Project Summary Transgender, Non-Binary, and Gender Diverse (TGD) communities have been historically marginalized in the United States and experience poor quality of care and significant health disparities in the setting of multiple barriers to accessing quality, affordable medical care for routine and gender affirming health care. Inadequate provider training leads TGD individuals to avoid care due to fear of mistreatment. Until we effectively expand the primary care workforce competent to care for TGD individuals, these disparities will continue. The goals of this educational program are to increase resident comfort and preparedness in caring for TGD patients, increase resident exposure to TGD patients, increase the number of residents who intend to provide Gender Affirming Healthcare (GAHC) after residency graduation, and increase the number of residency graduates providing GAHC, thereby improving the primary care experience for TGD patients and increasing the workforce competent to provide welcoming, affirming, and supportive care to TGD populations. We propose to create a comprehensive, longitudinal, systematically implemented, and reproducible didactic and clinical curriculum for family medicine and other primary care residents addressing the unique healthcare needs of TGD people across the lifespan that leverages both didactic and clinical education to create long- lasting gains in knowledge, comfort, and desire to provide GAHC to TGD communities. We will disseminate this curriculum for other primary care residency programs to adapt and implement. Residents will be involved in the curriculum development, and we will conduct annual resident surveys and evaluations to create a curriculum that is effective and responsive to their educational needs. Importantly, the clinical component of the curriculum will address the lack of adequate resident exposure to high-quality TGD patient care by providing a blueprint for assessing and improving clinical care for TGD patients within a residency teaching clinic and creating lasting partnerships with local GAHC programs for additional elective rotations. An Advisory Committee composed of patients and clinical experts will guide the development of the curriculum to ensure that it is responsive to the needs of the local TGD community. The paradigm of the curriculum will focus on partnering with TGD people to holistically address their social, mental, and medical health needs and well-being while respectfully affirming their gender identity. This entails patient-centered, trauma-informed preventive care and chronic disease management, in addition to gender- affirming interventions. This curriculum has the potential to improve care for people of all genders by challenging many of the binary assumptions inherent in healthcare. The application of the knowledge gained through learner participation in the curriculum will enhance the healthcare experiences of TGD people by expanding the workforce of competent GAHC providers, thereby improving physical and mental health and reducing health disparities within this marginalized community.

Project Narrative Education among healthcare providers remains a major barrier to care for Transgender, Nonbinary, and Gender Diverse (TGD) individuals, who experience poor quality of healthcare and significant health disparities across many domains. By creating a comprehensive, longitudinal, systematically implemented, and reproducible curriculum for primary care residents on care for TGD populations, we can increase the workforce of high-quality, competent, affirming healthcare providers. Disseminating this curriculum will enhance the healthcare experiences of TGD people and expand access to gender affirming healthcare, thereby improving physical and mental health and reducing health disparities within this marginalized patient community.