How UConn Health is teaching students about gender-affirming care through the lives of trans people

CT Insider – Thursday, January 2, 2025
By Cris Villalonga-Vivoni

Getting medical care as a transgender person can often come with a myriad of barriers that may deter them from seeking the help they need.

Take Dylan Bachmanm of Litchfield, who said he needed to be convinced by emergency medical services to get care after a serious car accident, despite fears of mistreatment from hospital staff. His worries came true when he said emergency room staff misgendered him and dismissed his pleas for a non-prescription pain killer. The experience left Bachmanm feeling vulnerable, “on display” and said it will affect his willingness to seek emergency room care in the future.

Bachmanm shares his health care experiences with the medical students at the University of Connecticut to show them how they can foster a safe clinical environment for trans patients. His work with students is part of an effort to diversify the types of patients students work with before they head into the field to foster a more inclusive workforce. His goal in sharing his stories is to make medical offices safer for all minority populations.

“After that first session with my first students, I left feeling like I have maybe made a difference for other trans people and maybe other bigger-bodied people,” he said. “But also, I feel like I opened up a good communication channel for these students that I don’t think people have unless they have the person who’s going through it to talk to them.”

The 2022 U.S. Transgender Survey of over 92,300 transgender and non-binary residents found that more than 24% avoided seeking medical care when they needed it out of fear of being mistreated. Nearly half of the 79% of respondents who did see a health care provider reported having a negative experience, including being refused care and verbal or physical abuse.

Bachmanm, who uses both he and they pronouns, said he’s experienced many issues while trying to access health care that often makes him hesitant to go back.

At his primary care physician, for example, Bachmanm said the administrative staff often misgender him and address him by his legal name, rather than his preferred one. He started his transition only four years ago and hasn’t changed his legal name on his identification, which is time-consuming and costly.

Bachmanm said that when staff use his birth name, also known as a dead-name, it immediately makes him feel nervous and puts him on guard. Whenever he tried to correct them, he said the staff explained that they used the wrong name and pronouns to avoid legal confusion.

He said his primary care physician is very supportive of Bachmanm’s transition and strives to use the correct pronouns, but he’s still hesitant to go.

“It can be very tough as a trans person to be able to go into that doctor’s office and just feel like a normal person,” Bachmanm said. “Just be able to go in for my doctor’s visit and not go into fight or flight of ‘am I in danger right now?'”

At the same time, Bachmanm said it can be difficult to know if the poor treatment he is receiving is because of his gender identity or if it’s because somebody is having an off day. However, he said that the care he’s received since making physical, visible changes to his body as part of the transition is different than before he came out.

“It can be very, very scary to go to any hospital or doctor’s office and be like, ‘Well, are they going to see me as a person and a patient, or are they going to want to avoid it? Are they going to make jokes outside the room? Are they going to be just so excited to get out of work and not have to treat me?'” he said. “That is something that I carry with me a lot.”

Sandra Scippa, director of the clinical skills program at UConn, said the program offers individuals who act as standardized patients for medical students to practice the skills they’ve learned, like taking patient history and performing physical exams.

However, Scippa said the pool they work with is comprised mainly of retirees who live in the community since it’s a part-time position. Over the last few years, she said it’s been a priority for the school to diversify that group and have a broader patient population that reflects the real world.

The idea to offer specific training focused on gender diversity came directly from the university’s Diversity, Equity and Inclusion committee and the previous program director, Scippa said. She said first-year medical students already participate in a session on working with the LGBTQ+ community, but they wanted students to hear directly from the community.

For this type of training, Scippa said they had small groups of students take turns acting out a doctor’s visit. Students take a participant’s patient history, ask for their pronouns, and practice their bedside manner. Afterwards, the patient and students discuss where they could improve, answer any direct questions or provide strategies to help them in the future.

She said the patients could share their real medical history and experiences or fall back on a script provided to them.

“This is the place where they can make mistakes and figure out how to ask the questions in a respectful way that makes them feel safe and comfortable, and the patient feels safe and comfortable,” Scippa said.

Teresa Sapieha-Yanchak, the administrative curriculum coordinator for the clinical skills programs at UConn, said connecting with trans and non-binary patients directly allows the students to ask sensitive questions in a safe place before heading to their clinical practice. She said they hosted the first training last school year and are hosting its second in early January.

Sapieha-Yanchak said they only needed 10 participants but received about 40 inquiries to participate in this school year’s gender-affirming training. Although she has been turning people away, she asks everyone if she can reach back out to them for any future training or projects.

“It’s so nice to have people that want to do this and want to help students understand and be comfortable and get the quality care that they deserve because there’s so many people that had poor treatment that they want the students to do better,” Sapieha-Yanchak said.

Bachmanm said working with students and seeing their interest in making health care safe after so many unsupportive experiences with medical providers is healing. He said the students gave him hope for the future of the field and encouraged others to step forward and share their stories with students.

“We are not powerless. Our feedback is so important, and that is something that I’ve learned,” Bachmanm said. ” I want people to know that their experience matters. No matter who you are, you bring something to the table.”

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