Halley Crissman, MD, MPH: Training with vision

Transgender and gender non-conforming individuals face numerous barriers to health care, including violence and discrimination while attempting to obtain health care. The University of Michigan has a comprehensive non-discrimination policy, which includes gender identity and is a great start to making Michigan Medicine a safe and accepting place for transgender patients, visitors and staff. However, a policy alone is not enough. In order to ensure staff are well equipped to provide excellent care for gender minority patients and visitors, training is needed.

The idea for this project came from talking to staff at Michigan Medicine. It became apparent that many of them had the best of intentions when caring for gender minority individuals, but lacked training in this area, and struggled with issues of language as well as practical skills for navigating issues of gender and sex.

The OB-GYN department has championed diversity, equity and inclusion, and is home to a number of faculty who are particularly interested in the care of gender minority patients. As my home department, it was a logical starting point for the project. The idea for early involvement of the Emergency Department came through personal experiences caring for transgender patients in that department, and was also based on evidence that suggests gender minority patients at times avoid or delay care due to fear of discrimination or lack of health insurance, and may thus be more likely to receive care through the Emergency Department.

The video training starts with an introduction that will be the same for all viewers, regardless of their role in the hospital, and covers topics of gender, sex and basic information about transgender identity. The second half of the video is job-specific, developed for clerical/registration staff, staff answering phone calls, providers (MDs, NPs, PAs, CNMs), nurses/medical assistants/techs and security/guest service specialists. The job-specific videos cover issues relevant to individuals based on their work in the hospital. The videos include scenarios such as checking in a patient whose name does not match their legal name, calling patients from waiting rooms, taking a history and bystander intervention in cases of discriminatory language.

The process for rollout is still in development with a target of late Summer or early Fall 2018. I am working with staff across the health system to make units aware of the videos in development, and the opportunity to use them for staff training across departments. A plan for pre- and post-training assessments is also in the works!

My hope is that all clinical staff at Michigan Medicine will be competent and confident in providing care to and welcoming individuals who are transgender and gender non-conforming. In turn, I hope that gender minority individuals will feel safe, accepted and welcomed when seeking care or visiting Michigan Medicine, and will receive the excellent care that we strive to provide.

From the moment I arrived at my UMMS interview, I felt like Michigan was a place where my individual interests and goals mattered and would be supported. I felt like this was a place where people genuinely cared about my unique interests and were committed to helping me develop and grow into the type of physician I wanted to be.

I came into medicine with a passion for issues of health and gender, reproductive justice, and caring for the LGBTQ community. UMMS embraced my individual interests and showed commitment to fostering my growth and development in those areas of interest. That was critical in my decision to ultimately attend UMMS.

UMMS has a vibrant culture of student groups. Extracurricular involvement in student groups, particularly OutMD and Medical Students for Choice (MSFC), helped me to develop as a clinician and activist, and provided a meaningful opportunity to build lifelong connections with fellow students and faculty with similar interests. Additionally, faculty at UMMS are as a whole incredibly approachable and encouraging of student engagement. The chance to work closely with leaders in clinical care and research related to my areas of interest provided amazing motivation and guidance in developing my early career path.

I first became interested in transgender health and gender minority populations in college while working on a project to educate incoming freshman about sexuality, gender and consent in sexual interactions. Working with faculty at Michigan Medicine providing care to transgender individuals, cross-disciplinary engagement with researchers working on gender minority health at the School of Public Health, and engaging with University organizations like the Spectrum Center and Comprehensive Gender Services Program all influenced my path in both clinical care and research.

I absolutely love living in Ann Arbor. I enjoy biking (both to work and outside of town), dinner with co-residents and friends at home and at the many great Ann Arbor and Detroit restaurants, and gardening.

Starting residency is always nerve-racking, and there is nothing that can completely prepare you for your first day on the wards as an MD. That said, I felt like UMMS prepared me as well as I could have possibly hoped for residency. I had a solid foundation of clinical knowledge and skills, and felt ready to jump onto the steep learning curve of residency. I am incredibly grateful for the training I got as a medical student at UMMS, and am honored to have been given the opportunity to continue my training at Michigan as a resident in OB-GYN.