Toward the inclusion of transgender and nonbinary residents among obstetrics and gynecology residency programs across the nation: a needs assessment.

Abstract

As the number of matriculating transgender/nonbinary medical students continues to increase, residencies should anticipate receiving a greater number of applications from gender-diverse students. Although research is limited, existing literature on the experiences of transgender or nonbinary medical students and providers demonstrate ongoing safety and discrimination concerns. To date, no published studies have explored the experiences of transgender or nonbinary providers in obstetrics and gynecology residency programs. Given the need to support increasing numbers of transgender or nonbinary residents, this study aims to evaluate for current strengths and barriers toward the inclusion of incoming transgender or nonbinary trainees in obstetrics and gynecology residency programs and identify opportunities for improvement. An online survey was distributed from May to November 2023 to healthcare providers affiliated with accredited obstetrics and gynecology residency programs in the United States. The survey explored program demographics, interpersonal interactions, physical space, and provision of gender-affirming care. Descriptive statistics and a logistic regression of quantitative responses were analyzed. Thematic content analysis was used to examine open-ended responses. Among 294 obstetrics and gynecology programs accredited in 2023, 127 participated, representing all US regions. 69% of respondents identified as faculty or ancillary staff and 57% stated that they have been affiliated with their residency program for 5 or more years. 27 programs (21.3%) had a transgender/nonbinary resident prior to and/or at the time of survey completion, of whom 7 programs (6%) identified having at least one transgender/nonbinary individual who was of a race other than White. 123 programs (97%) agreed that obstetrics and gynecology programs have a duty to provide an inclusive workplace environment for transgender/nonbinary residents, and 73 programs (57.4%) felt prepared to support an incoming transgender/nonbinary resident. Logistic regression found that having a transgender/nonbinary resident at the residency, offering pronoun pins to healthcare providers, and providing easily accessible gender-neutral bathrooms were associated with program readiness to support a transgender/nonbinary resident. Qualitative analysis identified 7 common themes exploring barriers and facilitators for providing an inclusive workplace environment for transgender/nonbinary residents. Although nearly all providers acknowledged the importance of creating an inclusive environment for transgender/nonbinary residents, close to half of participants felt their programs were unprepared to do so. This study identifies relevant and feasible opportunities for improved gender identity inclusivity within the workplace. Recommendations are summarized in a toolkit for residency programs working to build a supportive work environment.