Students of medicine at the University of Exeter and the University of Plymouth have reported a gap in teachings on gender-affirming healthcare within their school curriculums. A Freedom of Information request put out by Exeposé reveals that the medical curriculums do not align with recommended guidances to address trans healthcare issues. Whilst some students believe they are taught basic issues such as gender versus sex and general awareness surrounding the topic, others believe they “were taught nothing”.
Specialised professionals, such as Exeter-based founder of Gender Identity South West, Dr Debby Jackson, explain that the lack of robust teachings on the subject could be due to the polarised climate surrounding gender in the UK. However, more medical students being educated on gender-affirming care could not only reduce the stigma that surrounds the diagnosis of gender dysphoria but could also alleviate the considerable waiting times throughout the country.
More medical students being educated on gender-affirming care could not only reduce the stigma that surrounds the diagnosis of gender dysphoria but could also alleviate the considerable waiting times throughout the country.
Currently with the healthcare landscape, those more specialised in gender-affirming care are said to be working in the field “through personal interest” or after “meeting a gender-diverse patient”. With this, these professionals “rarely get a chance to dedicate more than a few hours a week to train in aspects that may help” which is why most gender dysphoria clinics are made up of part-time and largely self-taught gender specialists.
The Royal College of General Practitioners and the World Health Organization have declared that there are significant gaps in education, guidance, and training for GPs around treating gender dysphoria for both adults and children, in addition to the management of broader trans health issues. According to a Medical Education Journal, the guidance for an updated curriculum for undergraduates recommends “that the number of hours of [gender affirming] teaching time must be balanced with all other medical school curriculum demands”. Some of the criteria would involve the understanding of surgery, the nuances of hormone therapy, the difference between dysphoria and other mental health concerns, and routine primary care.
In an FOI request to the University of Exeter’s Medical School, there are some compulsory modules that cover training on gender. Most notable is the Bachelor of Medicine, Bachelor of Surgery (BMBS, commonly known as Medicine) first-year module which entails a small group learning discussion of Year One patient-centred, Problem-Based Learning Endocrine and Reproductive Systems Case, which is compulsory and lasts three weeks. Nevertheless, it does not fall within the recommended curriculum etched out for undergraduates. There is also an expected second-year “Considering Gender” module which lasts one hour. Other degrees taught by the medical school–such as Genomic Science (MSc) and Health Data Science (MSc)–include mostly optional modules that consider gender-affirming healthcare. The Neuroscience (MSc) contains a compulsory module that includes a one-hour-long lecture with “reference to transgender individuals”.
One fourth-year student from the University of Plymouth says on the curriculum: “I think it’s shocking that we haven’t had any teaching about it beyond understanding the definition of gender identity versus biological sex.” They add that they “understand that it is fairly specialist management, but all doctors will come across transgender people and should know the basics of their management, such as HRT [Hormone Replacement Therapy], how to support a newly presenting transgender person, and what issues they commonly face.”
“I think it’s shocking that we haven’t had any teaching about it beyond understanding the definition of gender identity versus biological sex.”
University of Plymouth Medical Student
When asked what students generally remember about their teachings on this care, many reveal they have not had any teachings on it. Others maintain that the teachings they do have are based on the discrimination trans people face or on how to approach taking medical history from gender-diverse patients. Students also mention that professors’ attitudes towards gender-affirming care are mixed, as they write that their attitudes can be “controversial and [that] some are not for this”. Others describe the perception as “good” with more “inclusive phrases” being used.
Both the University of Exeter and the University of Plymouth Medical Schools issued statements on gender-affirming care teaching. A spokesperson from Exeter’s Medical School comments: “[We] are committed to supporting our LGBTQ+ community, and striving to ensure our students are equipped to serve a diverse population. We’re continually working with staff and students to evolve our guidance and practices. Our own survey of year one and two Medicine students on gender identity and wider our LGBTQ+ issues, found that the majority of students felt that gender identity was represented within the curriculum, giving them the knowledge and confidence they required for this stage of training.”
Within Exeter Medical School’s own survey, the students “expressed interest in further increasing this teaching.” Accordingly, some lecturers have already begun to utilise resources and learning activities relevant to transgender healthcare. In a recent curriculum review, they employed Medicine students to work alongside staff to explore issues. They hope that the ongoing work “will result in guidance for tutors on how to enhance their teaching content.”
A spokesperson for the University of Plymouth Medical School states that they are “proud to have a strong track record of positivity around LGBT+ issues and [were] listed in the top 10 UK universities for inclusivity in 2023.” In the school, “significant changes have been made throughout each year of our BMBS curriculum and other subject areas, to make them more inclusive for all, encompassing the way sex and gender are discussed in life sciences, anatomy, clinical skills and more.” They explain that their teaching includes mandatory workshops on gender and medicine and LGBTQI+ health, delivered in conjunction with their colleagues from the social sciences. The school adds that they recognize the need to be knowledgeable and aware of the diversity of their communities, so they are committed to regularly reviewing their curriculum and to using feedback to ensure their teaching and learning “reflects societal change and enables future doctors to provide the best possible care to patients.”
With more training and education on gender-diverse care within the curriculum, there could be a reduction in waiting times in the future. More GPs will have specialised training and be able to offer full-time care to gender dysphoria clinics. In a previous Exeposé investigation, waiting times significantly affect the livelihood of University students and young people. When it comes to general practitioners allocating care to specialised services, gender diverse students report a gap of knowledge on their care which could result in a rejection of necessary procedures such as allocations to gender dysphoria clinics.
Further, some patients could still be rejected hormone therapy from their GPs even after waiting on the gender dysphoria waiting lists for years or using private forms of care.
“Trans people have to be very knowledgeable about our own healthcare and the procedures of transitioning, which some doctors respond to with hostility as they seem to believe they know best despite having extremely outdated information.”
One anonymous trans student describes the process of transitioning through the NHS: “Trans people have to be very knowledgeable about our own healthcare and the procedures of transitioning, which some doctors respond to with hostility as they seem to believe they know best despite having extremely outdated information.”
Moving forward, both medical students and gender-diverse students believe that changes within medical school curricula would be beneficial to a significant population of people. They articulate that at the core of biases and barriers to healthcare, training the future of those responsible for saving people could completely revitalize the system.
