New simulated patient program gives medical students opportunity to train with sexual and gender minority patients

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“In conversations with queer people in my life, medical trauma [and] trauma in healthcare settings is real,” Danielle Sato (MS 2024) said of the medical care that LGBTQ+ patients often experience. “Even in a place like Hawaiʻi, where it’s overall tolerant and progressive, slip-ups and harmful things [can] happen.”

It was in one of these conversations that Sato, a third-year student at the University of Hawaiʻi John A. Burns School of Medicine (UH JABSOM) got the inspiration for a new kind of standardized patient experience that both patient and medical student could benefit from. The standardized patient program is an integral part of JABSOM’s curriculum, where volunteers are asked to participate as patients to give medical students training in communication skills, good bedside manners, and competent clinical skills.

In a typical standardized patient experience, patient volunteers are given a training manual with the details of the patient they are portraying, such as their medical history. But after one particular conversation with a previous volunteer who identified as a sexual/gender minority, who had expressed interest in portraying themselves instead of a scripted patient, Sato had an idea for a simulated, rather than standardized, patient encounter.

“[He] was talking to me about how, ‘it’d be great if I could actually be myself and not [a] cisgender, heterosexual man having chest pain, and I can just be myself with my own unique identities having chest pain,’” Sato recalled of the conversation.

Sexual and gender minorities (SGM) are people whose identities, orientations, or practices differ from majority of society. It is an umbrella term that includes those who are part of the LGBTQ+ community. According to a 2022 Gallup poll, the percentage of U.S. adults who self-identify as lesbian, gay, bisexual, transgender or something other than heterosexual has increased to a new high of 7.1%. As the LGBTQ+ population increases, the importance of diversity becomes greater. Historically, SGM patients have had a negative experience with their health care and have consequently been hesitant to receive further medical care.

With inclusivity in mind, JABSOM is preparing our future doctors to provide compassionate care to this growing population. Though the JABSOM curriculum includes standardized patient projects and covers the topic of health care to sexual and gender minority patients, the two practices never overlapped.

She, along with her classmates Lauren Mooney and Melia Takakusagi, spearheaded the sexual and gender minority simulated patient experience project. The three, who are also a part of JABSOM’s Rainbow Pride Alliance student group, worked tirelessly to get the project off the ground in time for MD 2024’s December colloquia week.

The day-long project included a lecture by Renee Peterson and Stephanie Mikhail from the Lavender Clinic, a local clinic that specializes in gender-affirming care to SGM patients; the standardized patient experience, where each medical student was paired with an SGM patient, with a JABSOM faculty or physician collaborator present to observe; and a debriefing session with the students to discuss what they learned and their thoughts on how to improve care for the future.

“Of course we need it to be standardized, but [we also needed to] modify this in a way that teaches the students to think on their feet [and not] make assumptions,” Sato said. “It also provides a space for [the] patients, LGBTQ community members, to bring their own perspectives to the table and interface directly with future providers.”

During the patient encounter, students were tasked to introduce themselves to their patient in a gender-inclusive way, as opposed to automatically assuming the one’s gender. An example of this would be to say your name, your pronouns, and then asking the patient themselves how they would like to be addressed. After introductions, students were then to get a comprehensive sexual history of their patient while practicing non-judgemental, empathetic communication and active listening, without being presumptuous of their patient’s history.

Sato also mentioned that in the case of a transgender or gender non-conforming patients, a simple practice of calling them by their chosen name as opposed to their dead name (the patient’s former name) can be helpful.

“We’re trying to teach students that even through something that seems harmless can actually mean a lot to our trans, non-binary, and gender diverse patients,” said Sato.

Since the SGM standardized patient program is the first of its kind, Takakusagi, Mooney, and Sato hope it will continue on in the future. While they are gathering information from the pilot year of this program, they are looking to pass the torch or provide insights to future JABSOM classes and faculty who are interested in continuing this kind of standardized patient program.

“Our patients and our faculty members [think] that this would be something that every healthcare provider could benefit from,” Sato said. “If we could make it a sustainable thing, that would be great.”