to learn about this community inde-pendently and on its own, as members of this community have their own unique treatment challenges, including a common history of medical trauma. We are thankful we had a facilitator and community member, both of whom were able to speak on these topics openly and authentically. As this was an optional session and not required, we are limited in our ability to evaluate its longitudinal impact fully. Our ses-sion is at the forefront of a wave of inclusivity in medical ed-ucation. As our society grows in its understanding of sex and sex development, we call upon medical education leaders to think critically about more effective ways to teach sex devel-opment to clinicians in training. We hope our efforts will in-form and expand curricular opportunities that better prepare trainees to interact with individuals with differences in sex development with empathy, respect, and engagement. Conflicts of Interest The authors declare that they have no conflict of interest. References  1. Mayfield JJ, Ball EM, Tillery KA, Crandall C, Dexter J, Winer JM, et al. Beyond men, women, or both: a comprehensive, LGBTQ-inclusive, implicit-bias-aware, standardized-patient-based sexual history taking curriculum. MedEdPORTAL. 2017;13:10634. 2. Minturn MS, Martinez EI, Le T, Nokoff N, Fitch L, Little CE, et al. Early intervention for LGBTQ health: a 10-hour curriculum for preclinical health professions students. MedEdPORTAL. 2021;17:11072. 3. Sullivan W, Eckstrand K, Rush C, Peebles K, Lomis K, Fleming A. An in-tervention for clinical medical students on LGBTI health. MedEdPORTAL. 2013;9:9349. 4. Gupta A, Lockeman K, Edwards C. Increasing knowledge and self-efficacy on differences in sex development (dsd): a team-based learning activity for pediatric residents. MedEdPORTAL. 2021;17:11105. 5. Sax L. How common is intersex? a response to Anne Fausto-Sterling. J Sex Res. 2002;39(3):174-8. 6. How common is intersex? Intersex society of North America. [Cited 27 March 2022]; Aavailble from: https://isna.org/faq/frequency/.  

Medical Student Sensitivity Training on the Differences in Sex Development

https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1092&context=student_papers

Medical Student Sensitivity Training on the Differences in Sex Development

Abstract

Similar works

Full text

Available Versions

Jefferson Digital Commons