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This letter provides a commentary that expands on the recent work from Oliphant et al1 who outline the new healthcare guidelines and pathways in transgender healthcare in Aotearoa/New Zealand. Here, we identify challenges in instigating more education about such healthcare in the training of doctors and other healthcare practitioners.
Increasing recognition of transgender and non-binary gender identities, and associated health disparities, indicate an unaddressed and growing need for teaching about transgender healthcare. Globally, and in Aotearoa/New Zealand there is a corresponding need for high-quality research on how to best deliver this education. Examining the international literature and our own research with transgender community members, we find insight into why this educational 'gap' may have arisen and how it might best be addressed.
In some ways, it seems easy to understand how such an educational gap might have come about. Those who are transgender or of non-binary gender identity are often treated 'differently' to those who are cisgender, whose gender identity aligns with their sex assigned at birth.1 Thus, teaching about transgender healthcare issues can also be understood to be a practice that might be 'different' to customary teaching about healthcare, and perhaps 'too difficult' for some teaching staff-namely those who lack experience with transgender people or foundational expertise on transgender healthcare.
Challenge 1
Past research has established three main barriers to effective transgender healthcare teaching: a) healthcare practitioners' lack of understanding about transgender identities, b) gaps in healthcare practitioners' education about transgender healthcare and c) failure to set aside transphobic personal values.2 Our own preliminary research confirms these issues.3
We also found a notable additional issue around what it is to 'be' transgender: staff who teach trainee healthcare practitioners understand the topic of 'being' transgender as eminently caught up with issues of 'self' and 'selfhood' and that as such, these issues can be inordinately sensitive. Thus, we understand that the corresponding level of skill, and values, required to effectively teach transgender healthcare might be beyond levels currently understood to be effective; 'messing up' transgender education can have similar dire and personal consequences to 'messing up' a consultation in which a transgender person comes out.
Challenge 2
Evidence from the healthcare sector indicates that...