Transgender, nonbinary, and gender nonconforming TNGNC patients experience high rates of healthcare discrimination. Fear of discrimination may lead to delays in seeking healthcare and thus poorer health outcomes. Asking for a patient’s pronouns contributes to an inclusive environment, yet little is known about teaching and encouraging this practice among medical students. This study aims to characterize the attitudes and practices of pronoun use of students after implementing a standard pronoun curriculum.

We distributed a survey assessing attitudes toward and frequency of pronoun use to 310 students who completed a standardized pronoun curriculum and trained at continuity clinics. Attitudes (strongly disagree, disagree, agree, strongly agree) and frequencies (never, sometimes, often, always) were scored one to four respectively. T-tests determined factors’ associations with support of including pronoun training in the clinical curriculum pronoun curriculum, support of asking pronouns in new patients encounters standard pronoun use, and the frequency students asked patients’ pronouns student pronoun use. Factors included student age, gender, and whether the student had ever experienced pronoun use creating a better patient experience positive patient encounter.

The response rate was 32.1%. 54.5% of students reported never asking for pronouns. Common limiting factors were identified as: patient perceived as unreceptive (33.9%) and forgetting (18.4%). Cisgender women compared to cisgender men showed more support for the pronoun curriculum (3.42 vs 2.95, p=0.0062) and standard pronoun use (3.20 vs 2.83, p=0.0398) but no increased frequency of student pronoun use. No respondents self-identified as TNGNC. A positive patient encounter was associated with greater support of the pronoun curriculum (3.57 vs 2.82, p=0.0001) and standard pronoun use (3.43 vs 2.61, p=0.0001) as well as higher student pronoun use (1.90 vs 1.34, p=0.0005). Age showed no significant associations.

Despite being educated on pronoun use’s importance in gender-affirming care, the majority of medical students in this study reported never asking pronouns, largely limited by perceptions that a patient would be unreceptive. The only factor associated with both favorable attitude and increased student pronoun use was a positive encounter. This likely represents bidirectional causality as asking pronouns is permissive to positive encounters, and these positive experiences further encourage asking. To apply this, educating standardized patients to communicate positive experiences may encourage future pronoun use. Future directions may include implementing and assessing this curriculum change.