התמלול המלא של Inclusive Language in Medical Education

I mean, obviously the patient at the end is the most important person. But I think it's also incredibly important for clinicians to get this right. Because actually, if you don't get that right, particularly when you're first building a rapport and a relationship with a patient, to be able to get that trust, to be able to get the right history, to be able to give that person the right care. Um, if you don't have that trust there and that respect there, then that can affect the care that you're giving. So, um, I think for all parts of the journey, in the care journey that patients go on, it is really important. And obviously the, the first point of getting that right is education. So I completely agree. I think students have brought this sort of unique perspective as well into this where they talk about inclusive communication and they want to know more about this. And I think one of the main issues and challenges that we face from an educator perspective is sort of the time constraints we have in the curricula. Um, but there definitely have been questions that come up when students are saying that, you know, we don't feel well equipped enough to actually go out into the community and look after patients with these very specific health needs. Um, and they say that, oh, if I had to look after a patient who identifies as trans, I don't know how best to look after them. And, you know, there's serious concern from students regarding that. Yeah. I mean, just to prod that a bit further, because I think one of the issues always with the, with the, with the curriculum is everybody wants everything to go in it whenever you speak to anybody. Oh, I think this should be in the curriculum. I think this should be in the curriculum. I think this should be in the curriculum. And actually only so much can be in the curriculum. Um, and I suppose it's thinking about how do you embed this so it's not seen as something additional or different. It's part of the overall teaching. And you could argue that thinking about how do they treat a trans patient? Is that any different to thinking about how you might treat an elderly patient or a teenager or a child, or is that too simplistic? No, I think on one level I agree. I think this should just be an automatic part of what we do as clinicians and what we are teaching our students that are coming through. You know, the first thing that you're asked to do in every examination is to introduce yourself to the patient, check the patient's details. You know, that's a really important step. It's a really simple step to just make sure that actually you can, if you feel comfortable, identify your pronouns. And then if you're checking that that person's details, you can ask how they want to be addressed. It can be as automatic as checking someone's date of birth. However, another side of the coin. I appreciate that there is some additional complexities and language knowledge that people have to have that probably makes them feel more

comfortable to have those conversations. So although it can be embedded quite automatically, we probably need to do a bit of work to make that actually happen. So it's a bit of both. So what does that work involve? I think that involves teaching actually existing clinicians who, you know, if you've been working for twenty years, thirty years, these are issues that are becoming much more common now, that are becoming much more important and being prioritized, which is great, but people might be lagging behind a little bit with that regard if they're in their existing practice. And there and then obviously teaching the new generation that's coming through, which is obviously what we've got in our gift to do. Um, and I think that's that, that hopefully will make that bridge, those gaps that we're currently seeing. Yeah, I think you're right that in term of it becomes automatic. And we need to we need to make sure that, um, commission's, you know, you might term who've been teaching for a long time, but it's not just about in terms of their teaching, but also in their everyday practice. And how do we get that, get that manage across? Let's be a bit controversial here. I'm an educator. I know what I should be saying. How do you want to introduce yourself? I am, you know, want to be known as she her. What happens to educators who feel uncomfortable in that position? Because not everybody feels comfortable using pronouns. So how do we get around that? Or how do we encourage people either to be more comfortable or more fully engaged without making them feel uncomfortable, if that makes sense? For me, I agree that for folks who might not have done it in the past, it does feel a bit unnatural to do it initially because you're thinking, oh God, why do I have to clarify this in the first place? Um, but I think for myself, I started doing it a lot more when I kind of saw my peers doing it. So I was really involved with this organization called six expression UK, which is a national sexual health charity, but it's completely run by students. Um, whenever we would go to conferences and things like that, um, it would be almost second nature for everyone to introduce themselves by their pronouns. I found it at all. You know, I found it a bit uncomfortable initially because I just had never done it before. But seeing everyone be at so much at ease with it, it's like second nature. I felt comfortable doing it myself. And with regards to educators here, I think it doesn't have to always be something as obvious as, you know, just saying that, oh yes, my pronouns are he, him, they, them. I think it's the little things as well. So for example, in your email communications, for example, and you can sign off your emails by using your pronouns. Um, so while it might not be as direct as announcing it in front of a group full of people, but it's the tiny little ways where you can start introducing the use of pronouns. And I think it's once you start building on top of that,

