Thank you all for coming, and we're going to have a pretty interactive discussion, so if you'd like, you can move up now or I encourage you to move up now, but if not, we'll have kind of a group discussion a little bit later on, so you might want to circle up a little bit later. Okay, so we're going to get started. So I'm Dr. Chelsea Kosner, I use they, them pronouns, and this is Dr. Teddy Goetz, also using they, them pronouns, and we are presenting on meeting the healthcare needs of LGBTQI and other marginalized psychiatry trainees. And please let us know if you can't hear us at any point, just like, you know, raise your hand or something, just, it's kind of hard to hear with the feedback, so, and we want everyone to be able to engage fully. Oh yeah, so I have some funded research time, which, you know, I don't think should be a conflict of interest here, but, you know, unless the NIH, for some reason, doesn't want us talking about this, which I don't know about. And here are the objectives for our talk, so participants will be able to have a deeper understanding of the physical and mental healthcare needs of LGBTQI and other marginalized and excluded psychiatry trainees. Participants will be able to identify systemic barriers to LGBTQI and other systemically marginalized and excluded psychiatry trainees, and to adequately address physical and mental healthcare needs. And then participants will be able to advocate for better mental healthcare needs for trainees and build tools to address barriers to care for trainees in their institutions and advocate for trainees. And here are our objectives, again, this is a very interactive presentation, so encouraging people to come forward and get close. And who is this workshop for? It is for marginalized psychiatry trainees and those that they serve to build connection between trainees and to empower, and for just marginalized people overall, you know, that marginalized psychiatry trainees often will serve those populations and marginalized psychiatrists, the marginalized psychiatry trainees that go on to become marginalized psychiatrists. And then for people who are working with marginalized psychiatry trainees to help better advocate for them. And with that, anyone who works with trainees works with marginalized trainees, which I think is a really important. Why we wanted to have this conversation today is because so often we are seen as a dichotomy of, you know, the providers, the psychiatrists, the clinicians, and the patients, and that's just a false dichotomy. So we're, this is thinking about how are these systems that weren't built for individuals who have access needs that are not already implicitly built into the system, how can we better make the system work? And why this workshop? So LGBTQIA and other marginalized groups often suffer disproportionately from mental and physical health care outcomes disproportionately due to prejudice they face in their everyday lives and do have more specific and unique health care needs that are often under addressed. And psychiatry and the medical health care system is more recently recognizing the value of having more diverse providers to serve marginalized people from marginalized backgrounds, but there are often barriers to having trainees that come from more marginalized backgrounds and creating affirming places in training programs for these trainees. And psychiatry is in a unique position to reimagine the futures of providing more affirming care for mental health care for everyone and relating that to how it better serves the time between mental health care and physical health. And community involvement at the clinician level, whether psychiatrists or other clinicians, is really important for improving the outcomes for our communities. So again, breaking down that false divide allows us to foresee and anticipate certain needs that are not currently necessarily being acknowledged, and supporting trainees is the way to change the system overall. So thinking about why does this matter? I think it's really important to think about residency, whether you're in it right now or whether it's a memory you would like to block out and forget or whether it's the thing you're really looking forward to at the end of your medical school journey. In that case, I hate to break it to you, but it will end eventually. Residency is super stressful and vulnerable as a period. So I think that this is one of my favorite papers to talk about. People looked at telomeres of before and after intern year, and people's telomeres, aka a sign of cellular aging, basically, or cellular stress, thinking about how many replication cycles you have left in that cell before it becomes senescent, six years was the equivalent of one intern year. So all the people who gripe that they got more gray hairs during intern year, that's actually true. So thinking about the stress of six years into one year is huge. Also thinking about residents who have, residents in general have really low engagement with primary care, which is silly because we're doctors, right? We know preventative health care is really important, but that's correlated directly with how many hours people are working, and also the more people are sleeping, the more they access primary care, and the less they sleep otherwise, which makes sense. You don't have time. You're not going to non-emergent care. Also thinking about privacy. If we have health insurance that works within our health system, are we worried that people we work with are the ones who are looking at our health care records? Are those the people that we are seeing in the clinic? That can be a real barrier, especially for psychiatry. And lack of program leadership support in meeting