Introduction: Rural regions in the Southeastern U.S. are predominantly under-resourced and have poorer health outcomes compared to national averages. People living in rural Appalachia with intersectional identities often have limited choices in providers along with other systemic barriers to obtaining good healthcare. Barriers to competent and safe healthcare disproportionately impact people who are marginalized because of their identity. For transgender patients in South Central Appalachia, intersectional identities constitute barriers to receiving competent healthcare and increase the risk of poorer health outcomes. Literature indicates providers nationally receive on average between 45 minutes to five hours of training on transgender healthcare provision which may exacerbate poor care experiences in South Central Appalachia. The current study aimed to develop and implement a training program for rural-serving medical residents in primary care in South Central Appalachia. A six-stage, pilot development study is described.
Methods and Results: This project developed a cultural competency training for rural-serving medical providers specific to transgender health needs. The Kern Model was utilized to structure the development of this training. Data from clinic stakeholders, resident liaisons, and transgender community members were utilized throughout phases of development. Two major themes arose from planning with these key stakeholders: accessibility/reusability of the material and usefulness of the material to the residents. Stakeholders were asked to identify areas of competency that would be beneficial for their practices and what baseline information would be necessary for all participants to know. Trainings were a hybrid of virtual and live delivery to pivot in response to space allocations at each clinic and to allow residents who were on hospital rotations to attend. An educational consultant was utilized to inform the best style of training design to meet the stated pedagogical goals.
Discussion: Previous studies have indicated that medical providers receive limited training on transgender health needs. However, there is also literature suggesting differences in general medical education due to resource competition. Therefore, developing sustainable, accessible, and useful medical education is imperative. The inclusion of resident and community member feedback in the content creation of this project allowed customization to the community’s and residents’ needs. Stakeholder input on the pedagogy of this project was also imperative due to physical space constraints with social distancing guidelines. This training highlights the value in engaging virtual curricula, as it allows optimal accessibility for rural clinics. This project aimed to develop a training specific for South Central Appalachian providers that was informed by transgender people in the region and tailored specifically for regional providers based on stakeholder input. The resulting training may be an invaluable tool for the future medical providers in the rural-serving region that is medically and educationally under-resourced and experiences inflated intersectional discrimination within systemic and interpersonal levels.