Learning in the Shadow of Legislation: The Impact of Anti-Transgender Legislation on Adolescent Medicine Fellows' Training and Future Practice

作者：Emily Rider-Longmaid, Elle Lett, Ari S. Gzesh, Scott K. Jelinek, Nadia Dowshen · 发表于：Journal of Adolescent Health · 年份：2025 · DOI：10.1016/j.jadohealth.2025.10.018 · 被引用次数：2 · 研究领域：LGBTQ Health, Identity, and Policy、Diversity and Career in Medicine、Adolescent Sexual and Reproductive Health

PURPOSE: To assess how anti-transgender legislation influences Adolescent Medicine (AM) fellows' training choices, educational experiences, and future clinical practice. METHODS: A national survey was distributed to US AM fellowship programs (October-December 2024). This survey assessed perceived legislative climate, training quality, and moral distress. Open-ended responses were thematically analyzed. RESULTS: Fifty-six fellows from 24 institutions across 15 states responded. Most (79.5%) cited gender-affirming care as important in choosing AM; 62.5% reported that legislation influenced their rank list. Fellows in states with actual or perceived restrictive legislation reported higher rates of suboptimal (76.0%) and harmful (24.0%) care, and anticipated greater practice restrictions (80.0% vs. 45.2%). Qualitative themes included fewer educational opportunities, professional censorship, and ethical conflict related to legal threats and patient harm. DISCUSSION: Anti-transgender legislation significantly impacts the training, wellbeing, and future practice of AM fellows, threatening the clinical pipeline and quality of care for transgender and gender-diverse youth.