health needs is cited, as well as an inability to schedule health care around the busy work schedule, which we already alluded to. And of note, residency stress is compounded for marginalized trainees, and traditional interventions often fail to address the stress and burnout in marginalized residents, which means that we need to think about changing up not only the system that is actively toxic to our bodies and our ability to grow into the clinicians that we want to become and the people we want to become, but also thinking about how are the interventions, the traditional like wellness interventions we're doing, those are failing to serve the people who need them most, so what should we be doing instead? And our goal for you today, again in this workshop, is to leave with actionable items. So of course, as a gender studies undergraduate major, I can never have a talk without talking about Kimberly Crenshaw's essential work. So intersectionality is a buzzword that gets thrown around a lot now, but what does it mean? Originally, Kimberly Crenshaw, an extremely brilliant legal scholar, critical race theorist, came up with this idea specifically talking about black women initially, which I think is really important to know where theories come from, but then they can also be generalized. So she was talking about how black women experience more than the additive oppressions of being black and being a woman. So we can think about this for lots of different systemically marginalized and excluded populations, whether you are, if someone is a lesbian, gay, bisexual, if someone is trans, if someone is both, if someone is disabled or chronically ill, if someone is black, if someone is indigenous, there are many different things, and these are not just additive, but someone experiences more than the cumulative effects. So this is really important because if we're thinking about our patients, when they come to our office, what are the systemic barriers they're facing to sitting across from us in our office, but also to their ability to have good mental health outcomes once they leave that office? And then also thinking about how can we, like accessing healthcare in general outside of our office in ways that are actually really important for mental health, which one good case study for that is gender affirming healthcare, which is an extremely effective mental health intervention, reducing suicidality, reducing depression. However, that access is oftentimes more difficult, the more intersectional barriers someone has to accessing care. So those are things that we should be thinking about for our patients, but also for all the trainees you're mentoring or for ourselves, like what really prevents us from getting into those clinics as well. So also just thinking about when we're thinking about these cumulative stressors and how this influences our mental health in general and our ability to interface with systems, I think the gender minority stress model is really important. So gender minority, or like minority stress theory was originally conceptualized by Virginia Brooks about lesbian experiences, particularly, which was just the idea that if you are a minority population, in that case, lesbian women, you experience different stressors related to that that can be kind of traumatic throughout your normal life. Then it was generalized more to lesbian, gay, and bisexual populations and modeled into a model or like expanded into a model rather than just kind of a concept of like this distal and proximal stressors influence your mental health and can also, again, thinking about large and small scale traumas. And then Hendricks and Testa in 2012 talked about specifically transgender, non-binary, and or gender expansive populations and unique stressors that they face, again, compared to lesbian, gay, and bisexual communities, which can overlap as well. But if someone is transgender, non-binary, and or gender expansive rather than cisgender, they might experience distinct distal stressors, talking about discrimination, victimization, rejection, and structural stigma, and non-affirmation and validation, or proximal stressors like within the self of gender dysphoria, vicarious stress, and mental and emotional labor. So these are important things to think about when, again, for yourself and or for trainees that you're supporting. And what are some specific barriers for LGBTQI and other minoritized trainees? So power dynamics, you know, we all know medicine is a very hierarchical sort of system. And it can be really difficult to push back on anything like attending or residences if you're a medical student. And then there can be legal issues, particularly now it's becoming more pressing of an issue. I'm originally from Florida, and there's a lot of issues coming out of that state and other states. And then lack of access to care, again, this can highly vary depending on where you are for even just, you know, mental health care, let alone gender-affirming care. And then both microaggressions and macroaggressions that people may face down from just using incorrect pronouns, incorrect names, and then other things people often will face in their just day-to-day lives that can really add up. And then just lack of representation and mentorship while people are trying to expand the number of marginalized trainees in medicine. It can be really difficult being one of the first people in your program, in your medical school that might have your identity, and that can be really stressful to navigate. And then having nontraditional or complex family planning and reproductive care is another issue. And having to go to medical school, residency is a really long time, and having to think about those