Inclusive pedagogical practices are critical to preparing nursing and midwifery students to deliver equitable, affirming care for sexual and gender diverse (SGD) populations [1,2]. For the purpose of this review, inclusive pedagogical practices are understood as intentional teaching, learning, assessment, and curriculum design approaches that actively recognize, affirm, and respond to sexual and gender diversity; challenge heteronormativity and cisnormativity; and promote equitable participation and learning outcomes for all students. Sexual and gender diversity is conceptualized as encompassing diverse sexual orientations; gender identities and expressions; and sex characteristics, including but not limited to Two-Spirit, lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and other sexual and gender identities (2SLGBTQIA+). The term 2SLGBTQIA+ is used to reflect a broad and inclusive range of sexual orientations and gender identities. “Two-Spirit” is a Western term used by many Indigenous communities in Canada and the United States to describe Indigenous people of diverse gender identities, expressions and roles, and diverse sexual orientations. Approaches to incorporating sexual and gender diversity within preregistration curricula vary widely, encompassing content inclusion, instructional strategies, learning environments, assessment, and educator development [3,4]. A scoping review is the appropriate methodology to map the breadth and nature of evidence across diverse study designs, educational settings, and sources and to identify key concepts and gaps that may inform systematic reviews or guideline development.

SGD populations continue to experience significant inequities in health and health care access, driven by structural stigma, discrimination, and gaps in health care professional knowledge and confidence. International evidence demonstrates that SGD communities frequently report negative encounters with health professionals, including assumptions grounded in heteronormativity and cisnormativity, lack of understanding of diverse identities, and limited recognition of their specific health needs [1,2,5]. These findings are echoed in studies documenting that lesbian, gay, bisexual, and transgender (LGBT) parents and lesbian‑parented families often encounter heterocentric documentation, heterosexist assumptions, and discriminatory attitudes when accessing health care [6-9]. These experiences contribute to avoidable disparities in mental health, chronic illness management, reproductive health, and access to preventative services. As frontline practitioners, nurses and midwives play a central role in shaping health care experiences. Preregistration education represents a critical formative stage in which students develop foundational knowledge, attitudes, and professional identities. Focusing on this stage enables the examination of how inclusive pedagogical practices are embedded early in professional training. Ensuring that preregistration nursing and midwifery programs adequately prepare graduates to provide affirming, equitable care is therefore a critical educational and public health priority.

Despite the growing recognition of the need for inclusive and affirming education, research indicates considerable variability in how sexual and gender diversity is embedded in health professional training [3,4]. Reviews and empirical work highlight that while many midwives hold positive attitudes toward sexual and gender minority clients, important gaps remain in training, confidence, and preparedness [10,11]. Some institutions integrate discrete content focused on SGD population health, while others adopt broader curricular strategies such as simulation‑based learning, reflective practice, case‑based teaching, or community engagement. However, educator‑reported barriers are common, with limited training, uncertainty, and a lack of institutional support for teaching sexual and gender diversity identified across health care professions, including midwifery [3,12,13]. This variability results in inconsistent learning experiences for students and may limit the development of essential competencies related to communication, cultural humility, and affirming clinical practice. Nursing and midwifery education are considered together because of their shared professional values related to person-centered care, communication, equity, and the preparation of practitioners to deliver inclusive care to diverse populations. However, important differences may exist in curriculum content, educational priorities, and program structures. Midwifery programs in some countries are delivered through direct-entry routes (such as Canada, New Zealand, and the United Kingdom), while others require prior nursing preparation (such as the United States). These contextual differences will be considered during data extraction and interpretation of findings, and profession-specific patterns will be highlighted where possible.

Inclusive pedagogical practices are increasingly promoted to address these gaps. Such practices extend beyond simply adding content; they involve intentional strategies to shape learning environments, design assessments, select teaching approaches, and challenge implicit norms embedded within curricula. Within nursing and midwifery education, inclusive pedagogy may include the integration of diverse case scenarios; explicit attention to clinical communication skills; the use of simulation involving scenarios relevant to SGD populations; structured learning about terminology and concepts; and approaches that encourage students to critically examine bias, norms, and structural determinants of health. Evidence from work on cultural humility in nursing underscores that reflective, relational, and equity‑oriented approaches can support more inclusive and person‑centered care [14,15]. Furthermore, insights drawn from transformative learning and caring science highlight their contribution to shaping students’ attitudes and professional identity, reinforcing the value of pedagogical approaches that promote reflection, inclusivity, and culturally responsive practice [16-18]. Nevertheless, the nature, scope, and effectiveness of these pedagogical practices remain unevenly described in the literature.

