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Background Free Open-Access Medical education (FOAM) use among residents continues to rise. However, it often lacks quality assurance processes and residents receive little guidance on quality assessment. The Academic Life in Emergency Medicine Approved Instructional Resources tool (AAT) was created for FOAM appraisal by and for expert educators and has demonstrated validity in this context. It has yet to be evaluated in other populations. Objectives We assessed the AAT's usability in a diverse population of practicing emergency medicine (EM) physicians, residents, and medical students; solicited feedback; and developed a revised tool. Methods As part of the Medical Education Translational Resources: Impact and Quality (METRIQ) study, we recruited medical students, EM residents, and EM attendings to evaluate five FOAM posts with the AAT and provide quantitative and qualitative feedback via an online survey. Two independent analysts performed a qualitative thematic analysis with discrepancies resolved through discussion and negotiated consensus. This analysis informed development of an initial revised AAT, which was then further refined after pilot testing among the author group. The final tool was reassessed for reliability. Results Of 330 recruited international participants, 309 completed all ratings. The Best Evidence in Emergency Medicine (BEEM) score was the component most frequently reported as difficult to use. Several themes emerged from the qualitative analysis: for ease of use-understandable, logically structured, concise, and aligned with educational value. Limitations include deviation from questionnaire best practices, validity concerns, and challenges assessing evidence-based medicine. Themes supporting its use include evaluative utility and usability. The author group pilot tested the initial revised AAT, revealing a total score average measure intraclass correlation coefficient (ICC) of moderate reliability (ICC = 0.68, 95% confidence interval [CI] = 0 to 0.962). The final AAT's average measure ICC was 0.88 (95% CI = 0.77 to 0.95). Conclusions We developed the final revised AAT from usability feedback. The new score has significantly increased usability, but will need to be reassessed for reliability in a broad population.

Transforming our world the 2030 agenda for sustainable development is working towards a world that reflects equity, with universal respect for human dignity, pledging to leave no one behind. However, transgender and gender-diverse individuals experience significant health inequities, including negative health outcomes and multiple barriers to accessing care. In this article, we first highlight the health inequities that transgender and gender-diverse people face globally. We describe important aspects of transgender and gender-diverse health care, including the design and provision of health services, epidemiological considerations, transition-related care, changes in transition-related goals, cultural considerations, and political and legal issues. We then review the existing global literature on incorporating transgender health into medical curricula. We make a case for prioritizing improved education in medical schools on the specific health needs of transgender and gender-diverse people as part of addressing global health inequities in care. Our recommendations for comprehensive education on transgender health include cultural humility and anti-oppression training; involvement of transgender and gender-diverse community members; integration of transgender and gender-diverse health into curricula; practice-focused and in situ training; staff development in medical schools; and improving access to careers in medicine for transgender and gender-diverse people.Transformer notre monde: le Programme de développement durable à l'horizon 2030 aspire à un monde où règne l'équité, le respect universel de la dignité humaine, et s'engage à ce que personne ne soit oublié. Pourtant, les individus transgenres et de genre variant subissent de profondes inégalités sur le plan sanitaire, qui affectent leur état de santé et compliquent grandement l'accès aux soins. Dans cet article, nous commençons par souligner les inégalités sanitaires auxquelles sont confrontés les individus transgenres et de genre variant à travers le monde. Nous évoquons d'importants aspects à prendre en compte pour les soins de santé aux personnes transgenres et de genre variant, parmi lesquels la conception et la fourniture de