things can be really difficult. And then just fear of retaliation for seeking medical accommodations or medical leave. People will be stressed about letting down their co-residents, and then what administration may say, and that can lead to just worsening mental health outcomes for putting off gender-affirming care, mental health care, and delaying medical care that's necessary. And that fear of retaliation can specifically—it's not only retaliation against you as an individual, but also thinking about if you are the first out trans, non-binary, black, whatever resident that your program has matched or the first one in a while, that fear can be that you represent everyone who follows you, and that if you somehow were to have too many needs or be considered a problem, then that will be the end of that level of inclusion in your program, and that you're then reflecting poorly on other people, which oftentimes is not talked about, too, in addition to the direct retaliation. And what are specific barriers—oh, I'm sorry. What are other barriers for mental health care and just health care in general? Just insurance and cost, time off of work, stigma, and lack of competent or affirming clinicians and just ableism in general. This is something that is for anyone who's in a minoritized position and just pretty much any trainee as well. It's really difficult to get these things, and when you have intersecting identities, it can just really compound these issues. So we're adapting a little bit here to the size of the crowd here, because we had no way to really predict that. So instead of thinking—well, now I guess if anyone has any burning ideas or things you want to share, please feel free to go to the mics and to share some barriers at your institution. We also are going to turn this into, instead of breaking off into eight separate groups, because that would be, you know, like two people or one person per group, which isn't really that rigorous of a discussion, we're going to just have a big group discussion too. So we'll join you, the audience, soon to talk through eight specific cases that are kind of like—that we—or vignettes that we prepared that are based on real resident or trainee experiences, whether ours or those of other residents we know, which is really to give—I think it's important to preface that these are not very theoretical issues. These are real issues that have happened for folks. So if anyone wants to share right now about barriers to your institutions to kick things off, we enthusiastically welcome it. If you're still percolating, that is totally fine, and we can—and we invite you to then share about those as we talk through the individual scenarios. Great. Yes. Amazing. Thank you, Miles. Kick things off. Hi. Hello. I'm Miles. I know that at my institution, I—well, first of all, I postponed my transition in my fellowship and decided not to do it at all. So that's one issue, because I didn't know how to approach going through second puberty or explaining to the nurses and the whole hospital why I'm becoming a man. And then when I went to another institution, even though I had already transitioned—basically, I had started my hormonal transition—I had my name legally changed, but the hospital system refused to use my legal name change. And so that was a—for four months, I was dead named in every way, and it was like—it was very difficult. So, I mean, that was one thing. And then also, specifically, like, as I was going through my transition, taking testosterone, I was, like, very hungry. And, you know, we have a stipend for food, and I was judged for their, why are you eating so much? Is this, like, why are you eating so much? And I'm like, well, I'm hungry because of my muscle mass. But, like, these were things that weren't thought about. And then attempting to get time to see my endocrinologist for the blood work, and stuff like that. Absolutely. Unfortunately, extremely, extremely resonant. And thank you for sharing that. Yes, all of the, yes, really, really big issues. We can definitely dive in more to thinking about possible solutions or, like, ways that those can play out. Thank you for kicking things off. Some shuffling in the back. I don't know if folks are coming up to the mics or folks are coming to the front to talk. Amazing. Yes, please. Just a comment, and maybe a little bit of a question to pick your brains. My name is Hane. I'm the Associate Program Director in Alzheimer's Hospital Center in Queens, New York. And we are actually a fairly well-represented LGBTQ department and residency. And, you know, being in New York, where things are relatively more accessible and accepted, I think we get, I don't want to say complacent, but it's really what it is. We get very complacent that, oh, this is very open. You can be who you want. And we tend to ignore some of our more marginalized trainees, even within the LGBTQ spectrum. So, oh, just to preface, a lot of our trainees are also IMGs. So they're coming from different backgrounds where, you know, their LGBTQ status is not accepted. And yet, I feel personally that, you know, sometimes we overlook that and we think, oh, you're here now. You're free to be whoever you are. Just go. So my question is, you know, do you have any suggestions on how to not, like, directly out them out of their comfort zone and say, like, hey, like, come talk to us, because I identify you as part of my community, but to be more welcoming to kind of pave the road for them to approach us? Yeah, that's a great question. I really appreciate you coming to the session and thinking so proactively about how to support trainees. That's really important and makes a huge difference. I think there are a couple, I think, let's step back