Transgender Health Curriculum
At Kaiser San Francisco, we are uniquely situated to care for a large population of Transgender patients from both San Francisco and the surrounding Bay Area. For many years, these patients have chosen Kaiser Health Plan and the San Francisco Medical Center because of our expertise and reputation in this area. We are the referral site for gender-affirming surgery, which is a covered benefit of the Kaiser Health Plan.
We are recognized national leaders for the multidisciplinary team-based care we provide. This includes our Adult Gender Pathways clinic lead by Dr. Erica Weiss (ObGyn Associate Program Director) and Dr. Erica Metz (internal medicine specialist). Our comprehensive gender-affirming surgery program includes several Plastic Surgeons, led by Dr. Ali Salim, urologists, Female Pelvic Medicine Reconstructive Surgery, led by Dr. Michelle Morrill, and Dr. Erica Weiss. Our residents take part in caring for these patients, including: counseling, primary care, hormone management, and surgery (assisting with chest surgery and performing hysterectomies as well as participating in genital gender-affirming surgeries and the pre and post-operative care). They begin their exposure rotating in our Adult Gender Pathways clinic, which provides the foundation for further specialized care during their PGY1-3 ambulatory rotations. Residents are an integral part of the surgical team while on the gynecology service as PGY1s, 2s, and 4’s.
In recognition of our expertise and strong resident interest, beginning in 2019/2020 academic year, we have instituted a formal PGY2 Transgender Health and Advocacy rotation. Residents spend the majority of their time working with our plastic surgeons in the operating room assisting on phalloplasties, vaginoplasties, and chest surgery. They gain experience in the counseling of patients pre-operatively and care for these patients while hospitalized after surgery. They also have the opportunity during this rotation to gain additional experience in complex hormone management and other reconstructive cases, depending on their interests. Part of our advocacy curriculum is incorporated into this rotation as residents will identify an area of need and work toward a clinical or systems- based project in Transgender Health.
Our didactic curriculum includes up to date evidence-based lectures on transgender health and providing culturally competent care. Residents have worked with GYN and Plastic Surgery on various research projects. Erica Weiss, our Associate Program Director, is the regional OB/GYN Lead for Transgender health and is an active member of WPATH (World Professional Association for Transgender Health) and lectures nationally and internationally on gynecologic care for transgender patients, fertility and family building options and on gender-affirming surgery. She has collaborated with transgender specialists to present our cutting-edge program to a multi-disciplinary international audience.
The objective of the advocacy curriculum is to encourage growth and facilitate interest in healthcare advocacy for resident physicians. The curriculum was formalized by Dr. Amy Huibonhoa, a Leadership Training Academy Fellow with Physicians for Reproductive Health, and is supported by Dr. Erin Niemasik, an Associate Residency Program Director. Didactic sessions are held throughout the year and the curriculum is based on the ecological model, meaning that each session has a progressively wider advocacy focus so that residents appreciate advocacy at the individual, community, state, and national levels. During their Transgender Health and Advocacy rotation, PGY2 residents have the opportunity to reflect on and plan a resident advocacy project that is meaningful to them. We also encourage the attendance and participation in lobby events and group events throughout their residency and provide mentorship with experienced faculty.
Advocacy Capstone Projects for Residents:
Each resident is required to complete a healthcare advocacy project. Similar to lobby events, the capstone provides an interactive opportunity for residents to apply concepts and skills learned from didactics to real-world advocacy challenges. This project should relate to a topic that is particularly important to the resident or that the resident identifies as a significant patient need. The resident creates an intervention to address their particular advocacy need, improving healthcare for patients directly or indirectly. Advocacy projects may cover patient care, resident care, medicine, hospital practices, education, or similar scope. It can be done as an individual or part of a group. As part of a residency capstone project, the PGY2s now host “Advocacy Nights”, which is an evening discussion of mixed media (books, movies, articles) to focus on a particular advocacy topic with the broader OBGYN department.
Community Service and Volunteerism
Our faculty, in both their professional and personal lives, strongly support the principles of community service, volunteerism and women’s health advocacy. Our faculty regularly participate in local community service and international medical work. Our organization with the support of Community Benefits Programs has extensive outreach to local health care activities as well as coordinated efforts to support national and international Disaster response. These important values are woven into our residency training program.
Our residency training program emphasizes an awareness of and responsiveness to the larger health care context in which we live. This includes advocacy for women and women’s health. It is important to recognize disparities in health and health care in a variety of populations. We believe it is the role of women’s health care providers to advocate for patient populations and the individual patient, particularly poor and vulnerable women. We also believe it is important to recognize the role of physicians in legislative activities as they relate to women’s health policy.
Since 2009 our faculty have taken residents to the ACOG District IX Resident Lobby Day in Sacramento. Residents have the opportunity to learn firsthand from policy makers how to advocate for women’s health issues, and then spend the day lobbying elected State Senators and Assembly members on relevant bills. As these bills move forward through the legislative process we receive direct feedback on their progress. Additionally, most residents utilize their elective month working in underserved areas across the globe and many faculty members pursue similar activities on their own time. These activities are presented and celebrated at our annual Global Health Grand Rounds.