Breaking barriers: transforming healthcare education for transgender patient equity in a South African undergraduate paramedic program.
BMC Medical Education · 2026-05-05 · Qualitative study
Abstract
BACKGROUND: Despite growing global attention to diversity, equity and inclusion in healthcare, transgender health remains insufficiently addressed in undergraduate medical curricula, particularly in prehospital emergency care training. Transgender individuals often experience discrimination and substandard care linked to healthcare providers' limited knowledge and cultural competence. Emergency medical services (EMS) personnel, as first responders, play a crucial role in shaping early patient experiences, yet EMS education in South Africa has seldom addressed transgender health content in formal curricula. METHODS: This paper presents a qualitative, reflective case study of a curriculum innovation introduced in a South African undergraduate paramedic programme. Between 2019 and 2024, approximately six cohorts of 40 students each participated in a targeted one-hour session. The intervention combined LGBTQAI+ terminology and clinical considerations, a transgender lived-experience guest speaker and structured Q&A, reflective storytelling grounded in EMS practice, and the Genderbread Person as a conceptual scaffold. Evaluation drew on educator reflection/classroom observation and an interpretive thematic review of anonymous post-session questionnaire feedback, focusing on student reactions to curricular content, instructional strategies, the learning environment, and perceived learning. RESULTS: Student feedback indicated strong engagement with the session and reported conceptual clarification regarding distinctions between sex, gender identity and expression, and sexual orientation, supported by the shared visual framework. Students described the lived-experience speaker and reflective storytelling as making barriers to care and the consequences of unconscious bias more tangible, and many valued a safe, non-judgmental learning environment that enabled candid questions and correction of misconceptions. Reported learning included perceived shifts in awareness, empathy and preparedness to engage respectfully with transgender patients. However, some expressed discomfort or concerns about infringement of personal cultural or religious beliefs and questioned curricular relevance. CONCLUSION: Although the intervention does not measure clinical competence or behaviour change, it offers a feasible, contextually responsive teaching model for introducing transgender health in prehospital education. Its subsequent scaling to other departments within the Faculty of Health and Wellness Sciences suggests institutional transferability beyond a single cohort. To advance equitable, patient-centred emergency care, transgender health content should be embedded within formal curricula and supported by institutional leadership and longitudinal evaluation.
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Tags
Clinician perspective · Equity & disparities · Low- and middle-income settings · Students · Socially vulnerable groups
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