um, you'll find that, okay, maybe I can try introducing myself in classrooms with this and see how comfortable you feel. And I completely appreciate because anything new can make you feel a bit uncomfortable, but it's about challenging yourself and saying, right, if I do feel uncomfortable, let me try it a bit more and then it will become second nature. Yeah, I agree. I think, um, the reason why we use pronouns is because we've got pretty good evidence from particularly trans communities that that makes people feel included. They feel it's a safe space. So that's certainly why I share my pronouns. Um, however, I think the main thing is actually that patient in front of you. So you don't need to share your pronouns to have that consultation or to do that teaching session. But it's making sure that the, the awareness of that gender inclusive language for dealing with patients is something that's embedded into clinical practice, as I think a priority for me. And actually that gender neutral discussions is beyond that individual themselves. And whether they're trans or non-binary, it's also about their partners. You know, if we're taking a sexual history, it's really important to have that gender neutral communication as part of that sexual history taking. You can't assume the gender of someone's partners. Um, so it is wider than that. And I think as you see fit, if it's something that you start doing more often, then it just becomes automatic. A bit like you would introduce your name or your title. Um, it's just something that kind of rolls off the tongue and doesn't really become a big deal actually. And the whole point of that is, again, to normalize it and make it inclusive for everybody. And just picking up what you were saying about role modeling, I think that's what's really important. And just be interested to know, I mean, as an undergraduate student and you go out on clinical placements, did you see any good role modeling or was there a difference between specialties? No, not naming any names. But you know, in terms of specialties or areas of care or whatever, or because I think that's always the case, sometimes some areas do really well at it and some areas don't do so well. But we always talk about role modeling, don't we? You know, who's your role models? Who do you want to aspire to? So over here four and five, I've had the pleasure of going to lots of different departments. And honestly it's quite hectic. And then you go, oh my God, there's so many placements. But I think more so than departments, have also found that it varies by the individuals that you meet in there, some folk and certain departments are very good. They use gender neutral words sometimes. On the rare occasions, I've also seen clinicians introduce them by their pronouns. And safe to say, I was a bit surprised because I didn't expect that was going to happen. Um, it is a bit varied. I will say some specialties are quite bad at the assumptions that they make. Um, and it's quite surprising, um, because sometimes you find that the clinicians that you're working with are quite taken aback when they get an answer that they're not expecting. So for example, if they say, oh, I live with my partner and they assume, oh, it's their wife, it's their husband, but then they say, oh no, I live with my like a same gendered partner. Um, and they're quite taken aback. And, you know, it's, you see them get flustered and, you know, there's that moment of awkwardness in that room and you're trying to type your wardrobe notes and you just, you know, have that look in your eyes and you think, okay, it shouldn't be this awkward. It's not that big a deal. Um, but yeah, it does vary in between specialties, but I was, I was really happy when I went to my placement at the sexual health clinic. And you know, I was, it was really nice to see that, you know, everyone was so comfortable using pronouns and the language that they use, you know, it's the conscious choices that you're making that, you know, using gender neutral language, um, to make sure that everyone feels included in conversations. And I think it really makes a difference. And I know it makes a huge difference to patients, but it also makes a huge difference for students as well that come through these services. And they go, you know what? This is a clinician taking that bit of effort to make sure that everyone's included and I feel included as a student as well. And so just picking up on that, and you have sort of touched on it, Daniela, in terms of obviously, we're training medical students to become doctors. And the most important thing I feel is, you know, doctor's is providing good patient care. So you sort of talked about it a bit about how it impacts on maybe patience, trust and how they might receive information, good or bad. If they feel in a safe place. Have you, without going into detail, experience where. Perhaps. Or either of you seen where that hasn't happened and therefore it might. Have impacted on patients? Yeah. I mean, I think we have certainly both on a clinical. Um, sort of perspective, seeing individual patients, but also from seeing literature and reports and. Um, you know, there's been quite a few different, um, sort of summaries or feedback from. Trans and non-binary communities, particularly in England about what makes good services and what. What good care looks like to those populations. Um, and certainly if people are assumed to be. A different gender than what the um identify as or as Wade said about partners then that can signal to those individuals that actually this isn't a safe space, particularly in sexual health, but it's really important that we get the right history to provide that right care and that that one hundred percent can happen. And as I say, that's why it is really important and probably why sexual health has got, I would hope, certainly locally a good practice in place. But we're not perfect. And I think it's really

important. The one thing we probably haven't mentioned here is the patient and community voice. And I think it's really important to involve people who are receiving care as much as we can and to improve services, to improve our teaching and to make sure that we're all keeping updated. So and I think that's where sexual health has been generally pretty good. We've still got a way to go, but, um, and we're potentially other services could potentially learn from and probably also links into that. Although undergraduate is our focus here and is definitely important. Postgraduate education could also benefit from this as well. And so I mean just taking that one step further, I'm just thinking about something like um, huskies. Um, and when we have, you know, simulated patients, I mean, I can remember in the conversations, it was about we didn't have many people from, say, maybe ethnic minorities in patients or they were nearly all white and Scottish and whatever, and mostly elderly because those are the people who volunteered. How do we encourage those voices that you were talking about in terms of the patient, the community, not only to be involved, but to impact on how we might be teaching and using language. Yeah. So a lot of our, um, patient involvement is via third sector organisations. So there are multiple third