Training clinicians in culturally relevant care: a curriculum to improve knowledge and comfort with the transgender and gender diverse population.

PURPOSE: To design a replicable simulation curriculum collaboratively with the transgender and gender diverse community to improve clinician knowledge and comfort with providing reproductive care to this population. METHODS: This is a prospective, single arm pre-post analysis of obstetrics and gynecology residents at a single academic institution after completion of a novel simulation curriculum. The primary outcome was the change in resident comfort and knowledge in providing transgender and gender diverse patient care. A thematic analysis of learner and standardized patient free text responses was analyzed for insights on perceived learner experiences. RESULTS: This curriculum was created with iterative feedback from the transgender community and involved only transgender and gender diverse-identified standardized patients. Thirty residents participated, with 22 responding to both the pre-and post-curriculum surveys, and 11 responding to a 6-month post-curriculum survey. There were significant improvements in learner comfort and knowledge after participation that were found to persist at 6 months. Qualitative analysis demonstrated that this was a positive and powerful learning experience for both residents and standardized patients. CONCLUSIONS: This simulation curriculum may be an effective and impactful tool to increase trainee comfort and knowledge of transgender and gender diverse patient care, which is important given the lack of physician training in the care for these individuals. By building the foundation with resident learners, the ultimate goal is to enhance the pool of clinicians confident and capable of caring for transgender and gender diverse patients, to increase access to care, and to improve health outcomes in this vulnerable population.

Four cardiac hormones cause death of human cancer cells but not of healthy cells.

BACKGROUND: Four cardiac hormones, namely, vessel dilator, long-acting natriuretic peptide, atrial natriuretic peptide and kaliuretic peptide, have anticancer effects but whether they cause cell death of human cancer cells or normal cells is unknown. MATERIALS AND METHODS: These cardiac hormones were examined for their ability to cause cell death quantified by measurement of nuclear matrix proteins 41/7 which is a function of the number of dead or dying cells. RESULTS: Each of these cardiac hormones caused cell death in up to 36% (p < 0.0001) of the pancreatic adenocarcinoma cells and up to 28% (p<0.0001) of the prostate cancer cells over a concentration range of 100 pmol/l to 10 µmol/l. There was no cell death of normal human prostate, kidney, or lung cells at the above concentrations. CONCLUSION: Four cardiac hormones cause death of pancreatic and prostate cancer cells but not of normal prostate, lung, or kidney cells.