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A new study shows that doctors may have a bias against trans folks even if they are educated on trans issues.

According to this new research from Michigan Medicine, there is disturbingly no correlation between more hours of education and improved transgender care.

“We were surprised to find that more hours of education about transgender health didn’t correlate with a higher level of knowledge about this topic among providers,” the study claimed. “Transgender and gender-diverse individuals often face discrimination in healthcare settings and many are unable to find competent, knowledgeable, and culturally appropriate health care. Lack of provider knowledge is a significant barrier, but our findings suggest that simply increasing training may not be the solution.”

While the doctors surveyed was mostly a random sampling, the study screened for transphobia, meaning that the doctors interviewed did not have an inherent bias against trans folks, but still do not do a good job of providing patient care.

The survey acknowledges that many trans people report not being treated well at the doctors and recommends patient intake forms with neutral pronoun language and other tools that can make people feel more at home. Still, it is evident that compassion and understanding is needed even more so than formal education.