sector organisations throughout Scotland who either represent transgender communities or Um, are linked to transgender communities. So I think that would be the first step to involve those third sector organizations to try and make sure that what we're doing is fit for purpose. Um, and certainly that's, that's what we do if we're trying to improve services or design services or look at national initiatives. So having that patient and individual voice at the focus is really important. We're specifically talking about gender inclusive language here. So some people might question, but is that not just part of EDI because it's about inclusivity? Why do you think it is so important? I think when it comes to EDI, the whole purpose of it is to make sure that no one feels left out. And while I do think it is definitely in the broader scope of EDI, it is its own thing as well. Um, where we have as future clinicians the responsibility to look after everyone, care for everyone and make sure that we have the skills to look after them. I think it's that sense of worry and concern, which is why we're having this conversation in the first place, and which is why I think it's so important that we have ways that we can kind of help promote that inclusivity and how we speak, and kind of just touching on like kind of the last comment about how do we kind of integrate all of this into our curriculum. And especially, I think one of the things that we can do, especially for us is have a domain which actually kind of assesses students inclusivity and how they speak. And while I appreciate this is another sort of depth to be adding to an assessment, I think it

will add value to our students feedback and saying that, look, you did well on your timing, you did well on your clinical examination, and you were quite inclusive in your communication. But it doesn't have to be things like just asking about pronouns, but it's simple clarifications like what would you like to be called today? I think simple things like that can make a big difference. And in addition to that, I think probably benefit from having scenarios which have Lgbtq+ patients, um, without it being sort of the core of the scenario. So just kind of getting folk used to, the idea is that you will be looking after people with a variety of gender identities, but that doesn't necessarily change how you're going to tackle that OSCE. But I know every time, you know, sometimes somebody will say, oh, you're looking after a trans patient, sixty seven year old trans male. They'll be like, oh God, it has to be something regarding that when it's completely different to the core of the OSCE station. So it's getting folk a bit more comfortable with that. And so in terms of training our educators, it seems to me it's a bit like everything that we do. It's always multifaceted. Um, role modelling is obviously good, but do you think we should be doing formal training. Should be informal. we be running workshops about it? We'd be pointing people in the right direction of resources, I think. Yeah, I think it's more about integrating it across the curricula rather than having sort of, okay, in year three, section block one, you're going to have a whole day of teaching about trans identities and gender inclusive language, and that'll be it. I don't think that's going to work very well. I think it has to be sort of that building up each and every year, sort of like a spiral curriculum. Even so, you introduce the topic in year one, you build on it in year two and then, you know, allow students to apply it in year three, things like that. And I think having scenarios with a diverse patient population will get people more comfortable with looking after them rather than being, you know, that apprehensive fear. You know, I don't know what I'm going to do. You're sweating and you think that, you know, this is, you know, I'm looking after a trans patient. So therefore, this has to be the crux of the clinical situation that I'm dealing with. Whereas all you have to do is just You have to be more conscious of the language you use and recognize that, yes, things are slightly more different for them and you just need to be more aware of how you're speaking to them. So I think it's that integrating it all across. I mean, as a teacher and as somebody who's used to using this language. Tanya, what sort of hints would you give to other people in terms of making it as inclusive and almost well, not almost, but not your normal way of of working. For people who are educators who may be new to this or not quite sure how to approach it. Have you got any hints and tips about how to take it forward? Yes. I think if someone feels that they need a bit more input than there are resources online, which we can potentially link to, which could help with that just introduction to the sort of language that you can use and, and the different sort of prompts and questions that can be useful in these scenarios. And I think the main thing is just to be really open and honest with that individual in front of you and just to be really, um, respectfully curious, if that makes sense. So making sure that you're asking questions that you need to ask to do your care. Um, so I would ask people when they come in, you know, if they've not already completed our form around what their pronouns are, you know, what would you like to be called today? Um, and if you're dealing with somebody in a specific scenario where you need to, for example, examine them, then, you know, you can ask people about how they want to be examined, what additional support they may need or, and what their needs are. And I think that's really important. Just getting the feedback from that individual in front of you and not being scared to ask that, because actually that is signaling your respect to that individual that you're taking time to consider what they need for that consultation. Just broadening it up just a little bit before we come to the end is it's not just related to medicine. I mean, gender inclusive language is across the board and the university and everything. What do you think is different about medicine compared to teaching in that day in the law or, you know, learning English language or the arts or something? Do you think there's something different in terms of teaching when you're teaching medicine compared to other teachers? Do you mean in regard to teaching around gender inclusive language? Yes. Yeah. I think there are some some things that are going to be the same across the board. So actually, if you're writing, for example, if I was writing a protocol, making sure that you use gender inclusive language in that protocol or in that policy. So there's, there is definitely common threads regardless of what part of society you're working in. But there are obviously more specifics with regards to healthcare, because we're dealing with people all the time, with individuals all the time. So we have to be more nuanced and more aware and respectful of these issues. And obviously, then there is the clinical aspects of dealing with somebody who's went through transition and making sure we get that care right, which obviously requires a bit more input with regards to clinical training. I think for myself, we as healthcare providers, you have this duty of care and the words you choose have such a big impact on the patients you look after, and that can have such big consequences for the care they get in the future. I think, yes, there's so many common threads that run through all different professions, and I think you can apply them to everywhere. But in

