Preparing Pediatric Hospital Medicine Physicians to Care for Transgender Youth: A Call to Action

Angel, a transfeminine teenager, is admitted for status asthmaticus. As the attending physician, you receive a call from the bedside nurse to share that Angel and their mother want to leave the hospital immediately because hospital staff used their dead name. Angel is on continuous albuterol. You do not think it is safe for them to leave the hospital but are unsure how best to navigate this situation.Transgender and gender-diverse (TGD) youth are at risk of adverse health outcomes due to societal stigma, which can be compounded by limited access to gender-affirming health care, a challenge that has been magnified in the 2026 sociopolitical landscape in the United States.1 Adverse mental health conditions are prevalent among this population, with high rates of bullying, depression, substance use disorder, disordered eating, self-harm, and suicide.2 Mental and physical health outcomes among TGD youth improve when they are supported and affirmed in their identities.3,4 The American Academy of Pediatrics advocates for pediatric clinicians to use a gender-affirming care model, defined as “developmentally appropriate care that is oriented toward understanding and appreciating the youth’s gender experience.”5While previous research has examined the care of TGD youth in inpatient psychiatric care, primary care, and emergency settings,6 there remains a gap in understanding the perspectives of pediatric hospital medicine (PHM) physicians. As generalists who care for a variety of patients and who often educate the next generation of pediatricians, PHM physicians are important stakeholders in providing and advocating for competent, patient-centered care for this population.In this Perspective, we argue that PHM has an urgent but addressable gap in preparedness to care for hospitalized TGD youth. We briefly describe our institutional approach to closing this gap, while highlighting key lessons learned and outlining concrete educational and systems-level steps other PHM physicians can take to close this gap at their own institutions.Many PHM physicians may not have received structured education on best practices for caring for TGD youth. Although TGD-centered education in medical school curricula has increased over time,7,8 the Accreditation Council for Graduate Medical Education (ACGME) does not mandate competency in caring for TGD youth at the graduate medical education (GME) level.9,10 Furthermore, in a recent national survey, pediatric residency program directors reported lack of confidence that their graduating trainees could independently care for TGD youth.11As more youth feel comfortable identifying as TGD and sharing this with their clinicians, we will need competent pediatric clinicians to care for them in multiple areas, including the hospital environment. At present, there are no best practice models for how to approach teaching this content in a continuing education forum.Following Kern’s 6 steps for curriculum development,12 we conducted a foundational needs assessment and then piloted educational interventions at our institution that aimed to address important topics relevant to caring for TGD youth. Our didactic sessions included education on appropriate terminology, today’s legal landscape, health disparities, trauma-informed care, and an overview of social and medical transition. We also conducted case-based sessions so that physicians could interactively explore responding to common myths related to TGD youth, responding to others using incorrect name/pronouns, and discussing behavioral health concerns with TGD patients. Lastly, we held a panel with current gender clinic patients and their families so that physicians could hear their direct experiences. These sessions were tailored to be specific to the content and areas that were identified by our PHM physicians as gaps in their knowledge and comfort.Our attendees shared that introductory and didactic material was helpful to review and ensure clarity and shared understanding of terminology and definitions. In addition, our learners felt one of the most useful parts of the curriculum was the opportunity to collectively think through real-life case-based scenarios in which they could practice skills such as kindly correcting a staff member who uses the wrong pronoun for a patient as well as speaking with a parent who is struggling to accept their child’s gender identity. Participants also shared that learning about high-yield resources such as where youth can obtain low-cost or free gender-affirming garments (eg, binders) helped them approach TGD youth with confidence and an understanding of some of the nonmedical interventions that can be affirming to them.However, we also faced some challenges when implementing this curriculum. Because of the timing and structure of educational sessions, which are held virtually during business hours with optional attendance, we have had varying attendance and participation and, thus, consistency across sessions. In addition, because PHM physicians often attend virtual education sessions while on service, they are often listening while in shared spaces with other team members and with frequent clinical distractions, which has hindered their ability to participate meaningfully in the session. As a result of these challenges, few PHM physicians were able to attend and participate meaningfully in the entirety of the 5-session educational series. Variability in session attendance has made it difficult to refine our curriculum year-to-year, including deciding whether to repeat foundational sessions to broaden participation, introduce new content, or review prior material for those who missed earlier sessions.In addition, although we created these educational interventions based on PHM physician interest and need, a key stakeholder group whose perspective has been missing from our existing educational approach is TGD patients and their caregivers. Our team is currently conducting a qualitative study interviewing TGD youth who have experienced hospitalization, in order to learn how they feel PHM physicians could better provide them with effective, person-centered, trauma-informed care. We hope to use the results of this ongoing qualitative work to inform future education for PHM physicians and other hospital-based staff and to guide systems-level change to improve the inpatient care experience for TGD youth.From our review of existing national data on the competency of graduating pediatric residents to care for TGD youth, and from our own experiences providing this structured training to PHM faculty, we believe that PHM division leaders, educators, and fellowship directors should intentionally design longitudinal, role-specific TGD education