first, that you used LGBTQ multiple times to describe your trainees. I think that it's really important from an intersectionality and thinking about gender minority stress model is that's not a monolithic acronym. Like, LGBTQ, you know, we could spell it like E-L-G-I-B, you know, like, we could spell it out as, like, one word, and people oftentimes say that and invoke it. And I think that it's really important to think about, like, what do you mean when you say LGBTQ? Do you mean G? Do you mean L and G? Do you mean L-G-B? Or do you, or LGBTQ, do you really mean the T in that, too? And, like, that someone's experience as a cis gay man is probably gonna be very different from someone's experience as a cis bisexual woman or someone's experience as a queer non-binary person. And I think that of the residency programs I applied to, I would have been the first out, like, trans or non-binary person to match at any of those programs in, you know, their history. However many had, like, oh, we're very LGBTQ friendly, we have so many LGBTQ residents, but they have LGBTQ residents, and that's, they have very different needs, potentially. And that's, again, like, even among that kind of clumping of, you know, sexual orientation versus gender identity needs can, those are not monolithic communities either. So I think that that's your first concern, is, like, supporting every, if, I mean, thinking about who do you have and proactively putting in the, like, making sure the access needs are met for any aspect of different experiences, that if we think about, like, disability justice models, access, like, if someone is disabled, they're disabled by the environment. If access needs are met, that person is not disabled. So, for example, if, like, I'm 5'4", the top shelves in my house are very high up, and I can't safely pull breakable things off of them by myself. My spouse is 5'11", and she can. If I had a ladder, I am able to reach that, too. So if the ladder is there in the room, like, my, we don't have an access barrier, right? But if it isn't, like, so thinking about, like, what are the access barriers, or, like, what are the access needs that are, everyone has access needs. So, like, what is implicitly being met by your program now, and, like, what are the needs that you could anticipate some trainees that you don't currently necessarily represent, or, like, the system was not built for them? What are some access needs that you could foresee, and how can you proactively meet those needs? Like, are there gender neutral restrooms? Do you have a map for that? Do you have a name change policy? I had to drop a rotation as a fourth year, and then do a much more intense rotation because someone refused to accept my legal name change that had already been completed months before, and accepted by the, my medical school's main, like, hospital. It was a separate, like, a separate site, and they just wouldn't accept it, and that was, if you, like, if you should have those policies in place, and then you advertise them to everyone, because you don't know who needs them, right? If you have fertility care, someone, you know, one in four cis women physicians will experience infertility problems during, like, versus the population, which is a much less likely, you know, like, that prevalence, but then, so IVF resources are relevant for cisgender straight women, as well as people with uteruses and ovaries who are not, you know, both cisgender and straight, and that's, so, like, looking into, like, what are your resources, and advertise them to everyone, because also that gender neutral bathroom might be, you know, wheelchair accessible, and then if you have a wheelchair user in your program, like, that's relevant to them, too, even if it's not relevant from a gender standpoint, right? So, I think divorcing the access needs from, like, you know, monolithic labels of, like, oh, who do I need to tell about these resources? They could be relevant to everyone, and many people have invisible chronic illness or disabilities, so if you have options for getting, like, work accommodations or things like that, they should be advertised to everybody, because you never know who's going to need that. Is that helpful? Do you have anything? Sorry, that was a long answer. No, no, that's great. Okay. Great, so we're not doing eight groups. Let's all kind of group together. Great. We've got handouts. Okay, so just summarizing. These are some things that we all talked about already, and some things that we may not have touched on as much. So, what can help LGBTQIA+, and or otherwise systemically marginalized and excluded trainees in, you know, reaching their professional and personal needs and goals and training? Perceived institutional support decreases resident burnout, and those efforts are really appreciated. I think that's really important, right? That this is, it does actually work, and that's just feeling supported. That's, again, that one individual who helps advocate for you actually makes a difference, which I think is really heartening, as sometimes I feel like I'm one, you know, grain of sand on this giant beach. Nothing I do matters. It's really nice to know that actually it does. That one person does matter. Having process groups can be helpful. Finding diverse therapists and psychiatrists in the area who are willing to take insurance and work with residents and fellows at a reduced rate, or, you know, sliding scale, whether it's to take insurance, and that can also involve alumni who didn't just graduate and aren't otherwise supervising. So, like, having a referral list can be super important, and that's, again, we brought that up before. Advocating for expanded parental leave policies, as we just