Using Standardized Patients to Augment Communication Skills and Self-Efficacy in Caring for Transgender Youth

Acad Pediatr. 2021 May 19;S1876-2859(21)00262-X. doi: 10.1016/j.acap.2021.05.010. Online ahead of print.


Objective: To examine the impact of standardized patient encounters (SPE) on gender-affirming communication skills and self-efficacy of pediatrics learners.

Methods: Fourth year medical students, pediatrics interns, psychiatry interns, and nurse practitioner trainees on one-month adolescent medicine blocks completed a curriculum with e-learning activities that was expanded to include SPEs. Following e-learning, learners completed two SPEs featuring transgender adolescent cases. Faculty observers and standardized patients completed checklists focused on history-taking, counseling, and interpersonal communication, and provided learner feedback after each case. The curriculum was evaluated by comparing skills checklists scores from case 1 to case 2 via Wilcoxon signed-rank tests. Self-efficacy was assessed pre-curriculum (Assessment 1), post e-learning (Assessment 2), and post-SPE (Assessment 3) using a previously developed instrument. Changes in self-efficacy scores were assessed via linear regression models with generalized estimating equations.

Results: Forty-three eligible learners participated in the study. The majority were pediatrics interns, and 5 learners had worked in a transgender clinic prior to the curriculum participation. Learners increased median total checklist scores between cases from 22 to 28 (p<0.001) (maximum score of 34). Learners' overall self-efficacy scores improved by 3.4 (CI: 2.9-3.9; p<0.001) between Assessments 1 and 2 and by 1.5 (CI:1.2-1.7; p<0.001) from Assessment 2 to 3. Similar improvements in checklist scores and self-efficacy occurred within stratified learner types.

Conclusions: The combination of SPEs with e-learning is effective at improving self-efficacy and gender-affirming communication skills for a multidisciplinary pediatrics learners. The comprehensive curriculum allowed learners inexperienced with transgender youth to apply knowledge and practice skills.

Keywords: e-learning; medical education; standardized patients; transgender.