Curriculum Silence and Erasure: A Queer-Theory Analysis of Transgender-Inclusive Health Education in Internal Medicine Residency

Health professions education is increasingly called upon to prepare clinicians to provide equitable, patient-centered care; yet transgender and gender-diverse (TGD) health remains inconsistently integrated into formal curricula. Despite growing clinical literature, including evidence related to cardiovascular outcomes, educational integration of TGD health content remains limited across residency training programs. This disconnect between emerging evidence and curricular uptake raises questions about structural barriers that shape what is considered "core" knowledge. This study explored academic faculty perspectives on barriers to integrating TGD health content into residency curricula, using cardiovascular health as an illustrative case within Internal Medicine (IM) training. Drawing on a descriptive qualitative approach informed by Queer Theory, we conducted semi-structured interviews with 10 IM faculty members involved in curriculum development and teaching at a large Canadian academic institution. We purposively sampled participants to capture diversity in gender identity, academic rank, and clinical interest. We transcribed and analyzed interviews using NVivo. We performed a thematic analysis framed through a Queer Theory lens to identify how educational exclusion might reflect broader patterns of institutional cisnormativity. We constructed six themes from the data. While some participants cited lack of expertise or clinical exposure, others described structural forces-such as hierarchy-driven curriculum design, perceived niche status, and binary medical frameworks-that shape broader patterns of curricular inclusion and exclusion. When viewed through Queer Theory, these findings illustrate how the cisnormative image of the "default patient" renders some bodies and topics invisible to the curriculum, even when evidence and clinical need are well established. This exclusion of TGD health content, illustrated here through cardiovascular care, reflects cisnormative assumptions embedded within medical education. Just as the field has challenged the normative image of the physician, this study argues for a parallel interrogation of the patient. The same worldview that shapes which bodies clinicians are prepared to see also shapes what educators recognize as core content. Queer Theory exposes these exclusions and points toward structural work in curriculum design, faculty development, and institutional leadership required to address them.