discussed. Advocating for expanded sick days or leave and days off for residency, which can ensure that residents have protected time off. So, that can be for your appointments. That can be for your, I mean, whether like physical or mental health care, et cetera. If, for folks who are chronically ill, that you're not working in the hospital with a really severe migraine, like, that is preventing you from giving safe care to your patients. Like, it should never be a decision between, this isn't safe, or, like, it's not appropriate, but I'm stuck doing it. So, we can, again, be advocating for these policies. And advocating for more diverse applicants who are applying to our programs and treating all, and asking, yeah, again, and, like, enforcing staff treatment of everyone with respect. For example, if someone is being harassed by staff in a certain site, those who are in power can mandate certain, like, more trainings or, like, anti-bias, et cetera, for that site. I was a little skeptical about this working. I will say that I was horribly harassed as a first year in one of our clinical sites. Our program director made everyone do anti-bias training three times, and I've had a great experience as a second year working there on the weekends. Again, correlation, not causation, but it can, like, actually, and trying to enforce that kind of treatment can actually work. So, I always like to think about, like, you know, okay, the devil's advocate in the back of the room here is, like, oh, well, like, there's going to be a huge cost to giving people parental leave, or there's going to be a huge cost to having that protected two hours for going to appointments every week. It's going to ruin your clinical experience. It's going to bankrupt the health system. So, this is just not true based on the data we have. Again, I'm a scientist, so I like to look at the data. If you have different data, share it with me later. I would love to see it. But parental leave during residency has been shown to not impact residents' performance, and that was an ophthalmology, which is a surgical subspecialty, right? Okay. Then also, two hours per week, protected time for non-clinical time, improved resident, like, stress, burnout, and also improved people's ability to complete their documentation on time. Amazing. Win-wins, right? And then, because documentation needs to be completed in order for the hospital system to get paid, which is their priority, right? In contrast, burnout does increase the number of sick days that are utilized by resident physicians. This is key. Again, if programs, if administration wants us to be showing up to work every day, if we're burnt out, we just can't do that. We get sick because chronic stress depletes your immune system. It makes people who have chronic illness, it gives flare-ups, et cetera. So, like, supporting people actually does pay. We should care about it just because we should care about people, but also, capitalism cares more about money, so under capitalism, it also makes sense. And this is just something I think that's been in a lot of the consciousness lately, just unionization for residents. In this particular article, they talk about a case that really resonates with some of the cases we spoke about earlier, where there was a psychiatry resident who gave birth to twins, and with her new union contract, she was able to get more time for parental leave, which, as we discussed earlier, does show better health outcomes. And just seeing overall that doctor unions do show better health outcomes for both the physicians and the patients that they care for, and are a solution to a lot of these issues. And just opening up the discussion, what are solutions that people have that are being implemented at their institutions, or things that they would like to see at their institutions? I just wanted to make a comment on the previous slide. I was going to mention it previously, but I think it's a little controversial, but I did, but I think why you included the unionization. I am in, I think my program and my institution are, despite the non-legislative level, we are a quite supportive unionization. Our residents currently are fighting a strike in New York. There's actually quite a few programs in New York that are on strike already. Yes, out in Queens. Have been on strike, and I think we, I think we're coming to a, I think our residents now are coming to some sort of negotiation, but that may happen, and part of that is, you know, it's not fertility treatment. Yes, yes. I really recommend that all residents unionize. Yeah, absolutely. So just picking up for the, yes, yes, no, so just picking up for the recording audience at home, et cetera, that was just a discussion about how unionization efforts have been very successful for advocating for some of these things at some hospitals, and are seen even from administration as like a really positive intervention. That's great. Anyone else, anything? Also, I keep going. Oh, did you? Either one, yeah, one first one. I guess like from the level of a medical student, like some things that are good are that we do have like an LGBTQ plus health care elective that's offered to us at our school, and we do have some curriculum on it as like pre-clinical students, but it's very limited in that elective is all asynchronous online modules, and I really think like if we choose to take that elective and want to get into that, we like deserve to have further education, more engaging, like interactive sessions than just these modules that actually anybody can access for free. Like I shouldn't have to pay tuition to do free modules online, and like I think even more robust curriculum, so we have some small steps, but. Absolutely. Just