Teaching Racial Affinity Caucusing as a Tool to Learn About Racial Health Inequity Through an Experiential Workshop.

BACKGROUND AND OBJECTIVES: In its landmark report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, the Institute of Medicine concluded that unconscious or implicit negative racial attitudes and stereotypes contribute to poorer health outcomes for patients of color. We describe and report on the outcome of teaching a workshop on the tool of racial affinity caucusing to address these issues. METHODS: Applying the framework described by Crossroads Antiracism Organizing and Training, we developed a 90-minute workshop teaching racial affinity caucusing to family medicine educators interested in racial health disparities. The workshop included didactic and experiential components as well as a panel discussion. We administered pre- and posttests. RESULTS: Participants' (n=53) impression of and confidence in implementing racial affinity caucusing significantly increased following the workshop from a mean pretest score of 5.40 to a mean posttest score of 7.12 (P<.01) on a scale of 1 to 9. Ninety-two percent of participants indicated that the workshop made them more likely to think about implementing this tool at their home institutions (P<.01). CONCLUSIONS: This study demonstrated the first exploration in medical education of racial affinity caucusing and illustrated that it can be easily implemented in residency programs as an effort to address racial health inequities. Though the participating educators were mostly unfamiliar with it, the workshop was an effective introduction to this tool and by the end, educators reported increased comfort and enthusiasm for racial affinity caucusing, regardless of their preexisting levels of knowledge of or comfort with the tool. In addition, the overwhelming majority of the participants felt they could implement it at their respective institutions.

Supporting Transgender and Nonbinary Residents.

Transgender and gender nonbinary (TGNB) individuals experience challenges while applying for and completing residency, although limited research exists. An academic panel reviewed best practices for residency programs who interview and match TGNB residents. Program leadership should identify and utilize the affirming name and pronouns for all applicants, not ask gender identity during an interview unless self-disclosed, and ensure that health insurance covers transition care. Programs should proactively educate all residents, faculty, and staff on knowledge gaps regarding transgender health regardless of the presence of TGNB residents. Future studies are necessary regarding experiences of TGNB residents to investigate their specific needs.

Hormonal, Medical, and Nonsurgical Aspects of Gender Affirmation.

Although the acronym LGBTQ is often used as a catchall label for sexual and gender minorities, transgender people have unique and individual health needs and unfortunately experience significant health disparities. This article reviews essential terminology and concepts relevant to discussions of gender and gender identity, practical tips for changes that can be made on the clinical and institutional levels in order to create a welcoming and safe environment for transgender patients, as well as current recommendations for the provision of gender-affirming medical therapy.

Menstrual migraines: Which options and when?

Would your patient benefit from abortive therapy or prophylactic treatment? And which regimen is likely to provide the best--and safest--relief?

Gender and Sexual Health: Care of Transgender Patients.

Transgender and gender-nonconforming individuals experience significant health disparities. They are more likely to use drugs and alcohol, smoke, be diagnosed with HIV infection or other sexually transmitted infections, and experience depression or attempt suicide. Many also experience discrimination within the health care system. Office-level strategies to create a safe and affirming space for gender-expansive patients include posting of a nondiscrimination statement, use of intake forms that ask about current gender identity and birth-assigned sex, provision of gender-neutral restrooms, and staff training in use of appropriate language. Hormone or surgical therapy can be initiated for patients with persistent gender dysphoria who are of age and have the capacity to make informed decisions, and have reasonable control of coexisting medical and psychiatric conditions. Estrogens, antiandrogens, and progestins are used for feminization, and testosterone for masculinization. Hormone treatment should be followed by careful monitoring for potential adverse effects. Surgical options include male-to-female and female-to-male procedures. The family physician may need to provide a referral letter, preoperative and postoperative examinations and care, and advocacy with health insurance providers. Preventive care for transgender patients includes counseling for cardiovascular health, cancer screening, provision of appropriate contraception, and screening for sexually transmitted infections.

Adolescent pregnancy and contraception.

7% of US teen women became pregnant in 2008, totaling 750,000 pregnancies nationwide. For women ages 15 to 19, 82% of pregnancies are unintended. Adolescents have a disproportionate risk of medical complications in pregnancy. Furthermore, adolescent parents and their infants both tend to suffer poor psychosocial outcomes. Preventing unintended and adolescent pregnancies are key public health objectives for Healthy People 2020. Screening for sexual activity and pregnancy risk should be a routine part of all adolescent visits. Proven reductions in unintended pregnancy in teens are attained by providing access to contraception at no cost and promoting the most-effective methods.

Cardiovascular disease in women: contraceptive issues and nonvalvular cardiovascular disease.

Several reproductive issues affect cardiovascular risk in women. Polycystic ovary syndrome is common and may include menstrual irregularities, hirsutism, and metabolic symptoms. Patients with this syndrome have an increased risk of impaired glucose tolerance and dyslipidemia. Hysterectomy is a common gynecologic surgery that may affect estrogen levels in women. There are conflicting data on the cardiovascular risk associated with estrogen use in women after a hysterectomy. Human papillomavirus is a newly identified risk factor for cardiovascular disease (CVD), but the mechanism and effect are still unknown. Contraceptives are the most commonly used prescription drugs among women in the United States. The absolute risk of CVD in young women is low; therefore, the threefold increase in risk that is associated with contraceptives is still low. Estrogen is thought to be the primary concern related to the increased cardiovascular risk associated with combined oral contraceptives. Contraceptive pills also may affect insulin, lipid, and blood pressure levels.

Reproductive health care of adolescent women.

Reproductive health care of adolescent women is focused on prevention of disease. Adolescents are at higher risk for pelvic inflammatory disease than adult women; therefore, screening regularly for sexually transmitted infections is important. Immunization for human papillomavirus is the primary means of cervical cancer prevention because new guidelines recommend not initiating Papanicolaou smears until the age of 21. Contraception for adolescents is a challenge, and clinicians should focus on long-acting, reversible contraception in this group. The treatment of pelvic pain and menstrual disorders in adolescent women is distinct from adult women and is related to differing prevalence of conditions. Lastly, this article discusses the importance of confidential care when treating adolescent women.

Emergency contraception: an underutilized resource.

This emergency contraception update and telephone triage guide can help ensure that your patients get the help they need, when they need it.