This New Simulation Will Help Train Doctors in Gender-Affirming Care

For transgender and gender non-conforming folks, finding quality, gender-affirming health care can be challenging. A 2015 survey found that 33% of respondents who had seen a healthcare provider in the previous year had had a negative experience related to their gender identity, such as being refused treatment.

Many healthcare providers lack the training to offer this kind of care. Now, Kognito, a health simulation company, is trying to change that with new training for physicians.

"The topic itself, gender-affirming care, is one that we had found through our own research was a significant need in terms of training," Gurnek Singh, BS, MBA, who works on healthcare-related projects at Kognito and was involved in the creation of the simulation, tells Verywell. "There's a gap there that most, and especially early practicing professionals and students, are really worried about messing up."

That is, even if the professional understands the importance of practicing gender-affirming care, they may be doubtful and anxious about how to do it well.

That's where Kognito's gender-affirming care simulation comes in. The idea is that through artificial intelligence and virtual simulation, medical professionals can practice gender-affirming care. According to a blog post, the simulation covers three main learning objectives:

• Understanding and using gender-neutral language, as well as honoring patients’ pronouns and identity without making assumptions.
• Ensuring all questions are medically relevant and that patients understand why their answers are important to their care.
• Knowing when and how to apologize when mistakes are made.

How Does the Simulation Work?

Imagine this: You're a doctor, and you're walking into a treatment room to meet your patient, Nicky Hill. She's in her 50s, and after reading her case file, you know that your goal is to get her re-engaged in smoking cessation. So, you start talking with her, unpacking what is hindering her from quitting, and the health impacts of smoking on her health as she ages.

Then, Nicky, who is a transgender woman, asks a question: "How does smoking interact with my hormone therapy?"

This is the exact kind of scenario providers will encounter through the simulation. When meeting Nicky, Singh says, there are various steps the trainee goes through.

"It's really a wraparound learning experience," he says. There's content that's informational, setting up the learner to understand the basic principles of gender-affirming care. This ensures the trainee learns the information or is reminded, ideally setting them up to feel more prepared.

Then, they get background on Nicky. They learn about her smoking, and that she is a transgender woman. They eventually start talking with her, choosing responses as the conversation goes on. There are good, so-so, and poor ways to respond throughout the conversation, Singh says. "Depending on which options the learner picks, that conversation can either go really well or it can go right off the rails."

This is all meant to model what happens in real life, Singh adds. But there are also feedback mechanisms in place to help learners improve. The feedback can be through nonverbal cues from Nicky (like body language), feedback from a virtual coach, as well as from direct feedback meters. "They go up if you're improving the rapport and achieving your goals, and they go down when you're starting to alienate or distance the patient," Singh says.

Trainees can also undo choices and try different pathways, which Singh says they find to be very appealing for learners. Finally, at the end of that conversation, they get a performance dashboard that summarizes the conversation. 

"We've tried to create a really versatile experience that can be used in a lot of different settings for learners at different stages in the hope of providing enough practice to help those individuals feel really confident the next time that they're in a room and they're meeting a transgender patient for the first time," Singh says.

To create the simulation, Singh and colleagues worked with physicians, nurse practitioners, nursing students, and transgender individuals.

And when the simulation rolls out later this year, the same types of people who helped create it will be using it for realistic training, Singh says. "This is what it actually sounds like when we're talking about these things in the clinic so that students feel like they're really in the scenario."

Importantly, he adds, the virtual nature of it allows people to practice again and again without running the risk of potential harm on real-life patients. "It's just a lack of familiarity that could cause unintended harm," Singh says. But through the simulation, "you get exposed to a diversity of patients and different personas, which helps build that confidence right off the bat."

Addressing Disparities

Training like this can help address not just gender-affirming care, but other factors that matter in treatment.

Singh says gender identity is just one aspect that should be given more attention and treated in healthcare settings. "We tend to think about transgender issues as this sort of isolated thing," Singh says. But other factors come into play in health care as well.

"All of those things matter—not just your gender identity, but where you live, your socioeconomic status, how accessible care is, your past relationship with healthcare providers," he explains.

The fact that many transgender and non-conforming folks are less likely to seek out care due to negative previous experiences, Singh adds, is not unique. Healthcare disparities work against you especially when you're not White or are low-income, too.

Singh is hopeful that simulations like these will help to repair and reverse much of the damage already done.

"You know that [transgender and gender non-conforming patients] are coming in with these preconceived notions because they've had these traumas in the past," he says. "It's important that you do the small things that help them heal and feel comfortable and confident when they're interacting with you."