Gender Assignment Based on Mannequin Anatomy

Background
Misgendering transgender people in healthcare contributes to fear of discrimination and stigmatisation, and transgender health inequality. Much of the language used to describe biology is discussed in a cisnormative manner. We explored the language used in a clinical skills laboratory, where pelvic mannequins with external genitalia were used.

Approach
Urethral catheterisation practical sessions were organised for 4th and 5th-year medical students at a UK undergraduate medical department. Students and facilitators were blinded to the research nature initially. Sessions were directly observed by clinical educators who wrote reflections based on the language used in the classroom. Following the observation, the research details were presented to students. A questionnaire was used to establish students' previous learning experiences of transgender health and the students' awareness of their own language to describe medical mannequins.

Evaluation
Twenty-one reflections were generated by seven observers across 14 sessions. Fifty-five students completed the questionnaire. Three main themes were identified from the observer reflections: heavily utilised gendered language, linguistic mirroring between facilitators and students and one-dimensional task-focus. Fifty-two out of fifty-five (94.5%) of participants responded that they had not previously considered the appropriateness of using pronouns when referring to mannequins.

Implications
We identified the need for systemic changes including relabelling mannequins and procedures from ‘male’ and ‘female’ to using anatomical terms such as ‘penile’ or ‘vulval’ catheterisation. The finding of significant linguistic mirroring shows that better faculty training is necessary. There are also opportunities to introduce transformative learning in clinical skills practice, challenging unhealthy and unhelpful behaviours without compromising skill acquisition.