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Asynchronous Modules on Transgender, Gender Diverse, and Intersex Patient Care in an Obstetrics and Gynecology Clerkship: A Retrospective Pre-Post Study

This retrospective pre-post study demonstrates that implementing brief, required asynchronous modules on transgender, gender diverse, and intersex patient care within an obstetrics and gynecology clerkship significantly improved medical students' self-reported knowledge, comfort, and clinical vignette scores.

Original authors: Omid Cohensedgh, Anne-Sophie van Wingerden, Michelle L. Shui, Said S. Saab, Taylor B. Sewell

Published 2026-06-25

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CC BY 4.0

Original authors: Omid Cohensedgh, Anne-Sophie van Wingerden, Michelle L. Shui, Said S. Saab, Taylor B. Sewell

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine medical school as a massive, high-stakes training camp for future doctors. For a long time, this camp had a blind spot: it wasn't teaching students how to care for transgender, gender-diverse, and intersex patients effectively. It's like a driving school that teaches you how to drive a car but forgets to teach you how to drive in the rain or on icy roads. When these future doctors hit the real world, they often felt lost, and the patients they were supposed to help felt unsafe or misunderstood.

This paper describes a project at Columbia University's medical school that tried to fix that specific blind spot. Here is the story of what they did, how they did it, and what happened, explained simply.

The Problem: The "Missing Manual"

Before they started, the school asked its students a simple question: "How well do you think we are teaching you about LGBTQI+ health?" The answer was a resounding "Not very well." Students felt unprepared, especially when it came to intersex conditions and the legal or policy hurdles these patients face. It was like trying to build a house without a blueprint; the students had the tools, but they didn't know the instructions.

The Solution: Two "Micro-Lessons"

Instead of forcing students to sit through hours of boring lectures (which is hard to schedule when they are busy seeing real patients), the team created two short, digital "micro-lessons."

Think of these modules like 15-minute "training videos" you can watch on your phone whenever you have a spare moment, similar to a quick tutorial on how to use a new app.

The Transgender & Gender Diverse (TGD) Module: This taught students the difference between sex assigned at birth and gender identity, how to use inclusive language, and how to spot barriers that stop these patients from getting care.
The Intersex Module: This explained what "intersex" actually means (it's about physical traits, not gender identity), the prevalence of these traits, and the specific medical needs of these patients.

The "Secret Sauce":
The creators didn't just guess what to teach. They listened to the students first (the needs assessment). They also made sure the lessons felt real by including:

Real Stories: The intersex module included videos and quotes from actual people with intersex traits sharing their experiences.
"Patient as Professor": For the TGD module, a transgender woman came in to talk to the students face-to-face, sharing her own healthcare journey. It's like having a guest speaker who says, "Here is what it feels like to be me in a doctor's office."

The Test: Did It Work?

After the students watched these 15-minute videos and attended the guest talk, the researchers gave them two tests:

A Confidence Survey: "Do you feel more comfortable and knowledgeable now?"
A Knowledge Quiz: A graded test with 10 tricky medical scenarios (like, "What cancer screenings does a transgender woman need?").

The Results:

Confidence Skyrocketed: Before the lessons, students felt shaky. Afterward, nearly 96% of them said, "Yes, I know more now," and 95% said, "Yes, I feel more comfortable." It was like giving someone a flashlight in a dark room; suddenly, they could see where they were going.
Knowledge Improved: On the graded quiz, the class average was an impressive 90.4%.
- They were perfect (100%) on questions about cervical cancer screening for non-binary people.
- They were very good at identifying conditions like Congenital Adrenal Hyperplasia (97.7% correct).
- They did slightly less well (but still mostly correct) on distinguishing between two specific intersex conditions (5-alpha reductase deficiency vs. others), suggesting that part is a little trickier to learn in just 15 minutes.

The Bottom Line

The study concludes that short, required, digital lessons work. They proved that you don't need to overhaul the entire medical school curriculum to make a difference. By slipping these "training videos" into the existing schedule, they successfully upgraded the students' "software" to handle these specific patients with more skill and empathy.

Important Note on Limits:
The paper is careful to say this was a "before and after" snapshot. They know the students said they learned and scored well on a test. However, they didn't track these students for years to see if they actually treated patients better in the real world later on. It's like testing a driver in a simulator and seeing them pass; it's a great sign, but the real test is driving on the highway for the first time.

In short, this project showed that a little bit of targeted, community-informed education can go a long way in making medical students feel ready to care for everyone.

