A curriculum-based approach to make healthcare inclusive for the transgender population: challenges and lessons from Pakistan

BackgroundTransgender people experience significant healthcare inequalities due to stigma and lack of acceptance. Physicians and medical students have reported knowledge gaps regarding transgender health care (TGHC). Therefore, we conducted this study to assess the perceived need for and preferred approaches of medical students towards incorporation of TGHC in curriculum and any possible barriers that can arise. MethodsA cross-sectional survey was conducted amongst medical students from accredited medical colleges in Pakistan. Google forms were used to collect data including three outcome variables: need, preferred modalities, and barriers towards TGHC. The outcome variables were analyzed and compared using SPSS version 25.0. ResultsA total of 436 medical students from all over the Pakistan responded to the questionnaire. Of those, 264 (60.6%) were female. A majority of participants were from the southern provinces of Pakistan (n = 302; 69.3%). An overwhelming majority (98.4 %) of participants (n=429) felt there was a need to teach transgender healthcare (TGHC) education at the undergraduate level. This is contrasted by only 5% of participants (n=23) reporting being taught transgender health as part of their curriculum. Of these 5%, knowledge was mostly assessed either on multiple choice or essay questions. Majority students reported never having had any interaction with transgender patient during their clinical rotations. 82.8% students identified that education provided at their institute regarding transgender health education is inadequate while 80.8% students revealed that transgender health education was not an official part of their institutes curriculum. The biggest barrier identified was TGHC not being identified as a problem, followed by cultural and logistic barriers. The most recommended mode of TGHC education delivery as suggested by students was the use of small group discussions followed by student presentations and use of films and documentaries. ConclusionA clear gap exists regarding transgender health education in the medical curriculum in Pakistan. The study highlights important barriers and recommends possible modes of delivery to inculcate TGHC education in the curriculum.