Cultural Humility in Laboratory Medicine Education

Carlo Ledesma, MS, MLS(ASCP)^CMSH^CMDLM^CM,QLS^CM, MLS(AMT), ASCLS Diversity Advocacy Council Councilor-at-Large

Increased awareness in medicine through research activities and multidisciplinary approach in care has led to increased understanding of the physiological changes seen in patients with gender dysphoria undergoing gender affirmation hormone treatments. While there is more information that we need to learn, we have set evidence-based treatment protocols and monitoring systems to provide a safe and effective gender-affirming treatment to transgender patients. This era in laboratory medicine emphasized our importance in providing gender-inclusive medicine and promoting health equity.

The impetus in creating a sustainable change is to integrate transgender medicine in medical laboratory science curriculum. To develop a competent and knowledgeable workforce, a curriculum that will promote the understanding of the health needs of patients with gender incongruence is imperative. Developing a curriculum that is centered in cultural humility, medical laboratory science education will increase competency and develop a knowledgeable and culturally competent workforce of medical laboratory professionals¹.

It is important to begin efforts to close the gaps in care by implementing a curriculum designed to increase the cultural competency and cultural humility of healthcare providers—including the medical laboratory profession—serving the lesbian, gay, bisexual, transgender, queer, and intersex, asexual (LGBTQIA) community. Cultural humility requires a lifelong commitment to understand the patient population and recognize and address power dynamics in any provider-patient/client relationship. This structure of curriculum can be applied also to practitioners in order to promote an understanding of the patient population, especially in the advent of patient-centered personalized medicine.

The strengths of a curriculum bound in cultural humility includes a focus on (1) individuals instead of their cultural groups, (2) self-reflection, and (3) active listening². Integrating a gender-inclusive curriculum in medical laboratory sciences will develop future practitioners that will be cognizant of patient safety and promote quality of care and will continue to aspire to meet the unique needs of their patient population.

To increase the competency of medical laboratory professionals, a two-part training program can be developed to help address medical laboratory professionals’ healthcare encounters with persons who identify as LGBTQIA. This two-part curriculum will be composed of understanding the LGBTQIA demographic, and the other half would be to promote an understanding of transgender medicine. This will build a foundation for learners to learn of the demographic and understand the effects of gender-affirming care as it relates to laboratory medicine. Ultimately, even behind the scenes, laboratory professionals will be instrumental in promoting healthcare equity.

Future considerations related to the development of a curriculum to understand the effects of transgender medicine in medical laboratory sciences will include¹:

1. Increased awareness of transgender medicine for all levels of laboratory staff.
2. Ability to understand the needs of the patient population and be patient advocates to improve health outcomes.
3. Understand the physiologic effects of gender-affirming care and its impact on medical lab tests.
4. Determine inadequacies in an institution and help develop processes to help improve data collection important to understand the healthcare needs of the demographic.
5. Update the knowledge base of practitioners to further enhance laboratory services and promote healthcare equity.

Transgender patients are disproportionately disadvantaged in medicine because of the inadequate number of educational foundations to understand their unique health needs. Despite a growing social acceptance and a growing body of knowledge addressing the unique needs of transgender patients, discriminatory practices are still evident in today’s healthcare environment. There has been a lot of progress seen in medical laboratory science in terms of transgender medicine, but as we begin to unravel long-term outcomes of gender-affirming care, it is imperative for laboratory professionals to deliver results for patients and their providers that will appropriately guide their treatment and monitor effectiveness of therapy. For pathologists, lab directors and consultants, and advanced-practitioners Doctor of Clinical Laboratory Science (DCLS), an evidence-based, patient-centered approach should be the model of care and the center of our practice in laboratory consultation.

Laboratory medicine, through the different levels of practitioners, can be instrumental in dismantling healthcare disparities and improve the health of the patients by alleviating the health inequities of the transgender population and the LGBTQIA community. Once again, I appeal to the medical laboratory community to be the instrument of change in providing equitable healthcare. In doing so, we can realize our duty to our colleagues and the profession, our duty to society, and our duty to the patients in the communities we serve.

References

1. C J Ledesma, Integrating Transgender Medicine Curriculum in Medical Laboratory Sciences, American Journal of Clinical Pathology, Volume 158, Issue Supplement_1, November 2022, Page S53, https://doi.org/10.1093/ajcp/aqac126.104
2. Sprik, Petra, and Danielle Gentile. “Cultural humility: a way to reduce LGBTQ health disparities at the end of life.” American Journal of Hospice and Palliative Medicine^® 37.6 (2020): 404-408.

Carlo Ledesma is a DCLS Resident at the Oklahoma City VA Medical Center.

Part 1: LGBTQIA

A. Sex and Gender Orientation
B. Historical Perspectives in Transgender Health
C. Epidemiology and Health Outcomes of Transgender Patients

Part 2: Transgender Medicine

A. Gender-Affirming Hormone Treatment
B. Transgender Medicine in Medical Laboratory Sciences

“To develop a competent and knowledgeable workforce, a curriculum that will promote the understanding of the health needs of patients with gender incongruence is imperative.”