Teaching Philosophy

I have had the fortune of receiving remarkable mentorship, and moreover incredible sponsorship, under the wings of many who emulate the integrity, accountability, and excellence that I seek to reflect and amplify in my daily practice.

My debts are owed to countless individuals in the queer community, Holly, Magdalen, Billy, and P. (Rest-in-Power) of Safe Space who showed me the power of grassroots advocacy. Dr. Shauna Devine opened my eyes to the ‘history of medicine’ and the role of socio-political contexts that have shaped medicine.  My best physician teachers include: Dr. Catherine Yu, Dr. Rob Silver, Dr. Robert Conn, Dr. Jeanette Goguen, Dr. Lisa Richardson, Dr. Sandra Kim, and Dr. Ray Fung, who continue to foster my knowledge, expertise, and skills in social justice and Endocrinology. I immortalize a piece of teaching from each of my mentors and seek to pass the same wisdom on to my future trainees. Each of my mentors has an uncanny ability to transcend learners from the pits of self-doubt to the summits of self-actualization.

Upon reflecting on the learning that I have received, my teaching roles, and my teaching perspectives inventory (TPI), I find my teaching style is ingrained in nurturing and apprenticeship. I seek to build a supportive learning environment where the achievement of knowledge and training is a product of a learner’s effort and ability put forward. From the pedagogy of David Ausubel who famously stated that “the most important factor influencing learning is what the learner already knows.” In a safe environment, with the aid of Socratic questioning, it is our duty to tease apart what learners know, and what ‘they don’t know, that they don’t know’.

Many medical students and residents do not get adequate exposure to gender affirming hormone therapy and gender-diverse health. A survey of North American medical schools found the median number of hours spent teaching LGBT-related content over 4 years was only 5 hours; medical trainees lacked clinical exposure, and fewer than 35% of medical schools surveyed studied the health of transgender patients. This ultimately translates into consultant physicians who are uncomfortable discussion or managing gender identity affirmation through hormone initiation and maintenance. This was substantiated by survey data from Transgender care by endocrinologists in the United States, where 80% of respondents had not received any formal training in care of transgender individuals, despite 80% of survey participants stating they have cared for transgender patients. It is my career goal to improve trainee and physician knowledge, competence, and comfort in providing gender-affirming hormone therapy to our gender-diverse patients.

With the aim of cultivating the mind, enhancing the climate, and focusing on a growth mindset, I began teaching LGBTQ2S+ rounds with a focus on transgender health at Mount Sinai Hospital. The positive feedback from trainees allowed for expansion of the dialogue through larger opportunities where I served as an invited lecturer for Internal Medicine Academic Half Day at the University of Toronto, University of British Columbia, University of Ottawa, and Dalhousie University. Although didactic in format with case-based scenarios, the emphasis is on creation of a safe-space through my own self-identification as a member of the LGBTQ2S+ community, and importance of asking questions in a judgement-free space. Resident physicians provided feedback that ‘

Although understanding gender identity is considered to be part of the core competencies of Endocrinology, there have not been formalized objectives pertaining to the specifics of hormone management of transgender patients. We have a duty to continue to push boundaries of normative institutions and integrate equitable care into our endocrinology curricula.

1) In every patient encounter, show compassion. From the Latin root words “pati” and “cum”, compassion means ‘suffer with’; it means in every encounter you have an opportunity to go into that place of suffering and build a relationship there.

2) Be comfortable with uncertainty. We may not have all the information or all the answers, but it is okay to tell your students ‘I don’t know’ and follow that with ‘here are some ideas to find out’.

3) As per Paulo Freire, the purpose of education is to liberate human potential which encourages problem-based learning, questioning the status quo and thought expansion (Torre, et al., 2017).

4) Model for your patients (and your learners!) that they are and will always be, more than their diagnosis.

5) Ask your residents what they want to see more of and bring that enthusiasm to the mundane. No two cases are the same.

6) Medicine is a team sport.  Although it is tempting to get things done quickly by yourself, you can accomplish more as a group.  Drawing on the African proverb ‘If you want to go fast, go alone, if you want to go far, go together.’

7) Realize that at least 4% of Canadians are 2SLGBTQ+ (Statistics Canada, 2021) and in the United States 5.6% of adults identify as 2SLGBTQ+ (Miller, 2021). The intersectionality of minority race and 2SLGBTQ+ status can exacerbate marginalization and affect the education, health and health-seeking behaviour of 2SLGBTQ+ patients, learners and staff.

8) Sex, gender, and sexual orientation are related but distinct concepts.  Sex is based on biological differences.  Gender is a social construct in reference to the societal rules and norms assigned to varying degrees of femaleness or maleness.  Gender identity is the individual’s internal sense of their gender and can be a spectrum or constellation.  Sexual orientation is how a person identifies their emotional and physical attraction to others.

9) 2SLGBTQ+ patients and learners should be treated with dignity and respect which can be promoted by learning 2SLGBTQ+ health vocabulary; not all 2SLGBTQ+ patients refer to themselves using the same nomenclature, and these terms may evolve.

10) Inclusive clinical environments that are affirming to queer patients, students and staff should be created.  Adding gender pronouns to nametags and email signatures is a strategy for inclusivity.  Use of the words “spouse/partner” is preferable to “husband/wife”.   Gender-neutral restrooms help create a welcoming environment.  “Genitals”, “gonads” and “chest” are the preferred non-gender language for “private parts” and “breasts” respectively (Thompson, 2020).

Learners are most productive when they are working on building skills without fear of failure, and without systemic obstacles. This requires deconstructing hegemonies in our learning environments and unveiling the multiple systems of intersecting oppressions that challenge our trainees from all angles. We should highlight, demonstrate, and do anti-oppression and anti-racist work in all our daily interactions. “If it’s not uncomfortable, we’re not doing it right.” By supporting learners to explore the historical and sociopolitical contexts of power and privilege in medicine, we also begin to tackle pervasive social determinants of health. We must meet our learners where they’re at, and that also means having a deeper understanding of where they’ve come from.

As I complete my Master of Science and Community Health from the Dalla Lana School of Public Health, addressing the 2SLGBTQ+ health gap in medicine is driven by a firm commitment to social accountability, sponsorship of marginalized groups, and relationship-centred care.

To move the needle forward, we need the standardization of curriculum at undergraduate, post-graduate and additional continuous professional development training to begin doing this heterogeneous community justice. It begins with recognizing that although the acronym 2SLGBTQ+ is frequently used, these are entirely diverse groups, each with unique health needs. A history of oppression has effectively led to an erasure of these populations until recently when society (and thus social constructs of gender and sexual diversity) have progressed.

At the macro level, we need our accrediting bodies to develop and implement objectives that ensure medical students and residents are sufficiently poised to care for the health needs of the 2SLGBTQ+ community. At the meso level, we need to elevate and highlight intersecting identities ie) Black Queer Women, and place them both in positions of consultation and leadership to help direct curricular goals. At a micro level, we need visible anti-discrimination policies in all hospitals/training environments, the common use of pronouns on name badges, and the normalization that identities lay on a spectrum of gender and sexual health diversity.

Endocrinology is uniquely poised on multiple fronts for advocacy, whether it is for patients with diabetes and associated healthcare expenditures or providing gender-affirming hormone care to gender-diverse patients. The very meaning of hormone is ‘to excite’ and I am excited for the future discoveries and patient-centred leadership engrained in the culture of this specialty.