When I was on my Family Medicine rotation during my third year, I discovered that there was a Transgender Primary Care Clinic (TPCC) that operates out of the same clinic where I was completing my FM clerkship. A few years prior to this, I had played rugby with a “transman” (someone who was assigned female at birth but identified as male). He was allowed to play on our womens’ team because he hadn’t begun taking masculinizing hormones (testosterone or “T”). He wanted to start T, but didn’t have access to a doctor who could prescribe it. He didn’t want to buy it himself and take it incorrectly or in a way that would not be safe. Ever since then I had been curious about access to hormone therapy and the care and management of transgender patients in general. So while on my FM clerkship, I asked if I could spend one day in Transgender clinic. My preceptors were happy to oblige my request.
I spent one afternoon seeing patients in the trans clinic and I loved every minute of it. My single experience at TPCC was enough for me to decide that I wanted my quality improvement (QI) project to be centered on this population and helping them receive the care that they need. Over the subsequent months, my classmate and I built a team and devised a plan to revamp the informed consent documents at TPCC. However, our project hit an early roadblock. The leader of the quality improvement project curriculum identified that the outcomes of our proposed project were not measurable and therefore would not meet requirements. Thus, we went back to the drawing board, consulted the physicians working at TPCC, and devised a new plan. Our new project focus as well as our problem statement and planned outcome measure are detailed below.
Proposed QI Project, May 2019
This project is ongoing, but there are many takeaways from the past few months working on this project that can be highlighted. This has been my first attempt at developing and initiating a quality improvement project from scratch; a daunting task for any medical professional, let alone a student. I’ve learned that early and frequent communication with all members of the team are essential to keeping the project moving forward. I’ve also learned that setting a timeline is essential, even if that timeline needs to be extended once or twice or a dozen times. I’ve learned that to do quality improvement work, you must have a significant driving force or else you may lose sight of your original goal. And lastly, I’ve learned that I still have a lot to learn! (and that’s okay!).
Medicine is a career rooted in lifelong learning, and I’m not shying away from it. During my residency I want to further develop my skills in orchestrating quality improvement. It is of immense importance for healthcare providers to be continually looking for areas in which patient care can be improved. I also plan to continue educating myself about the ways in which I, as a physician and ally, can provide the most sensitive and appropriate care for transgender patients. I’ll start by attending the Eleventh Annual Ruberg Symposium, whose theme and keynote lecture this year happens to be “Multidisciplinary Care for Transgender Patients”! See the agenda for the Ruberg Symposium here!
Registration for 2019 Ruberg Symposium.