services de santé, les considérations d'ordre épidémiologique, les soins liés à la transition, l'évolution des objectifs liés à la transition, les facteurs culturels, ainsi que les enjeux politiques et juridiques. Nous examinons ensuite la littérature internationale consacrée à l'intégration de la santé transgenre dans les programmes d'enseignement médical. Nous soutenons que, dans le cadre de la lutte contre les inégalités sanitaires au niveau mondial, il faut privilégier une amélioration de l'enseignement dans les écoles de médecine afin de sensibiliser aux besoins spécifiques des individus transgenres et de genre variant en matière de santé. Nous avons formulé plusieurs recommandations en vue d'instaurer un enseignement qui tient compte de la santé des personnes transgenres: apprentissage anti-oppressif intégrant la notion d'humilité culturelle; implication de membres de la communauté transgenre et de genre variant; ajout de la santé transgenre et de genre variant dans les programmes de cours; formation centrée sur la pratique, dispensée sur le terrain; développement du personnel des écoles de médecine; et enfin, amélioration de l'accès aux carrières médicales pour les individus transgenres et de genre variant.Transforming our world: the 2030 agenda for sustainable development (Transformar de nuestro mundo: la Agenda 2030 para el desarrollo sostenible) trabaja por un mundo que refleje la igualdad, con respeto universal por la dignidad humana, comprometiéndose a no dejar a nadie atrás. Sin embargo, las personas transgénero y con género diverso experimentan importantes desigualdades en materia de salud, incluidos resultados sanitarios negativos y múltiples obstáculos para acceder a la atención sanitaria. En este artículo, destacamos, en primer lugar, las desigualdades sanitarias a las que se enfrentan las personas transgénero y de género diverso en todo el mundo. Describimos aspectos importantes de la atención sanitaria a las personas transgénero y con género diverso, como el diseño y la prestación de servicios sanitarios, las consideraciones epidemiológicas, la atención relacionada con la transición, los cambios en los objetivos relacionados con la transición, las consideraciones culturales y las cuestiones políticas y jurídicas. A continuación, revisamos la documentación global existente sobre la incorporación de la salud transgénero en los planes de estudio de medicina. Defendemos la necesidad de dar prioridad a la mejora de la formación en las facultades de medicina sobre las necesidades sanitarias específicas de las personas transgénero y con género diverso como parte del tratamiento de las desigualdades sanitarias globales en la atención sanitaria. Nuestras recomendaciones para una educación integral sobre la salud de las personas transgénero incluyen la formación en humildad cultural y lucha contra la opresión; la participación de los miembros de la comunidad transgénero y con género diverso; la integración de la salud de las personas transgénero y con género diverso en los planes de estudio; la formación centrada en la práctica e in situ; el desarrollo del personal en las facultades de medicina; y la mejora del acceso a las carreras de medicina para las personas transgénero y con género diverso.تحويل عالمنا جدول أعمال عام 2030 للتنمية المستدامة: يسعى نحو عالم تتحقق فيه العدالة، مع الاحترام العالمي لكرامة الإنسان، والتعهد بعدم إهمال أي شخص. ومع ذلك، يعاني الأفراد المتحولون جنسياً وأصحاب التنوع الجنسي من تفاوتات صحية كبيرة، بما يشمل النتائج الصحية السلبية والعوائق المتعددة أمام الحصول على الرعاية. نقوم أولاً في هذه المقالة بالتركيز على التفاوتات الصحية التي يواجهها المتحولون جنسياً وأصحاب التنوع الجنسي على مستوى العالم. نحن نصف الجوانب المهمة للرعاية الصحية للمتحولين جنسياً وأصحاب التنوع الجنسي، بما في ذلك تصميم وتقديم الخدمات الصحية، والاعتبارات الوبائية، والرعاية المتعلقة بالتحول، والتغييرات في الأهداف المتعلقة بالتحول، والاعتبارات الثقافية، والمسائل السياسية والقانونية. ثم نراجع الثوابت العالمية الموجودة بخصوص دمج صحة المتحولين جنسيًا في المناهج الطبية. نحن نسعى لإعطاء الأولوية للتعليم المحسن في كليات الطب حول الاحتياجات الصحية المحددة للأشخاص المتحولين جنسياً وأصحاب التنوع الجنسي كجزء من التعامل مع التفاوتات الصحية العالمية في الرعاية. إن توصياتنا للتعليم الشامل حول صحة المتحولين جنسياً تشمل التدريب لمواجهة التحرش الثقافي ومكافحة الاضطهاد؛ وإشراك أعضاء المجتمع المتحولين جنسياً وأصحاب التنوع الجنسي؛ ودمج صحة المتحولين جنسياً وأصحاب التنوع الجنسي في المناهج الدراسية؛ والتدريب بالتركيز على الممارسة وفي الموقع؛ وتطوير فرق العمل في كليات الطب؛ وتحسين الحصول على وظائف طبية للأشخاص المتحولين جنسياً وأصحاب التنوع الجنسي.