Towards the inclusion of transgender and non-binary residents among Obstetrics and Gynecology residency programs across the nation: a needs assessment.

OBJECTIVE Given increasing numbers of matriculating transgender/non-binary (TGNB) medical students, this study aims to evaluate for current strengths and barriers towards inclusion of incoming TGNB trainees in obstetrics and gynecology (OB/GYN) residency programs and identify opportunities for improvement. STUDY DESIGN An online survey was distributed from May to November 2023 to healthcare providers affiliated with accredited OB/GYN residency programs in the United States. The survey explored program demographics, interpersonal interactions, physical space, and provision of gender-affirming care. Descriptive statistics and a logistic regression of quantitative responses were analyzed. Thematic content analysis was used to examine open-ended responses. RESULTS Among 294 OB/GYN programs accredited in 2023, 127 participated, representing all US regions. 69% of respondents identified as faculty or ancillary staff and 57% stated that they have been affiliated with their residency program for five or more years. 27 programs (21.3%) had a TGNB resident prior to and/or at the time of survey completion, of whom 7 programs (6%) identified having at least one TGNB individual who was a race other than White. 123 programs (97%) agreed that OB/GYN programs have a duty to provide an inclusive workplace environment for TGNB residents, and 73 programs (57.4%) felt prepared to support an incoming TGNB resident. Logistic regression found that having a TGNB resident at the residency, offering pronoun pins to healthcare providers, and providing easily accessible gender neutral bathrooms were associated with program readiness to support a TGNB resident. Qualitative analysis identified seven common themes exploring barriers and facilitators for providing an inclusive workplace environment for TGNB residents. CONCLUSION Although nearly all providers acknowledged the importance of creating an inclusive environment for TGNB residents, close to half of participants felt their programs were unprepared to do so. This study identifies relevant and feasible opportunities for improved gender identity inclusivity within the workplace. Recommendations are summarized in a toolkit (Appendix B) for residency programs working to build a supportive work environment.