Proposal (02/11/2021)

A Theoretical Application of Kern’s Six-Step Model for Transgender Health

Curricular Development in Endocrinology and Metabolism

Tehmina Ahmad

Student ID: 20177549

Health Professions Teacher Education (HPTE)

Dalla Lana School of Public Health

University of Toronto

CHL5607H: Teaching and Learning by the Health Professions - Principles and Theories

Major Scholarly Paper- Assignment 1

Dr. Abbas Ghavam-Rassoul

November 2, 2021

Despite the 2014 publication of the American Association of Medical College’s (AAMC) Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born with DSD, uptake of transgender health associated training objectives has lacked both in consistency and content across Canadian post-graduate medical education (Hollenbach, Eckstrand, & Dreger, 2014). Although each group is heterogenous and faces disenfranchisement from the medical community, transgender individuals (persons whose sex-assigned at birth differs from their gender identity), encounter disproportionate inequities in health care access, such that a 2017 survey of transgender individuals in Ontario reported that 43.9% had an unmet health need (Giblon & Bauer, 2017).

As we look towards experts of hormonal care, in a survey by Irwig, 80% of practicing endocrinologists had not received any training in caring for transgender individuals, with only 63% stating they were willing to provide such care, and only 50% of those surveyed had read Endocrine Society’s clinical practice guidelines for instituting such care (Irwig, 2016). The problem is evident, there is a paucity of transgender health training and unification of objectives required to treat transgender patients in Endocrinology and Metabolism.

In 2022, Endocrinology and Metabolism training programs across Canada will begin implementing competence-based medical education (CBME), where residents must independently demonstrate specific knowledge, skills, and attitudes to graduate (Long, 2000). The CBME model poses an opportunity to fill the competency gap and standardize transgender health objectives across Canadian Endocrinology and Metabolism training programs. Current objectives of subspecialty training portending to transgender health, in particular ‘gender identity,’ are obsolete both in language and competence setting (Royal College, 2013):

“2.1.11. Disorders of reproduction in females, including… gender identity…

2.1.12. Disorders of reproduction in males, including… gender identity…

3.2. Counsels patients and/or families in an empathetic, accurate and supportive manner with attention to age, disability, gender, gender identity, sexual orientation…

4.2. Respect diversity and difference, including but not limited to the impact of age, gender, gender identity, sexual orientation, religion, and cultural beliefs.”

I propose utilizing Kern’s six-step model for curriculum development as framework for the development of transgender health educational objectives and competencies (Kern, 1998). The model is centered around: 1) Problem identification, 2) Needs assessment, 3) Goals and objectives, 4) Educational strategies, 5) Implementation, and 6) Evaluation and feedback (Kern, 1998). The six-steps are not meant to be approached in a linear fashion but instead, occur dynamically as the curriculum content evolves (Kern, 1998).To delineate the problem identification and needs assessment, I will search the literature to highlight what formalized training is provided to Endocrinology and Metabolism trainees in Canada. Although scholarly articles point towards a lack of knowledge and comfort in providing transgender care, a modified Delphi method subject to Endocrinology and Metabolism program directors could arrive at an expert panel decision of the training required. A second literature search for objectives or targeted competencies can then ensure to define transgender health related goals and objectives. Pre-existing literature can help direct what educational strategies are being implemented to teach transgender care (Nolan et al., 2020). The implementation of such an endeavor will vary based on locality, content expertise, and buy-in from program directors nation-wide. Ultimately, evaluation would come from learner assessments through CBME and program curricular evaluation. The theoretical framework has been used previously for undergraduate curricular development of objectives, and would bode well in expanding such development to the field of Endocrinology and Metabolism (Berenson et al., 2020).