《改变我们的世界：2030 年可持续发展议程》致力于建立一个体现公平、普遍重视人类尊严的世界，保证不让任何一个人掉队。但是，跨性别者和性别多样化个体遭遇了严重的健康不平等问题，包括负面的健康结果以及在获得护理方面面临的多重障碍。在本文中，我们首先强调了全球跨性别者和性别多样化人群所面临的健康不平等问题。描述了跨性别者和性别多样化群体医疗保健服务的各个重要方面，包括卫生服务的设计和供应、流行病学考量、变性相关护理、变性相关目标变化、文化考量以及政治和法律问题。然后，我们回顾了有关将跨性别者健康问题纳入医学课程的全球现有文献。作为解决全球医疗卫生不平等问题的一部分，我们充分说明了优先要求医学院就跨性别者和性别多样化人群的特殊健康需求问题加强教育的原因。对于如何就跨性别者健康问题全面开展教育，我们的建议包括：提供宣扬谦逊精神和反压迫的培训；让跨性别者和性别多样化人群的社区成员参与；将跨性别者和性别多样化人群的健康问题纳入课程；提供注重实践的现场培训；在医学院加强医护人员的培训；以及为跨性别者和性别多样化人群提供更多进入医疗界的就业机会。.Документ Преобразование нашего мира: повестка дня в области устойчивого развития на период до 2030 годанаправлен на построение мира, который отражает равенство, всеобщее уважение человеческого достоинства и обязательство принятия во внимание интересов всех и каждого. Однако трансгендеры и люди с разнообразной гендерной самоидентификацией сталкиваются со значительным неравенством в отношении здоровья, включая негативные последствия для здоровья и множественные препятствия для доступа к медицинской помощи. В этой статье прежде всего подчеркивается несправедливость в отношении здоровья, с которой трансгендеры и люди с разнообразной гендерной самоидентификацией сталкиваются в глобальном масштабе. Авторы описывают важные аспекты медико-санитарной помощи трансгендерам и людям с разнообразной гендерной самоидентификацией, включая разработку и предоставление услуг здравоохранения, эпидемиологические соображения, медицинскую помощь в процессе смены пола, изменения в целях, связанных с процессом смены пола, культурные аспекты, а также политические и юридические вопросы. Затем следует обзор существующей мировой литературы по включению здоровья трансгендеров в медицинские учебные программы. Авторы приводят доводы в пользу придания приоритетной значимости повышению качества образования в медицинских институтах в отношении особых медицинских потребностей трансгендеров и людей с разнообразной гендерной самоидентификацией в рамках решения проблемы глобального неравенства в отношении здоровья при оказании медицинской помощи. Рекомендации по всестороннему обучению в вопросах здоровья трансгендеров включают: культурное принятие и обучение по принципам отсутствия притеснения; вовлечение в этот процесс трансгендеров и представителей групп людей с разнообразной гендерной самоидентификацией; включение вопросов здоровья трансгендеров и людей с разнообразной гендерной самоидентификацией в учебные программы; практическое обучение и обучение на месте; повышение квалификации сотрудников медицинских институтов; улучшение доступа к возможностям карьерного роста в медицинской сфере для трансгендеров и людей с разнообразной гендерной самоидентификацией.

PURPOSE Trans and gender nonconforming (TGNC) people face significant health disparities compared with their cisgender (nontrans) counterparts. Physician-level factors play a role in these disparities, and increasing the participation of individuals from sexuality and gender minority (SGM) communities in medical training has been proposed as one way of addressing this issue; however, very little is known about the experiences of TGNC medical students. This study aimed to understand the experiences of TGNC medical students in Canada. METHOD Between April 2017 and April 2018, 7 TGNC participants either currently enrolled in or recently graduated from a Canadian medical school completed audiorecorded semistructured interviews. Interviewers asked about experiences with admissions; academic, clinical, and social environments; and interactions with administration. The authors analyzed interviews using a constructivist grounded theory approach. RESULTS The authors developed 5 overarching themes: navigating cisnormative medical culture; balancing authenticity, professionalism, and safety; negotiating privilege and power differentials; advocating for patients and curricular change; and seeking mentorship in improving access and quality of care to TGNC patients. This article focuses on the first theme, with associated subthemes of culture and context; interactions with classmates, curriculum, policy, and administration; and gendered spaces. CONCLUSIONS The results of this study delineate heterogeneous experiences of medical cultures with a shared underlying pattern of erasure of TGNC people as both patients and clinicians. Findings were largely consistent with previously published recommendations for improving academic medical institutional climates for SGM people, though the need for access to appropriate gendered spaces beyond washrooms was highlighted.

