Obesity preclinical elective: a qualitative thematic analysis of student feedback.

BACKGROUND: Education about the prevalent chronic disease of obesity is still minimal and variable in medical school curricula. In a student-led effort with faculty support, the authors designed and implemented an obesity medicine elective at Case Western Reserve University School of Medicine (CWRU). The 10-week elective, taught by seven physicians and one dietitian, was offered in January 2023 to medical students and included: weekly lectures, an interactive session with a patient, shadowing in obesity medicine practices, attendance at a distance-learning intensive behavioral lifestyle program, student presentations, and a final written reflection. The purpose of this study was to analyze the elective reflections and identify themes about the elective's value and areas to improve. METHODS: The authors analyzed reflections from the 20 medical students that completed the elective via qualitative thematic analysis. The analysis was performed using the Braun and Clarke six-phase framework: (1) become familiar with the data, (2) generate initial codes, (3) search for themes, (4) review themes, (5) define themes, and (6) write-up. RESULTS: The themes identified were improved: (1) understanding of obesity as a chronic disease, (2) knowledge about treatment options for obesity (3) confidence in compassionate obesity counseling skills, and (4) skills to confront weight bias. Theme (5) consisted of highlights (hearing from experts, practicing evidence-based medicine, and interacting with patients), and areas to improve (session length, presentation format, more peer-to-peer interaction, and more diverse patient interactions). CONCLUSIONS: Medical student assessments of a new obesity medicine elective described improved attitudes, knowledge, and skills to address obesity and obesity bias. Students were very satisfied and contributed ideas for improvements. This elective structure and evaluation method is a feasible model to provide medical students with meaningful experiences related to obesity.

One survey fits all? Evaluating the relevance of sexual function measures designed for cis women in trans women postvaginoplasty.

BACKGROUND: Providers are currently using surveys designed for cisgender women and/or creating their own questionnaires to evaluate the sexual function and satisfaction (SFS) of transgender women postvaginoplasty (TWPV), despite the marked difference in anatomy and lived experience between these groups. AIM: To evaluate the appropriateness of the current assays that have been validated in cisgender women and to assess their applicability in studying SFS in TWPV. METHODS: Surveys assessing female SFS that were validated in English speakers in North America were compiled and reviewed. Percentages reflect the proportion of surveys that asked questions deemed relevant or irrelevant for TWPV. Assessed variables included questions about endogenous lubrication, pain/discomfort with penetration, and other sexual activity. OUTCOMES: Outcomes of interest were questions that fell into 1 of 2 categories: questions irrelevant to TWPV (present/irrelevant) and those relevant for TWPV (present/relevant). RESULTS: All surveys contained present/irrelevant questions. Endogenous lubrication-a property of the natal vagina that may not be present in the neovagina-was the primary present/irrelevant question and was asked in 69.2% of the surveys. Vaginal pain, a present/relevant question, was assessed in 46.2% of surveys. Furthermore, questions requiring a partnered relationship to answer were asked in 61.5% of surveys, which may detract from the assessment of SFS in individuals who do not have sexual partners. Notably, there was also a lack of questions important for evaluating SFS in TWPV, such as assessing satisfaction of the caliber and depth of the neovagina, erogenous stimulation of the prostate during insertive intercourse, and cosmetic appearance of the vulva. CLINICAL IMPLICATIONS: This analysis raises concerns about the clinician's ability to meaningfully assess SFS in TWPV using the tools available. STRENGTHS AND LIMITATIONS: This article is the first of its kind to qualitatively assess the applicability of currently validated SFS questionnaires in TWPV. Limitations include the inability to draw definitive conclusions due to the qualitative nature of the study and the possibility of missing complex biopsychosocial factors, as trans individuals were not directly involved in the assessments of applicability. CONCLUSION: Given that the existing surveys are not designed to assess the SFS of TWPV, we call for the development of a validated survey for this population, which is in line with the precedent set by several other questionnaires validated for similarly specific populations.

Incidence of prostate cancer in transgender women in the US: a large database analysis.

The risk of prostate cancer among transgender women undergoing medical and surgical gender-affirming interventions remains unclear, though up to a fivefold decreased risk has been reported in comparison to cisgender men. In this study, we conducted a comparative analysis of the risk of prostate cancer among transgender women (TW) using data from TriNetX, a large database, versus SEER. Our findings indicate that, overall, transgender women exhibited a 2.56-fold lower risk of prostate cancer compared to cisgender men. Specifically, among TW on hormone therapy between ages 50-64, we observed a 2.06-fold decrease in risk. Contrary to the previous perception of prostate cancer being rare in transgender women, our study suggests that it may not be as uncommon as previously believed.

Are cisnormative surveys adequate to assess sexual well-being in trans men post-genital gender-affirming surgery?

INTRODUCTION: For transmasculine spectrum individuals, there is a lack of validated surveys to assess sexual well-being (SWB) post-genital gender-affirming surgery. Currently, either providers are designing their own SWB surveys or surveys designed for cisgender men are being used. OBJECTIVE: This study investigated the applicability of SWB surveys validated for cisgender men to transmasculine spectrum individuals post-genital gender-affirming surgery (TMSX). Recognizing the paucity of validated tools for assessing SWB in transmasculine individuals post-genital gender-affirming surgery (TMSX), we evaluated current surveys for their inclusiveness and relevance to this population. METHODS: Our methodology involved analyzing surveys validated in English-speaking North American cisgender men. We conducted a systematic review, yielding 31 surveys, out of which 12 met our inclusion criteria. These were then assessed against the 10 domains of holistic SWB as identified by Özer et al. Each survey was scored based on its reflection of these domains, thus generating an SWB score. Additionally, we performed a thematic analysis to identify areas needing modification for better applicability to TMSX. RESULTS: Our findings indicate an average SWB score of 5.17 out of 10 across the surveys. The surveys predominantly addressed sexual function, with a marked underrepresentation of domains like quality of life, sexuality, and sexual pleasure. This underscores the tendency of these surveys to focus more on the biological mechanisms of sex, rather than on a nuanced biopsychosocial understanding. Thematic analysis revealed significant gaps, such as the irrelevance of questions about erections and ejaculations for TMSX, and the need for greater emphasis on psychosocial factors. CONCLUSION: Given these gaps and the inadequacy of most cisnormative surveys, we recommend the creation of a novel, validated SWB survey specifically for TMSX. This should be developed in collaboration with a multidisciplinary panel and TMSX community advisory board, ensuring a tool that truly reflects the unique SWB needs of this population.