Technical Summary: Asynchronous Modules on Transgender, Gender Diverse, and Intersex Patient Care in an Obstetrics and Gynecology Clerkship

Problem Statement
Medical education regarding the care of transgender and gender diverse (TGD) and intersex patients suffers from well-documented gaps. National data indicate that a majority of medical students feel incompetent in treating gender minority and intersex populations, with over half perceiving their medical school curriculum as inadequate. These educational deficits correlate with significant barriers to healthcare access for TGD and intersex individuals, including discrimination and avoidance of care due to fear of mistreatment. While curricular interventions exist, many are elective, single-session, or focused on only one population. There is a need for structured, required educational content embedded within core clinical clerkships that addresses both TGD and intersex care simultaneously to ensure all trainees receive training at a "teachable moment" during direct patient care.

Methodology
This study employed a retrospective pre-post design conducted between January and December 2024 at Columbia University Vagelos College of Physicians and Surgeons (VP&S), an allopathic medical school in the United States. The project was classified as an Educational Quality Improvement initiative, waiving the need for ethics review and informed consent.

Needs Assessment: A 2021 survey of 560 medical students identified specific curriculum gaps. LGBTQI-identifying students rated the curriculum significantly lower than their heterosexual/cisgender peers, particularly regarding intersex issues (mean score 1.73/5) and legal/policy topics (mean score 1.60/5).
Curricular Intervention: Based on the needs assessment and aligned with Association of American Medical Colleges (AAMC) competency frameworks, two 15-minute asynchronous modules were developed:
- TGD Module: Covered sex assigned at birth vs. gender identity, health disparities, barriers to care, unique OBGYN needs, inclusive environment creation, and trauma-informed care.
- Intersex Module: Defined intersex vs. TGD, covered prevalence, specific conditions (e.g., AIS, CAH, 5-alpha reductase deficiency), barriers to care, unique OBGYN needs, and trauma-informed care.
- Content Features: The intersex module included first-hand video accounts and quotations from individuals with intersex traits, with feedback from InterACT. The TGD module was supplemented by a synchronous "Patient as Professor" session featuring a transgender woman.
Participants: 134 medical students rotating through the required OBGYN clerkship.
Assessment:
- Self-Report: Anonymous retrospective pre-post surveys (8 items for TGD, 10 for intersex) using a 5-point Likert scale to measure knowledge and comfort.
- Knowledge Assessment: A graded, 10-item multiple-choice test based on clinical vignettes.
Statistical Analysis: Descriptive statistics and Wilcoxon signed rank tests with Benjamini-Hochberg post-hoc correction (false discovery rate 0.05) were used to compare pre- and post-module responses.

Key Results

Survey Responses: All 134 students completed the TGD survey; 130 completed the intersex survey.
- Knowledge and Comfort: Students reported statistically significant gains ( $p < 0.001$ ) in self-reported knowledge and comfort across all learning objectives for both modules.
- Perceived Improvement: Post-module, 95.6% of students agreed or strongly agreed that their knowledge of TGD care improved, and 94.6% reported improvement in intersex care knowledge.
Knowledge Assessment: 133 students completed the graded assessment.
- Overall Performance: The mean score was 90.4% (SD 0.9%), with 20.3% achieving a perfect score.
- Specific Competencies: 100% of students correctly answered questions regarding cervical cancer screening for nonbinary individuals assigned female at birth and the screening schedule for a 65-year-old transgender woman (breast and colon cancer).
- Areas of Difficulty: The most frequently missed question involved distinguishing 5-alpha reductase deficiency from congenital adrenal hyperplasia (74.4% correct). In a vignette regarding a transgender woman on estrogen, 40.6% correctly recommended prostate cancer screening, though 100% recommended at least one appropriate screening.

Significance and Claims
The authors claim that brief, required asynchronous modules can produce significant and consistent gains in medical student knowledge and comfort regarding TGD and intersex patient care. The study highlights a scalable model for addressing LGBTQI health education gaps through:

Needs Assessment-Driven Design: Ensuring content targets specific, identified curriculum deficiencies.
Community Engagement: Incorporating patient voices and advocacy group feedback to ground the curriculum in lived experience.
Multi-Modal Assessment: Combining self-reported comfort with graded clinical vignettes to validate learning.

The paper concludes that embedding these modules in core clerkships ensures universal exposure for trainees, offering a transferable framework for other institutions and clerkships (e.g., internal medicine, family medicine) to improve equitable care for TGD and intersex patients. The authors acknowledge limitations, including the potential for recall bias in retrospective surveys, the single-institution setting, and the lack of long-term retention or clinical behavior assessment.

The Problem: The "Missing Manual"

The Solution: Two "Micro-Lessons"

The Test: Did It Work?

The Bottom Line

Technical Summary: Asynchronous Modules on Transgender, Gender Diverse, and Intersex Patient Care in an Obstetrics and Gynecology Clerkship

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