Study objective Online educational resources such as blogs are increasingly used for education by emergency medicine clinicians. The Social Media Index was developed to quantify their relative impact. The Medical Education Translational Resources: Indicators of Quality (METRIQ) study was conducted in part to determine the association between the Social Media Index score and quality as measured by gestalt and previously derived quality instruments. Methods Ten blogs were randomly selected from a list of emergency medicine and critical care Web sites. The 2 most recent clinically oriented blog posts published on these blogs were evaluated with gestalt, the Academic Life in Emergency Medicine Approved Instructional Resources (ALiEM AIR) score, and the METRIQ-8 score. Volunteer raters (including medical students, emergency medicine residents, and emergency medicine attending physicians) were identified with a multimodal recruitment methodology. The Social Media Index was calculated in February 2016, November 2016, April 2017, and December 2017. Pearson's correlations were calculated between the Social Media Index and the average rater gestalt, ALiEM AIR score, and METRIQ-8 score. Results A total of 309 of 330 raters completed all ratings (93.6%). The Social Media Index correlated moderately to strongly with the mean rater gestalt ratings (range 0.69 to 0.76) and moderately with the mean rater ALiEM AIR score (range 0.55 to 0.61) and METRIQ-8 score (range 0.53 to 0.57) during the month of the blog post's selection and for 2 years after. Conclusion The Social Media Index's correlation with multiple quality evaluation instruments over time supports the hypothesis that it is associated with overall Web site quality. It can play a role in guiding individuals to high-quality resources that can be reviewed with critical appraisal techniques.

Study objective Open educational resources such as blogs are increasingly used for medical education. Gestalt is generally the evaluation method used for these resources; however, little information has been published on it. We aim to evaluate the reliability of gestalt in the assessment of emergency medicine blogs. Methods We identified 60 English-language emergency medicine Web sites that posted clinically oriented blogs between January 1, 2016, and February 24, 2016. Ten Web sites were selected with a random-number generator. Medical students, emergency medicine residents, and emergency medicine attending physicians evaluated the 2 most recent clinical blog posts from each site for quality, using a 7-point Likert scale. The mean gestalt scores of each blog post were compared between groups with Pearson's correlations. Single and average measure intraclass correlation coefficients were calculated within groups. A generalizability study evaluated variance within gestalt and a decision study calculated the number of raters required to reliably (>0.8) estimate quality. Results One hundred twenty-one medical students, 88 residents, and 100 attending physicians (93.6% of enrolled participants) evaluated all 20 blog posts. Single-measure intraclass correlation coefficients within groups were fair to poor (0.36 to 0.40). Average-measure intraclass correlation coefficients were more reliable (0.811 to 0.840). Mean gestalt ratings by attending physicians correlated strongly with those by medical students (r=0.92) and residents (r=0.99). The generalizability coefficient was 0.91 for the complete data set. The decision study found that 42 gestalt ratings were required to reliably evaluate quality (>0.8). Conclusion The mean gestalt quality ratings of blog posts between medical students, residents, and attending physicians correlate strongly, but individual ratings are unreliable. With sufficient raters, mean gestalt ratings provide a community standard for assessment.

BACKGROUND Historically, there have been numerous barriers to trans people - including youth - in terms of their access to health care in a variety of settings. Trans-specific care for youth is sparse across the country with long wait lists to access care. Further, there is a known period of vulnerability for trans people who have decided to access transition support and have not yet received it. OBJECTIVES This needs assessment survey was a first step to assess what training clinicians have received regarding working with trans patients, how comfortable they are working with trans patients, and what might be barriers to providing good care to trans patients. Addressing clinician perceived barriers may improve access to care. DESIGN/METHODS A 36-question survey was distributed electronically to faculty within the departments of paediatrics and psychiatry and to paediatric residents. The anonymous survey was designed to take approximately 10 minutes. The questions covered the topics of training, comfort, and practice. Data was analysed descriptively, and will be used to inform future educational sessions. Results are reported in the following areas: Training, Comfort, Practice, Barriers and Facilitators. RESULTS 38 clinicians completed the survey (29 faculty, 7 residents). 16% reported having received training in trans-specific care. 86% indicated interest in training in trans-related care, with the majority favouring grand rounds (74%) and online modules (71%) as learning formats. 22 respondents (58%) felt ‘comfortable’ or ‘very comfortable’ in assessing overall health of trans patients. More than 40% of respondents responded ‘not applicable’ to questions about prescription of puberty blockers/exogenous sex hormones, indicating that they consider this outside of their scope of practice. 82% of respondents agreed that they were aware of colleagues to whom they could refer trans patients. Two respondents (5%) indicated that they regularly provide trans-specific care. One respondent (3%) indicated having a religious and/or cultural objection to providing trans-specific health care. Most respondents reported using patients’ preferred names and gender in verbal communication (89%) and when documenting (78%). 68% of respondents indicated that they would mirror language used by patients or try to use gender-neutral language when discussing anatomy. Ten participants with experience in caring for trans patients identified a variety of facilitating factors. It was noted that this is “rewarding work” and “very much needed”. 76% cited a ‘lack of training in trans-specific care’ as the primary barrier. CONCLUSION Information collected from the survey will assist us in creating appropriate educational sessions for the relevant departments. It is hoped that addressing clinician perceived barriers will facilitate better access to care amongst a group of patients that has historically been marginalized within health care.