Experiences of surgery readiness assessments in British Columbia

Abstract

Background: A surgical readiness assessment is a major step in the medical journey of trans people seeking gender-affirming surgery. Much of the peer-reviewed literature surrounding surgical readiness assessments emphasizes the perspectives of academics and clinicians, leaving the voices of trans and gender diverse patients largely unheard.

Aims: This paper foregrounds patient experiences with surgery readiness assessments to discuss the tensions, challenges and opportunities they generate.

Methods: We conducted a thematic analysis of 35 in-depth interviews with trans people who accessed or were seeking to access gender-affirming surgery in British Columbia.

Results: We developed three main themes to capture participants’ narratives of their surgical assessment experiences. The first, assessments as gatekeeping, explores the stories of people who described their assessments as outdated and even discriminatory processes. The second, assessments as a barrier to care, discusses the informational missteps, bureaucratic regulations, economic issues, and geographic concerns that made assessments difficult to access. The third, assessments as useful, includes positive stories about assessments that often involved feeling supported by an assessor and feeling prepared for the next steps.

Discussion: These narratives demonstrate how much variation exists among people’s experiences of readiness assessments for gender-affirming surgery. No matter how their actual assessment turned out, many participants approached their appointments with a great deal of anxiety and trepidation. We attributed this stress was to challenges ranging from lengthy wait times, arbitrary medical gatekeeping, a lack of access to knowledgeable and supportive providers, unclear or changing administrative processes, and insufficient communication. To address these challenges, it is crucial for the medical system to create more accessible pathways with centralized, up-to-date information for people trying to access assessments. Patients are best served by multi-disciplinary gender-affirming teams that provide individualized care.     

Assessing visual STM in infants and adults: eye movements and pupil dynamics reflect memory maintenance

Though previous work has demonstrated substantial short-term memory (STM) development in the first year of life (e.g., Ross-Sheehy, S., Oakes, L. M., & Luck, S. J. 2003. The development of visual short-term memory capacity in Infants. Child Development, 74(6), 1807–1822. doi:10.1046/j.1467-8624.2003.00639.x), limitations in infant-based procedures make it difficult to assess the continuity of STM mechanisms from infancy though adulthood. The goal of the current work is to present data collected from both infants and adults using a novel STM assessment task. Eye-tracking was used to capture gaze and pupillometry in 5-, 8- and 11-month-old infants and adults (n?=?176). Infant data replicate and extend previous findings demonstrating clear evidence of STM improvement from 5- to 11-months-of-age. Analysis of adult data reveal qualitatively similar patterns of responding, and additionally reveal several behavioural markers of STM accuracy including pupil dilation, saccade count, and switching. These results suggest that change-detection tasks recruit similar memory mechanisms in both infants and adults, and further suggest that visual dynamics may provide important new continuous measures of STM from infancy through adulthood.