for both practicing PHM physicians and trainees.As faculty development needs are likely context-specific, educators should consider conducting a baseline needs assessment to assess their own PHM physicians’ confidence in caring for TGD youth across multiple domains (eg, medical care, mental health care, social and emotional support, and navigation of sociopolitical and structural constraints that may impact care) and use the results to guide faculty-level curricula specific to caring for TGD youth.12 In the absence of such assessment, curricular efforts may fail to address the most salient gaps in clinician preparedness.Given the literature to support increasing TGD-centered content at the undergraduate medical education level but ongoing gaps in GME readiness to practice, PHM physicians’ knowledge and comfort in caring for TGD youth may vary based on the number of years since completion of residency. A local needs assessment could also support identification of subsets of PHM physicians who may benefit most from specific TGD-based content and assess practicality and uptake of curricular interventions.Educators should also consider selecting a theoretical framework in which to situate their curriculum. In our own curricular development, we are using transformational learning theory,13 an adult learning theory that focuses on how learners interpret experiences—called “disorienting dilemmas”—to change their worldviews, beliefs, and mindsets. For example, caring for TGD youth may represent such a dilemma for many clinicians, particularly when navigating unfamiliar terminology, addressing misgendering, or managing complex interpersonal dynamics with patients, families, and care teams.The transformational learning framework is well aligned with this content area because the educational gap is not solely one of knowledge, but also of one of communication and systems awareness.14 Transformational learning suggests that simply providing information is insufficient; instead, clinicians benefit from structured opportunities to reflect on their assumptions, practice new skills, and receive feedback in psychologically safe environments.We therefore believe that effective education for PHM physicians should move beyond knowledge transmission and toward structured opportunities for reflection, skills practice, and systems awareness. For example, while it may be helpful to review common terminology, health disparities, and best practices for caring for TGD youth, transmitting this knowledge alone will not ensure that pediatricians are able to lead a team through the nuanced situations that could arise when caring for patients like Angel.At our institution, we have a track record of utilizing high-fidelity simulations to provide a safe space for clinicians to learn serious illness communication skills. We believe a next step to ensure PHM physicians’ preparedness in caring for TGD youth is to offer high-fidelity simulations of cases involving TGD youth so PHM physicians can practice necessary skills such as correcting misgendering in real time and responding to common myths about the care of TGD youth.Our approach is supported by literature from analogous educational interventions,15 including training on the delivery of difficult news and on bias and microaggression, in which experiential and skills-based strategies—such as simulation, role-play, and facilitated reflection—have been shown to be more effective than didactic instruction alone in changing clinician behavior and improving patient-centered care.We believe that successful implementation of TGD-based content will be through multimodal curricula for faculty and resident trainees that include content ranging from basics of caring for TGD youth to simulation and experiential-based, psychologically safe settings to practice skills in communication and team-based approach to patient care, and that can build off the work of others in doing so.16,17We believe hospital pediatrics must take an intentional, multilevel approach to preparing clinicians to care for TGD youth, particularly in inpatient settings, where vulnerability and harm can be amplified,18,19 and in a challenging sociopolitical landscape that can negatively impact the identity formation of TGD youth. We hope that this Perspective can serve as a call to action for other institutions to consider the educational needs of PHM physicians who provide care for TGD youth, knowing many may not have had dedicated instruction in this area. For those who would like to take action at their own institutions, we would recommend first performing a needs assessment to ascertain the current level of knowledge and prior training of faculty members in caring for this patient population (Figure 1). Next, we would recommend targeted didactic education to fill in knowledge gaps. Lastly, we would recommend interactive case-based or simulation experiences to allow PHM physicians to apply this knowledge in realistic scenarios. These efforts have the potential to improve the patient experience,20 which is especially important in the evolving climate of both inclusiveness and discrimination toward TGD youth. We would be happy to share any of our educational materials with interested groups.As PHM physicians, we may not be able to eliminate experiences of misgendering, or other stigma, for patients like Angel and their family. However, by building skills and confidence in PHM physicians, we hope that they can support TGD youth if such an experience occurs. With appropriate education, an increasing number of PHM physicians will be equipped to provide effective gender-affirming care—ensuring that patients like Angel feel safe and supported in the hospital while receiving culturally inclusive and equitable care. In Angel’s case, a prepared PHM physician might pause the discharge discussion, acknowledge the harm caused by misnaming, ensure the care team uses correct names and pronouns, and engage hospital leadership to address the system failure—while also explaining the medical risks of leaving and partnering with the family to keep Angel safe.The authors acknowledge the Section of Pediatric Hospital Medicine at the Children’s Hospital of Philadelphia for their contribution to these important findings and their general enthusiasm and interest in learning how to best care for this patient population.The authors used generative artificial intelligence (ChatGPT, Claude) to assist with language editing, clarity, organization of the manuscript, and creation of the figure graphic. The AI tool was not used to generate original ideas, analyze data, interpret findings, or make clinical recommendations. All content was reviewed, revised, and approved by the authors, who take full responsibility for the accuracy, integrity, and originality of the work.