repeating in the mic is a call for more robust education for medical students, as well as residents, as well as faculty. Just from a personal interest standpoint, are you talking about the Stanford modules, the cartoon ones? Well, just for a little fun fact, there was a character in that named Teddy who has curly red hair. That's based on me. My friend was very involved in making those. Yes. You mentioned it. Yes. Anyway, yes, the Stanford modules, highly recommend. They're fabulous. Those were made, it was a Medical Student Pride Alliance project with some mentorship at Stanford in the medical education division. The Medical Student Pride Alliance is the first LGBTQ national organization of medical students. It started, I was one of the starting folks, and that was back in, I think, 2018, which it's expanded a lot, and that's great for any medical students who are listening from home. That's a great place to get involved. Yeah, if you Google Medical Student Pride Alliance, I believe it's mspa.org or medpride.org. We went through a couple URLs, but yes, great. And then certainly at least my institution, there's an LGBTQ house staff group. I think that we have pretty limited power, though, for implementing things like that, and I think that departments individually do more of their own education or not, so that's a really great point to have more education built in and more education that's required, right? Because the people who sign up for the elective might not be the ones who really need it. Yeah, Miles? Oh, sorry. In the back with the white mask. Did you have anything? Because from what I'm learning, there's a lot of nuances to it, and I am fairly good at union, and that union is a culture, real to me, in a way. Because there's a lot of disagreement about it, and there's a lot of that. And this is totally my thing. Yeah, I can't personally speak to that. Sorry for the mic, a question about unionization efforts in the South and Midwest. Yeah, I can't say specifically. I know University of Miami Jackson is unionized. I think that's been a union for a while, and I believe the nurses there are also unionized. I just know coming from Miami. I can't speak to all of it, but I know it is something that's been just growing across the healthcare field. I can anticipate just with the increasing stress and burnout, especially in the South, too, that it's something that's going to expand there as well. Yeah? I guess one thing that maybe doesn't already exist that I've been thinking about just sitting in this session is a lot of these resources for trainees and then for program directors are just word of mouth. And if there was just any sort of – because it's not as if there's an overwhelming amount of information and things that need to be done in order to accommodate trainees. But if there was a place where trainees could go to look for resources or support, like knowing that you can advocate for medical care to be covered by a different insurance, that if you don't get the care provided in your hospital is something that is just not known, right? Absolutely. Excellent, excellent question. This is about where to find this information about what rights and what resources that you should have access to and can advocate for for yourself. So there – I mean, I think that in marginalized communities, word of mouth is how a lot of things happen in general. A lot of word gets around, but that's not my only answer. I just think that – I think it's worth acknowledging that to me this was so normalized that I didn't even think about that. Just because that's how you also find out if you are researching different top surgeons and you want to find out who has good reputation, who does not, et cetera. That's like word of mouth. I think – so one possibility is the APA publishing just put out a new text – a new book. It's called, I think, a Psychiatry Resident Trainee Handbook or something. I forgot what the title is. I have a chapter in that that I co-wrote with Laura Erickson-Stroth. She's an attending psychiatrist. Was it – Columbian is now at the Jed Foundation doing suicide prevention work. And then Murad Khan, who's at Yale. So we wrote a chapter about LGBTQIA plus resident needs and how to support trainees. But we have a lot of information in that chapter that is like the things that I've put here that are like my – like the things that I've learned about through my own experience and through word of mouth. And like putting – and similarly for them, putting that type of information. So that textbook is now finally bound, published, et cetera. So that's available. I think that there – the Medical Student Pride Alliance, I think, might have some resources about like what you can do as a medical student. Certainly, if the AGLP, we've put out some – the Trans and Non-Binding Committee, we've put out some press releases, but not like on their website, not that much. Are you aware of other resources? But like the chapter existed because we didn't feel like there was something other than word of mouth. No, I think you covered most of the stuff that – Cool. Okay. Should we click on – Yeah, so other things. Okay. So again, we don't want to leave here dejected because everything is horrible. What is – we'd like everyone here in this room, ourselves included, to leave here with one actionable thing that we can take home to implement. If anyone has an idea of that, we would love if you shared. It's also like totally okay if you don't want to share or if you're still thinking. Like that is really – like the workshop isn't done until you think of your thing because it's important to – yeah. This is – actually, this was a question and also – Great, great. We talked a lot about