What would you do?

Your physical therapy student is sharing his experience after just returning from a clinical affiliation.  He had been gaining independence as a student PT to the point where his clinical instructor gave him his first solo patient initial evaluation.   The patient complained of numbness and tingling into the R upper extremity of unknown cause.  Upon further inquiry, the patient revealed that he had undergone transgender surgery with female to male chest surgery 4 weeks prior, but didn’t think that the surgery would have anything to do with his current complaints.  

As an instructor, you take advantage of this clinical experience to discuss the importance of taking a good history as well as possible medical complications, post operative scarring, etc.  When you finish speaking, the room goes unusually silent and you notice most of the students are staring at the floor or looking at their desks. You pause to see if anyone has anything else to share or if there are any questions.  The absence of sound only increases.  At this point most of the class has forgotten the fact that in order to remain an active class member , breathing is required.

The elephant in the room slowly walks out as you ask another student to share their clinical experience…

So what would you do if presented with this situation?  Please share your comments and experiences.  Here’s what some other faculty members had to say:

Faculty Member 1:

I probably wouldn’t move on to the next clinical experience.  I would probably directly confront the issue of the silence.  I teach lifespan and so we talk about sexual dysfunction post pregnancy.  I often get the same silence.  At times I feel like I am teaching a sixth grade health class.  …  I often find that the students in general are just uncomfortable speaking about sex, no matter if it’s about transgender issues or if it’s just talking to their client about having sex with low back pain.  So I think what I probably would do is explore (to see) if their discomfort is related to the fact that the person is transgender or if their discomfort is related to the fact that we are discussing some sort of sexual issue… In order for them to adequately address their patient , they need to be comfortable speaking about a wide range of … uncomfortable topics including sex, including death and dying …

We talk about adolescence and bullying  … One of the things (I teach my students) to look out for is if your client is being physically bullied.  If your client is showing up with bruising,  (don’t) jump to conclusions (about a family member being the abuser) because they may be being bullied by peers.  LGBT (people are) at a higher risk for things like being bullied – are at a higher risk for things like suicide.  I find that in general the students are uncomfortable speaking about … sex and its embarrassing for them that I would be standing up in front of them and talking about that.- Like I’m their Mom.

 How do you address their being uncomfortable?

 I make them keep talking.  I put it in the same light and I explain to them that I have worked in hospice for a number of years and that many people are uncomfortable talking about dying to their patient who is dying.  The patient knows that they are dying right?  The patient in front of you knows that … they had transgender surgery. If they have not been embarrassed in disclosing that, then you can’t react and be weird about it.  And so often times (in class) we might do some role playing. We might talk about why it’s uncomfortable.  We kind of explore the discomfort and (we) practice(having that)  uncomfortable conversation…Sometimes you may not be familiar with the surgical techniques of female to male or male to female transgender surgery …  The person who is transgendered and has gone through a transformative surgery like that understands that it is not a common thing.  …(So) we do a lot of exploring of the discomfort.

 So when you have that opportunity, you take advantage of it. Do you think that diversity topics are covered well in our curriculum?

 Well, I think that we could do better.  I feel like cultural diversity in terms of racial diversity is covered very well.  I think that religious diversity and how that might impact our practice as PT’s is covered well.  I think, frankly because of the sexual orientation composition of our department, we are heterocentric and so it is hard for me to often think of how it would be to be a lesbian woman in a clinical setting.  … You need to be mindful ( that) many people would feel uncomfortable treating people who were of a sexual orientation that was different than theirs.  And I don’t think that we as a department really consider that too often.  … I know that students have brought that up as an issue.  If students bring something up as an issue, it’s an issue.

Faculty member 2:

I would force the interaction just like I would any other scenario

 Do you think your classes are an appropriate place to include discussions on topics in diversity?

Depends on the scenario. There are teaching situations where a discussion is required such as risk of stroke in different communities.

 Can you give any examples of times in the classroom where opportunities to address issues of diversity have come up?

 See above. I also include same sex couples and a variety of racial groups in any patient scenarios.

 What is your overall impression of how “visible” the topic of diversity is in your unit (how much it is discussed amongst faculty, incorporated into staff meetings, included in the curriculum planning etc)?

Not very visible.

Is there anything that you would want to see done to increase or decrease this?

I think it is fine as is.