Psych CASC / OSCE · Specialty psychiatry — gender and sexuality
Explain gender dysphoria, affirming care and mental health support — CASC communication station
MRCPsych/FRANZCP-style communication station: explain gender dysphoria, affirmative care, parallel MH treatment, hormone liaison, anti-conversion stance, and safety-netting.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the gender and mental health clinic. [2]
Candidate instructions. Explain gender dysphoria in plain language, outline affirmative psychosocial care, discuss parallel treatment of depression/suicide risk, describe specialist hormone pathways with fertility counselling (without unsupervised prescribing), state that conversion efforts are not offered, advise partner support, and check understanding. The examiner plays the patient. [2][3]
Candidate scenario
Your patient meets criteria for gender dysphoria with non-binary goals (possible low-dose masculinising hormones later; no genital surgery planned). They have moderate depression and occasional self-harm urges when misgendered at work. A relative has urged "conversion therapy." They fear psychiatry will try to stop them being non-binary. [1][4][5]
Marking domains
- Empathy, structure, use of they/them pronouns consistently
- Clear distinction: identity vs dysphoria (distress/impairment)
- Affirmative stance without abandoning thoroughness
- Parallel mental health care and safety-net for self-harm/suicidality
- Hormone pathway: specialist-led, monitoring, fertility discussion
- Explicit refusal of conversion practices with brief rationale
- Partner support coaching without pressure
- Teach-back / checks understanding [2][4][6]
Reveal assessor key
Open and agenda-set. Affirm name/pronouns; name time; ask priorities (fear of conversion; work stress; hormones; partner role). [2]
Explain dysphoria. "Gender dysphoria is the clinically significant distress that can come with a mismatch between your gender and the sex you were assigned at birth. Being non-binary is your identity — we are not trying to change that. We assess distress, safety, and what care might help." [1]
Affirmative care. Respect identity; explore goals; support social affirmation where helpful; treat depression and workplace stress; collaborate with gender services. Thorough assessment is supportive, not hostile. [2][3]
Risk and MH. Elevated self-harm/suicidality is recognised in the literature; we make a safety plan and treat mood — this is not a punishment or a barrier invented to block care. [5]
Hormones. If wanted, endocrine/gender specialists discuss options, partial medicalisation for non-binary goals, monitoring, and fertility — I will not start hormones today unsupervised; we will liaison. [6][3]
Conversion. We do not offer therapies aimed at changing your gender identity; evidence associates conversion efforts with harm. [4]
Partner. Support means using correct pronouns, reducing pressure, helping with practical safety — not forcing decisions. [2]
Close. Summarise, teach-back, crisis contacts, follow-up. [2][5]
References
- [1]Zucker KJ, Lawrence AA, Kreukels BP Gender Dysphoria in Adults Annu Rev Clin Psychol, 2016.PMID 26788901
- [2]Coleman E, Radix AE, Bouman WP, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 Int J Transgend Health, 2022.PMID 36238954
- [3]Safer JD, Tangpricha V Care of Transgender Persons N Engl J Med, 2019.PMID 31851801
- [4]Turban JL, Beckwith N, Reisner SL, Keuroghlian AS Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults JAMA Psychiatry, 2020.PMID 31509158
- [5]Marshall E, Claes L, Bouman WP, et al. Non-suicidal self-injury and suicidality in trans people: A systematic review of the literature Int Rev Psychiatry, 2016.PMID 26329283
- [6]Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline Endocr Pract, 2017.PMID 29320642