advocating for ourselves. Yes. And maybe kind of things like that. session or seminar at all of the academic PD conferences, right, but they are for LDPGIA training? To my knowledge, no. I would say that the textbook chapter would still be helpful for you because that, you know, it talks about different things that, like, different issues and it's written also for, like, you know, program directors. I'm saying there should be. Oh, there should be. Yes. Well, so bring it. Yes, absolutely. Absolutely. There should be. That would be great. I would. Yes, please, please take that home and go do it. Yes. Yes, wonderful, thank you. Yes, love to chat as well and thank you for bringing that work out of this room and to the people who need it. Yes, absolutely. Absolutely, absolutely, advocating for universal medical education within our own institutions, fabulous, fabulous, at the medical student level. So no one's taking ownership of that course. Yes, absolutely, that's definitely a barrier. I think that one opportunity would be if I think every department should have someone who takes point on like that relevance to their curriculum. I think ideally that this LGBTQIA plus medical education is not its own department, it's not a niche subspecialty, it is an aspect of every other, it's every specialty has that care and that need so that should be integrated into every curriculum. So I think that that's something if you have a Dean of Education or like Dean of Curriculum, I would try to make a meeting with the Dean of Curriculum and again if that person is an advocate that would be great, if they're not then you know there are other avenues to explore. But the Dean of Curriculum is someone who could try to push every individual course director to integrate that information within their curriculum. And I know at least from a you know end of one, but when I was as a medical student the head of the endocrinology block we did not have any education about gender-affirming hormone therapy as part of our endocrinology block. I and a couple other colleagues asked the head of the block if she would please you know integrate that and there wasn't time to add an extra lecture my year but she prepared a whole lovely handout that like went into depth about different aspects of treatment and she sent that to everyone and then the next year ideally was going to be integrated into the mandatory curriculum. So I think that those conversations can be really helpful but like as opposed to you doing the work of meeting with every individual course director and advocating I think the Dean of Curriculum has a lot more weight behind that conversation. Amazing yeah and so I think going have asking your colleagues who are on that committee if you aren't to bring that issue that's again one way that we did it a lot that's great. Of course I need to run across San Francisco I have a I'm at the AGLP's like their headquarters I have to give a talk about a paper there so I will let Chelsea continue here thank you all so much for your engagement and thoughts and I look forward please find me in the conference I'm pretty I've been told I'm pretty easy to pick out of a crowd so please come talk to me more about these things and thank you and just something that Teddy mentioned earlier and I think it's been brought up before is that we're all I think taking individual steps is really important but also just making connections with others and being able to build power together either program directors as faculty or as students or residents. Here are some CME questions if you need CME questions and here just a list of national organizations that do provide more information so AGLP, the APA, GLAMA and WPath so just other ways to make connections or to get more information about some of the subjects we brought up today but at this point just wanted to open it up for more discussion or any questions that people might have you know like in these communities like how do you go about like advocating for yourself but not like you know pissing off the patient essentially or like you know like obviously sometimes like it's I don't know if you let it go, move on, but I've definitely had uncomfortable situations Yeah, I would say, and also opening this up for attendings or other people in the room to comment, I would say especially as a medical student, I would check in with your attending and just know that it's not acceptable to be treated in that way, regardless, just because you're in healthcare, I think we put up with a lot, especially in psychiatry, we put up with a lot because, you know, we're dealing with mental health and we attribute a lot of things to people being in mental health crisis and it's still not acceptable for people to be racist, be homophobic, be transphobic, even if they are going through those things. So just reiterating to the patient in a professional manner that it's not acceptable removing yourself from the situation as much as it's safe and checking in with your supervisor and debriefing. I don't know if other people have comments or things they wanted to add for that. But, you know, in a lot of programs, there's also many-purpose programs where there's a few one or two agendas that, you know, you really need to identify, similarly. I'm trying. Thank you. Okay. Yes, definitely. I appreciate those comments. Any other questions or things people want to discuss or had thoughts about? If not, well, thank you everybody for coming in and really appreciate your participation in this presentation and all the great discussion that's come out of it.

LGBTQI healthcare

marginalized trainees

systemic barriers

intersectionality

inclusive education

policy enforcement

unionization

mental health support