healthcare, it's that sort of that critical moment where you can make a difference to an individual's life, and the effect it can have for their future and their health is tremendous. You're clearly passionate. One of the things I know that you've done is, um, you know, a scoping review and looking at the, the literature just to sort of maybe flesh it out a bit, what, what are the key points that you have found? Or what are the key themes that you've taken away from that? Because that might be quite interesting to see. You know, what else is out there? So there's a couple of things that I've actually come across in this scoping review. Um, resoundingly through most of these studies, a lot of the student voices have said that yes, we want to know more about this topic. Um, a couple of them were on volunteer basis, but majority of the students have said that yes, this is an important topic. We, we don't get enough time teaching it. I think a couple of studies have looked at the amount of time that's actually spent in teaching LGBTQ curricula across UK universities, and it's actually quite varied. I think someone put it about a median of five hours of LGBTQ teaching across the five years of medical curricula, which is not very much. So students want more information and want more knowledge and want to be equipped with these skills. Additionally, educators have also kind of come out with similar, um, feelings that there is space for teaching. Um, and institutions are trying to make changes in their curricula to integrate it better. Um, but about a lot of, uh, clinicians and teachers and educators have said that there is a lot more work that needs to be done. I think a lot of them have used very different strategies. Some have thought a lecture based system works best for them. They've thought that we'll have a lecture, we'll have a day of teaching, um, where they'll use didactic lectures, then do e-learning and have small, small group based teaching as well, and from what I can discern is from. For most folk, what's worked best is small case based learning or small group based teaching. I think students have really enjoyed kind of having that sort of protected space where they can discuss topics that might be a bit uncomfortable for them. And, you know, having that open, non-judgmental space has been very valuable for students. Lastly, what's worked really well is having sort of like a panel discussion almost, and having members from the community to actually come speak to students themselves. And I think that's a very invaluable sort of experience for students having voices from the trans and non-binary community themselves directly, kind of talking about their experiences, whether it be just in just in life or with healthcare. Um, students have taken a lot of value from that. One hundred percent agree. I think, um, if you think back to, you know, learning that you've had yourself, the thing that you remember is that individual, that patient. So having those, you know, those panel discussions or small group work, I think sounds really great in terms of trying to move this forward. And bearing in mind that this podcast is based at the clinician educator or the clinical educator. I'm going to ask both of you now, um, what is the one key takeaway or one key message that you want them to take away from this podcast that you think will influence or change either how they speak, communicate, teach. I think if someone's listening to this, they've probably already got some either interest or have identified a learning need. And that is the first step, isn't it? Thinking right? Actually, I have to learn a bit more about this or get a bit more information. And that person listen to this is probably on that journey. I think often when we try, we're trying to change a bigger picture. It's often trying to get to those individuals who are not at that point in their journey that need to potentially have a bit more of a push or an introduction to try and change their practice or increase their knowledge in a particular area. So I think my main takeaway would actually be if you're listening to this podcast, actually share it with other people that you are working with. Um, try and get people to look at gender neutral language as something that they do on a day to day basis and, and really just normalize it. So that would probably be my main takeaway. Wow, that was actually brilliant. Um, for me, my key takeaway is sort of just being humble, I think, and a sense of cultural humility even. Um, I think the language that we use is constantly evolving. And I know I've spoken a lot about a lot about it, but I'm no expert. Even I'm learning every day I step out. Everyone teaches me something new. And I think it's having that openness to change. It's very crucial for us as anyone in healthcare or in education, and I want people to keep an open mind and say, okay, I don't understand this, but I want to be able to keep an open mind and have the capacity to change. I think that's what I would want educators to take away. That's great. Thank you. And just to remind everybody that for all the educators out there, we do have our faculty development site on Turas. Uh, I can tell you that vid is developing an e-learning module on this very subject, but there are also lots of e-learning modules and resources on other subjects related to, um, to teaching the undergraduates. And also to remember that, uh, Nauzene is our new website where you can access resources as well. And so finally, I'd just like to thank Vidya and Daniela for coming today. It's been a really interesting conversation and hopefully it'll spark some debate amongst you all in the future. Thank you.