Gender minority portrayal in patient simulation: transgender and non-binary healthcare providers consider the priorities and ethics of practice

Abstract

Gender minorities experience extensive health inequities. Discrimination and bias in healthcare are contributing factors. Increasingly, medical educators are utilizing patient simulation to teach gender-affirming clinical skills. However, institutional practices vary widely in case authoring, casting and training. To date, no guidance for ethical practice has been established. Gender minority healthcare providers offer an important perspective on this due to their patient simulation experience and embodied knowledge. Transgender and non-binary healthcare providers and trainees ( Casting gender minorities in gender minority roles is the gold standard. In situations where this is not possible, participant opinion diverged on whether it is preferable to cast cisgender simulated patients or cancel the case. Participants described gender-affirming patient simulation as impactful. They noted the potential for harm to gender minority simulated patients due to repeated learner errors. The study provides a point of reference for educators designing simulation activities. Developing gender minority case content is important and should be undertaken with care. If recruiting gender minority simulated patients proves difficult, programs should engage their local transgender and non-binary community for input on recruitment and next steps. Increasing the simulated patient-to-learner ratio, engaging gender minority simulated patients remotely and/or involving gender minorities in case development and training may be viable alternatives.