Ethan Wilson (he/him) is a medical student at the University of Glasgow, having previously qualified as a Biomedical Scientist. He has a substantial history of involvement in trans equality and right activism, having shared his personal experiences online of transitioning, and longstanding involvement in transgender students’ representation. Now, both within and alongside studying medicine, he focuses his efforts on trans health education and awareness. Primarily he does this through “the THISTLEproject”, which he set up as a way to run practical workshops and education seminars, lead health improvement campaigns, and advocate for inclusion of transgender healthcare teaching, within medical and wider healthcare course curricula. On rare occasions that Ethan is not doing one or both of these things, you can likely find him lifting heavy things in the gym, painting small scale plastic people, or probably having a nap somewhere.
Integrated. Involved. Indistinct.
Answering the question of what my vision for LGBTQ+ health care teaching in the medical curriculum looks like, is a surprisingly challenging thing to put into words. It is both wide reaching, and yet full of tiny details; there are a great many things that I think it should be. So, for the purpose of this blog post I have decided to focus more broadly, on three ways in which I think LGBTQ+ health care teaching, should feature in the medical curriculum.
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Integrated.
Teaching should be integrated. There is a time and place, of course, for stand alone modules and sessions - and I do still believe them to be necessary for LGBTQ+ health care teaching, as they can offer more specific and focused pieces of learning. But, generally speaking, I would like to see LGBTQ+ health care education more integrated into the entirety of the curriculum.
Humans are a wonderfully diverse group of people, our organs and tissues (mostly) do not exist entirely by themselves, just as our identities of self are all intertwined with one another. It’s what makes us who we are.
In medical school we learn about Topic A, but it is in the context of Topic B, and when we then subsequently learn about Topic C, we find mentions of how both Topics A and B tie in.
That should be the same for LGBTQ+ teaching. Where we learn about a condition that disproportionately affects members of the LGBTQ+ community, we ought to be taught about that, and more importantly we ought to be taught why.
For instance: transgender individuals actually face the greatest burden and risk of HIV, with trans feminine[1] individuals having a prevalence 66 times higher. Why then, does the same old stereotype linking HIV and gay male couples keep appearing, when this is evidently not an accurate reflection at all?
Language in the curriculum needs updating too, reproductive teaching is still very cisgender-heteronormative. Speaking personally… sitting in the week’s teaching around the “female reproductive system” as a transgender man, who conveniently and ironically happened to be menstruating that very week, is isolating, alienating, and most certainly does not make me feel represented in the curriculum or in health care settings.
Involved.
Teaching should be involved. By this, I mean the content within the medical curriculum as relates to the LGBTQ+ community, should be developed in partnership with members of the community, or at the very least it should be reviewed by them, before being added into use.
Without the lived experiences of a certain group, one can hardly write and teach content about said group. It’s important that the community is included, especially to help flag and correct the small things that would likely otherwise go unnoticed and be published, but could be offensive or damaging, such as any stereotypes, wording errors and similar.
Again, examples help. So, I am a transgender man, or a trans man. I am not, a transman, or a trans-man. You might wonder what the difference is, so let’s substitute for something else to clarify. Keeping with the LGBTQ+ theme of this, of course, would you write a lesbian woman as lesbianwoman or lesbian-woman? No, or at least, I would hope not.
Similarly, transgendered and transgendering - not terms, though I have had doctors use both in spoken and written communications with and about me. Would you say someone is gayed, or bisexualing? Again, no. This is why the LGBTQ+ community needs to be involved.
Indistinct.
Teaching should be indistinct. Go with me here on this one - I know it might sound like an odd statement. Why push for the addition of something to the curriculum, only to try and make it mundane and no big deal?
Whether the teaching is on cell biology, the cardiovascular system, LGBTQ+ health care, or practical surgical techniques; they are all important. None are arguably more important than the other, as medical school is designed to cover a bit of everything.
Sure, some topics will capture one students’ interest more than another’s, and that comes down to the aspirations of each and every unique student. The same is true regardless of which course one is studying. That is absolutely fine, and normal amongst student cohorts.
Whether teaching is on LGBTQ+ health care, disability, presentation of rashes on different skin colours, or any other topic that generally comes from a place of focus on a discriminated or marginalised group, it should be common place. It should be just as normal, and accepted, that it is content one will see in a medical curriculum, as the expectation that the structure and function of organ systems will be there.
In that respect, I believe it should be indistinct. Not to say that it is unimportant - because, obviously, it is very much so - but that it shouldn’t become something there is a celebratory song and dance made over it. It shouldn’t be something a school turns round to gain status points by saying “look what we have” in our curriculum, and “aren’t we great”.
I will accept, with sadness, that in the beginning there will be an element of this. Sadness, because it means it is something that is still seen as new, when it really shouldn’t be.
But, if some sort of inter-med-school status rivalry, can encourage people to sit up and notice, and get the content into the curriculum in the first place, in the short term a song and dance may be necessary and worth it.
Most importantly, I suppose, if you ask me what my vision for LGBTQ+ health care teaching is in the medical curriculum? My answer would be that my vision is for it to actually be there.
[1] Stutterheim, SE., van Dijk, M., Wang, H., and Jonas, KJ. (2021) The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis. PLoS ONE. 16(12):e0260063. [Accessed: 12 June 2022] Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0260063
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