Healthcare Simulation offers powerful tools to address health disparities, and one of the most urgent gaps lies in the care of transgender and gender-diverse patients. Simulation in healthcare can be used not just to teach clinical skills but to build cultural humility, affirming language, and provider confidence in the provision of high-quality care to the LGBTQIA+ populations. This article shares practical steps for the integration of affirming care principles into nursing simulation through a transgender-focused scenario. Based on a dissertation study conducted in a prelicensure nursing program, this guide outlines how to design, implement, and evaluate clinical simulation experiences that center equity and inclusion (Charbonneau, 2022).
Transgender Healthcare Needs
Transgender patients face widespread healthcare inequities that range from misgendering and denial of care to outright discrimination. Research shows that most nursing and medical students receive little to no training on affirming care. Healthcare simulation can fill this education gap through safe, immersive learning environments for students to practice inclusive, trauma-informed communication. Trauma-informed communication includes the initial understanding of the impact of trauma on individuals and integrating this awareness into all aspects of care to avoid re-traumatization (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014).
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Use of Healthcare Simulation for Transgender Care
Effective healthcare simulation begins with realismโnot only in moulage or manikin use, but in the creation of psychologically authentic scenarios. One approach is to use a standardized patient (SP) trained to portray a transgender individual in pursuit of routine care. In the study conducted, the scenario involved a transgender patient who presented for a primary care visit and discussed hormone therapy. The scenario was guided by affirming care frameworks and included moments for students to practice using affirming language, pronouns, and shared decision-making (Charbonneau, 2022).
Prebriefing is critical to successful simulation in healthcare, especially with the exploration of sensitive or identity-based topics. In the prebrief, faculty should review ground rules, affirm psychological safety and respect, and explain the learning objectives. Prebriefing should also include language modeling and discussion of bias. One helpful tool is a glossary of gender-affirming terminology to orient students to inclusive language use (Charbonneau, 2022). For example, faculty can introduce terms such as gender identity, nonbinary, cisgender, gender dysphoria, and chosen name with clear definitions and examples in a printed or digital handout. During the prebrief, instructors might read sample patient-provider exchanges aloud and ask learners to identify moments of affirming or non-affirming language. For instance, a prompt like โTell me your preferred pronounsโ can be revised to โWhat pronouns do you use?โ to model respectful phrasing. These interactive discussions help reinforce the use of inclusive language and prepare students for real-time communication with patients.
High-fidelity simulation is powerful, but the real learning happens in the debriefing. Simulation debriefing should invite students to reflect on their communication, decision-making, and internal reactions. In this study, written reflections revealed themes such as the need to: confront personal discomfort, develop affirming communication skills, and recognize the value of representation in healthcare (Charbonneau, 2022).
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Learner Reflections and Themes
The collection and analysis of student reflections allows faculty to assess the impact of the scenario beyond the immediate encounter (Charbonneau, 2022). In this study, written reflections revealed three major themes: the need to confront personal discomfort, develop affirming communication skills, and recognize the value of representation in healthcare.
To guide this reflective process during the debrief, faculty can use targeted questions that invite critical thinking, personal insight, and connection to professional practice. These questions may include:
- How did you feel when the patient shared their gender identity? Promotes emotional awareness and creates space to unpack discomfort or bias.
What affirming language did you useโor wish you had usedโduring the encounter? Reinforces specific communication strategies and encourages accountability. - How might this scenario influence how you approach similar clinical situations in the future? Links the simulation experience to real-world application and future behavior.
- What surprised you during this scenario? Encourages learners to explore assumptions and reflect on implicit biases.
- Did anything in your communication inadvertently create discomfort or reinforce a stereotype? Supports a trauma-informed and humble approach to care.
In written reflections submitted after the session, learners often acknowledged gaps in knowledge about hormone therapy, uncertainty around pronoun use, and the challenge of navigating unfamiliar terminology. These responses highlight the importance of debrief questions that go beyond clinical accuracy and explore learner mindset, empathy, and readiness to grow.
Common Pitfalls in Clinical Simulation on Transgender Patients
A common pitfall in diversity simulation is tokenismโthe superficial or symbolic inclusion of marginalized individuals without meaningful integration of their perspectives or lived experiences. In medical simulation, this can occur when a transgender character is added merely to โcheck a box,โ without authentic representation or thoughtful context. Tokenism risks reinforcing stereotypes, reducing complex identities to one-dimensional traits, and causing harm to both learners and the communities they aim to serve.
To avoid this, clinical simulation faculty should collaborate with LGBTQIA+ individuals in scenario design and, when possible, hire standardized patients from within the community. Community engagement ensures that the scenario reflects real-world experiences and challenges, and helps avoid caricature or bias. Involving community voices throughout the development process also deepens authenticity and supports a truly affirming learning experience (Charbonneau, 2022).
Simulation should not be a one-off experience. The integration of transgender health content across clinical simulation courses ensures reinforcement and deep learning. Programs can start small, with a single scenario or standardized patient, and build toward longitudinal integration. Additional scenarios may include gender-affirming surgery consults, mental health assessments, or emergency care.
Affirming Transgender Care
Affirming care is not just about the memorization of pronouns, but requires confidence, cultural humility, and active practice. Medical simulation provides the space to develop these three aspects of affirming care. Through intentional design, skilled prebriefing and debriefing, and reflection-based assessment, clinical simulation programs can empower future clinicians to deliver respectful, person-centered care to transgender communities.
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References
- Charbonneau, G. (2022). The use of simulation with the School of Nursing and Health Professions (SONHP) prelicensure students to support affirming practice with transgender communities (Doctoral dissertation, University of San Francisco). USF Scholarship: A Digital Repository @ Gleeson Library | Geschke Center. https://repository.usfca.edu/cgi/viewcontent.cgi?article=1607&context=diss
- Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). SAMHSAโs concept of trauma and guidance for a trauma-informed approach. https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf
- Eppich, W., & Cheng, A. (2015). Promoting Excellence and Reflective Learning in Simulation (PEARLS): Development and rationale for a blended approach to healthcare simulation debriefing. Simulation in Healthcare, 10(2), 106โ115. https://doi.org/10.1097/SIH.0000000000000072
