07 May 2024

Co-produced scenario-based simulations: Respect for trans communities

In July 2018, a significant milestone was achieved when the Government unveiled the National LGBT Action Plan, a pivotal initiative aimed at advancing the rights of LGBT individuals. This plan is crucial to enhancing the way public services function for every citizen, irrespective of their sexual orientation, gender identity, or sex characteristics (NHS, n.d).

However, despite substantial strides made in the direction of inclusivity and acceptance, transgender and gender diverse (TGD) individuals still grapple with discrimination and disadvantages when it comes to accessing healthcare services. Their unique and complex health needs are frequently overlooked or misunderstood, leading to suboptimal care experiences (Coleman et al., 2022).

One glaring gap that persists in healthcare education is the scarcity of comprehensive curricula addressing transgender patient care. This deficiency in undergraduate programs is a critical concern (Muckler et al., 2019). It not only deprives future healthcare professionals of the essential knowledge and skills needed to provide competent and compassionate care but perpetuates a cycle of misunderstanding and insensitivity in healthcare settings.

Recognising and addressing these challenges is paramount for the healthcare industry and healthcare education. It is not merely a matter of ensuring equal access to healthcare services but also a matter of upholding the fundamental principles of empathy, respect, and dignity in patient care.

Embracing diversity in all its forms, including gender identity and expression, enriches healthcare education and fosters a more inclusive and compassionate healthcare system that truly meets the needs of all its constituents.

Learning Through Real-World Scenarios 

One innovative approach that has proven remarkably effective in enhancing healthcare education’s understanding of TGD individuals is the use of actor-simulated training. This approach creates a dynamic and immersive learning experience that transcends the traditional confines of textbooks and lectures.

Actor-simulated training immerses healthcare students within a realm of practicality that transcends the passive confines of conventional learning methods. It thrusts them into authentic scenarios mirroring real-world interactions with TGD individuals. Through active engagement with these dynamic situations, students transcend theoretical knowledge and gain profound experiential insights. These insights extend far beyond the classroom, offering an understanding of the multifaceted challenges, emotions, and perspectives that TGD individuals often encounter when seeking healthcare services. This firsthand immersion serves as a potent catalyst for empathy and understanding, nurturing healthcare professionals who are not just knowledgeable but also deeply compassionate.

Actor-simulated trainings can elicit emotional responses from students as they navigate scenarios involving TGD patients and healthcare providers. This emotional engagement becomes a pivotal component in fostering genuine empathy and sensitivity. It encourages students to embark on a self-reflective journey, where they scrutinise their biases, preconceptions, and reactions. This introspection ultimately leads to increased levels of compassion, paving the way for more patient-centred care.

The versatility of actor-simulated training shines through in the creation of dynamic and highly realistic scenarios. These scenarios can be tailored to encompass an expansive spectrum of healthcare situations, ranging from routine check-ups to nuanced and sensitive discussions about gender identity, transitioning, and related healthcare needs. This adaptability ensures that students emerge from their training well-prepared for the diversity of encounters they will face in their future healthcare careers. Additionally, this immersive learning environment operates within the bounds of safety, offering students the space to make mistakes, learn from them, and refine their approach without the risk of compromising real patients. This safety net encourages the growth of confidence and competence in dealing with TGD patients and underscores the invaluable role of actor-simulated training in cultivating essential communication skills that extend beyond the TGD context, enriching all patient interactions.

Left to right: Julie Miller, transgender actress, facilitator and advisor on LGBTQ issues to SimComm Academy; Julie sharing her own lived experiences as part of the ‘What Matters to Me’ workshop.

SimComm: Creating Authentic Scenarios

To ensure the utmost authenticity and relevance, SimComm developed a workshop developed in collaboration with individuals from the TGD community. The scenario content was translated from real-world experiences, shedding light on the prejudice and disrespect they often encounter within healthcare settings. This co-production process ensures that the scenarios presented in training accurately reflect the challenges and realities faced by TGD individuals.

The delivery of these scenarios consisted of 2 components. The first is through the dynamic medium of forum theatre. At the heart of the scenario is an individual from the TGD community, portrayed by a skilled trans-actor. They interact with a healthcare professional played by another actor. This setup mirrors real-life interactions and the assumptions that healthcare professionals may carry into such encounters.

As the scenario unfolds during the first run-through, the audience watches attentively. Upon its conclusion, a facilitated discussion provides a platform for participants to express their thoughts, emotions, and insights. This dialogue encourages a deeper understanding of the complexities surrounding TGD healthcare experiences.

During the second run-through, audience members are invited to intervene and modify the behaviour of the healthcare professional. This engagement empowers participants to steer the scenario toward preferable, respectful, and safe care. The actors are trained to adapt their actions in response to audience instructions, under the guidance of the facilitator.

Following the simulation, the trans-actor undergoes a crucial de-rolling process. This separation is vital, as it allows the actor to shift from their role and return to their authentic self. The trans-actor shares their journey of transitioning their gender identity and presentation. This narrative serves as a bridge between the simulated experience and the lived reality, fostering empathy and deeper understanding among participants.


The co-produced scenario-based simulation has been successful in promoting respect and understanding of those from the TGD community. Audiences have been a broad range of professional groups: vocational, undergraduate and registrants. This session has been repeated over fifty times, with changes made to suit the audience’s background. Health professionals have had the opportunity to learn and practice appropriate communication skills. The lived experience component post-simulation was impactful in providing personal insight into the challenges faced by TGD individuals. Participants note an increase in knowledge of the needs of, and confidence in communicating with, members of the TGD community.

The co-produced, replicable, scenario-based simulations, featuring forum theatre and lived experience, are an effective method of promoting respect and understanding of those from the TGD community. The simulation provides healthcare professionals with the opportunity to learn and practice appropriate communication skills. Separating the simulation with lived experience is an essential component, due to ethical and safety issues, although linking the two, strengthens the authenticity of the session.


  1. NHS England. NHS England, LGBT+ action plan priorities [Internet]. www.england.nhs.uk. Available from: https://www.england.nhs.uk/about/equality/equality-hub/patient-equalities-programme/lgbt-health/lgbt-action-plan-priorities/
  2. Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health. 2022 Aug 19;23(sup1):S1–259.
  3. Muckler VC, Leonard R, Cicero EC. Transgender Simulation Scenario Pilot Project. Clinical Simulation in Nursing. 2019 Jan;26:44–8.