Cenário de simulação em atendimento à pessoas transgênero

Abstract

Introduction: There is evidence that health professionals are unprepared to embrace, care for and understand the singularities of LGBTQIA+ people (lesbian, gay, bisexual, transvestite and transsexual, queer, intersex, asexual and other identities). Addressing this issue in the training environment helps to improve professional practice. Objectives: The aim of this study was to analyse the perceptions of clerkship medical students about their formation and assistance to the LGBTQIA+ population. Methods: This quantitative cross-sectional observational study consisted of two stages. The first involved assessing the perception of LGBTQIA+ people about prejudiced attitudes in healthcare environments, using an online form, and of clerkship medical students about the competences developed during their graduation, using the questionnaire "Competences for lesbian, gay, bisexual, transvestite and transgender healthcare". In the second phase of the study, based on the gathered information, a clinical simulation scenario was developed for clerkship medical students. The students answered the simplified "Satisfaction with Simulated Clinical Experiences Scale". The following tests were used to compare sociodemographic variables with the answers to the questionnaires: Fisher's exact, Pearson's chi-square and Mann-Whitney. The data was statistically analysed and a 5% significance level was adopted. Results and discussion: A total of 134 people from the LGBTQIA+ community took part, aged 30 on average, the majority of whom were black, cisgender and homosexual. Of these, 35.8 % rated the quality of care they received positively and 47.8 % said they had easy access to healthcare. However, people on low incomes seem to have a greater perception of difficulty in access when compared to people on high incomes (p < 0.05). Of the sample, 31.3% had already suffered some form of discrimination in a healthcare environment, with gynaecology being the area most frequently mentioned. 63.4% believe that specific health services should be available to meet their needs and 85% perceive that health professionals are not prepared to deal with the LGBTQIA+ population. Regarding the undergraduates, 104 took part, with an average age of 24.7 years, of whom 50% were white, the majority were cis women (60%) and 28% self-declared LGBTQIA+. Of the total, 56.7% had not had the opportunity to discuss the health needs of transvestites and transsexuals during their undergraduate studies, and 89.4% had not learnt about the National Integral Health Program for the Lesbian, Gay, Bisexual, Transvestite and Transsexual population. A scenario was designed in which a trans man with secondary amenorrhoea was portrayed, with two standardised actors who were self-declared trans men. A total of 25 undergraduates took part in the simulation. 44% found it difficult to use social names and corresponding pronouns, and 60% to provide counselling on health promotion and prevention. Exploring sexual history was a challenge for 48% of the participants, and 80% were unable to correctly advise the patient on access routes for body modifications through the public health system. Conclusions: The debate on the specificities of gender-diverse people's health is still limited in medical training, which can have a negative impact on the health care provided to this population. Participants were very receptive when exposed to the scenario developed. Realistic simulation can be a useful tool for exposing undergraduates to scenarios seldom explored during their education and facilitating the development of cultural competences.