“I’d talk to you like I would anybody else”: a qualitative analysis of interprofessional standardized patient training for gender- and sex-diverse care

Abstract Background Gender- and sex-diverse (GSD) individuals face significant health inequities driven by cisnormative assumptions and gaps in medical education. While the need for GSD-affirming care is well-documented, there is limited research on how these interactions unfold in real-time across both clinical and administrative roles. This study evaluates an interprofessional standardized patient (SP) training intervention on the communication practices of internal medicine residents and office staff within a large urban hospital system. Methods Using a qualitative approach grounded in situated learning theory, 45 participants (34 residents, 11 office staff) engaged in SP encounters involving four complex GSD cases developed by a community advisory board. Encounters were video-recorded and transcribed. Data were analyzed using reflexive thematic analysis to identify patterns in linguistic, relational, and structural practices. Results Four major themes emerged: (1) Language as Central to Affirming Care, highlighting the tension between “knowledgeable curiosity” and pathologizing questioning; (2) Broader Communication Practices, emphasizing the roles of trauma-informed care, non-verbal demeanor, and shared decision-making; (3) Intervention Experience, capturing participant reflexivity regarding knowledge gaps and the value of SP feedback; and (4) Medical Education Needs, identifying structural deficits in intersex health, anatomy-based risk assessment, and the transition from “checklist” medicine to relational attunement. Conclusions Effective GSD-affirming care requires moving beyond static competencies toward a dynamic, relational practice. The findings underscore the importance of interprofessional training that includes administrative staff and is integrated into medical education curricula. SP simulations provide a critical practice for learners to navigate uncertainty and repair missteps, ultimately fostering clinical environments that promote trust and healthcare equity for GSD populations.