EDMONTON—Twelve years ago, James Demers was trying to navigate the health-care system in Calgary as a transgender man. On a quest to find medical doctors that could help with his transition, Demers said the search was sometimes “a nightmare.”

“There was no path,” Demers recalled. “I had to find other trans people, non-medical professionals to help navigate the system.”

Demers now works as an advocate for other transgender people in the community, helping them carve out their own path within the health-care system. Not much has changed since he began his transition, he said. The system remains convoluted, plagued by long wait-lists and a lack of communication between physicians.

“It’s not uncommon for a medical transition to take up to a decade,” Demers said.

But medical students at both the University of Calgary (U of C) and the University of Alberta (U of A) are envisioning a better future ahead for transgender patients in the province, and are spearheading movements to bring transgender care to the forefront of not only their medical schools’ curriculum, but to other schools across Canada.

Medical researchers and advocates say many doctors who are currently practising haven’t received adequate training through their medical school education on how to properly care for transgender patients, which can lead to poor health outcomes for the community. An update to medical school curriculums, Demers said, is a step toward seeing positive changes that members of the transgender community long for.

“Implementing a curriculum like this could cut (transition time) significantly,” Demers said. “It would save us a lot of grief.”

There is currently no written code outlining best practice of care for transgender patients in Canada. But students at both Alberta medical schools have conducted curriculum reviews, and have had consultations with members of the transgender community and the doctors serving them, to weave changes they say are necessary into their classrooms.

Derek Fehr, a soon-to-be medical graduate of the U of A, is a key figure in updates that were implemented as recently as last year into his university’s curriculum with respect to transgender care.

Growing up Nipawin, Sask., which he described as a small, conservative town, was challenging for Fehr, who is gay. But he said it inspired him to dive deep into how discrimination can lead to poor health outcomes, and how medical school curriculums can better equip would-be doctors to care for LGBTQ patients.

Upon reviewing the U of A’s old curriculum after his first year of medical school, Fehr said he found that students only spent four hours learning about LGBTQ health care, and within that, learned very little about transgender health care.

“It became very clear that transgender health was where the most need was,” Fehr said.

When Nicole Thompson, a medical student at the U of C, conducted a similar review, she found basically the same thing — students spent four hours learning about LGBTQ health, three hours less than the North American average.

“We were missing a lot of the main domains,” Thompson said, including how to do a physical exam that recognizes a person’s preferred gender, medical information on transition, and overall sexual health for transgender people. Thompson then linked up with Demers, and set out to develop content that would fill those gaps.

A pilot of those lessons began in February 2018, Thompson said, where students were taught in small groups by a trans-identifying person and a physician experienced in transgender care. The result was an increase of up to 10 hours of material dedicated to LGBTQ health, which was implemented permanently in U of C’s curriculum as of September 2018.

Students now receive a reference manual, a podcast of an interview with a transgender advocate about health care, and two hours of small group learning sessions, Thompson said. Trans-identifying and gender nonconforming patients are also now being reflected in general cases, effectively threading transgender care throughout the curriculum.

Many of the same changes are reflected in the U of A curriculum following Fehr’s review. He said students were already taught the basics, thanks to the work of students who came before him. Fehr’s contributions, however, have helped the U of A include up to 14 hours of LGBTQ health care in their curriculum, with increased emphasis on transgender care, according to assistant dean of diversity at the faculty of medicine, Dr. Helly Goez.

Both Fehr and Thompson said faculties at their medical schools have been largely receptive of the changes they’ve spearheaded, but they would not have been possible without the work of students who came before them.

“It very much always seems like a student-driven initiative,” Fehr said.

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Thompson is now leading a Canada-wide study that brings students, faculty, doctors specializing in transgender health care, and members from the transgender community together to create a standardized syllabus on gender-affirming care that can be used in medical schools across the country. It is the first initiative of its kind, Thompson said.

“We have the privilege of working in an environment where people have crusaded before us,” Thompson said.

Demers, who is also part of Thompson’s Canada-wide research project, said it may take a decade to begin to see real change in doctors’ offices for transgender patients as students go through the new curriculums. But those changes will make an enormous difference.

“It saves us from having to become the educators for our doctors,” Demers said.

Nadine Yousif is a reporter/photographer for Star Edmonton. Follow her on twitter: @nadineyousif_

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