Given the breadth of approaches and the emerging nature of this field, scoping existing evidence is essential to guide curriculum development, inform educator training, and support institutions seeking to advance equity-focused educational practices. A scoping review offers a rigorous method for mapping how sexual and gender diversity is currently addressed within nursing and midwifery education, identifying theoretical or conceptual frameworks used, and highlighting gaps where further research or evaluation is needed [19,20]. Clarifying the current state of evidence will also provide a foundation for future systematic reviews and contribute to the development of best‑practice guidance for educators and program leaders.

Several cited studies represent the coauthors’ prior work, which has informed the conceptual development of this review; however, these are presented alongside a broader body of international literature to ensure balanced representation. The decision to focus on the literature published from 2021 onward reflects developments in equity, diversity, and inclusion initiatives within health professions education globally. Increasing recognition of systemic inequities in health care, growing attention to transgender- and gender diverse health needs, and calls from professional organizations for more inclusive curricula have accelerated educational innovation in this area. The review therefore seeks to map contemporary pedagogical approaches that reflect current understandings of inclusive practice rather than historical approaches that may no longer align with present educational and social contexts.

The primary review question is as follows: How are sexual and gender diversity addressed through inclusive pedagogical practices in preregistration nursing and midwifery education?

The secondary review questions are as follows: (1) What types of inclusive pedagogical practices are reported in preregistration nursing and midwifery education to address sexual and gender diversity, and how are these practices characterized and implemented? (2) What theoretical or conceptual frameworks underpin these pedagogical practices? (3) What gaps exist in the literature regarding inclusive pedagogy for sexual and gender diversity in nursing and midwifery education?

This protocol is informed by the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis guidance on scoping reviews and will be reported in accordance with the PRISMA‑ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. The completed PRISMA‑ScR checklist will be submitted with the protocol. This protocol has been registered on the Open Science Framework (OSF; 10.17605/OSF.IO/8GHVD [21]).

We will search the following databases: CINAHL (EBSCOhost), MEDLINE (via Ovid or PubMed), PubMed (for in‑process and publisher‑supplied records in addition to MEDLINE indexing), Scopus, and Web of Science. Searches will be supplemented by reference list screening of included sources. Preliminary searches (Textbox 1) were conducted in November 2025 to inform strategy development; the final search will be conducted in May 2026. Boolean operators (AND and OR) were used to combine search terms, with truncation (*) applied to capture variations. Quotation marks were used to identify exact phrases (eg, “gender diversity”).

The search strategy was developed iteratively around three concept blocks: (1) sexual and gender diversity, (2) nursing or midwifery students, and (3) equitable education or pedagogy.

All search results will be exported to Covidence (Veritas Health Innovation) systematic review software and deduplicated. Two reviewers will independently screen titles and abstracts against the inclusion criteria, followed by full-text screening. During independent screening, disagreements between the two reviewers will be resolved through discussion and consensus. If consensus cannot be reached, a third reviewer (senior researcher) will make the final decision. The number of conflicts and the methods used to resolve them will be recorded for reporting. Reasons for exclusion at the full-text stage will be recorded. The study selection process will be reported using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram [22], detailing the number of records identified, duplicates removed, records screened, full-text articles assessed, and studies excluded to enhance transparency and reproducibility.

The search strategy was developed in accordance with JBI guidance for scoping reviews. Reporting of the completed review will follow the PRISMA-ScR checklist to enhance transparency and completeness of reporting.

Data synthesis will follow the PAGER framework, which was developed specifically to strengthen transparency and methodological rigor in scoping review reporting [23]. The framework provides a structured approach for organizing and interpreting evidence beyond descriptive mapping.

Following data extraction, findings will undergo analysis. Extracted data relating to pedagogical approaches, implementation characteristics, theoretical frameworks, outcomes, contextual factors, and equity considerations will be coded and grouped into themes. Themes will subsequently be organized according to the five PAGER domains: (1) patterns: recurring pedagogical approaches and implementation strategies; (2) advances: innovative or emerging educational practices; (3) gaps: areas where evidence remains limited or absent; (4) evidence for practice: implications for curriculum development, educator preparation, and educational policy; and (5) research recommendations: priorities for future research and evaluation.

Themes will be examined across nursing and midwifery contexts, geographic regions, educational settings, and SGD populations where sufficient evidence exists.

No ethics approval was required because the review used data from published studies and their findings. No primary research involving individual-level data from human participants was conducted. Dissemination will include publication in a peer-reviewed journal, presentations at conferences, and sharing findings with stakeholders with an interest in this area of research.

This scoping review is expected to identify a diverse range of inclusive pedagogical practices used to address sexual and gender diversity in preregistration nursing and midwifery education. These are likely to include curriculum-based approaches, simulation-based learning, case-based teaching, reflective exercises, and short-form educational interventions (eg, lectures or workshops), delivered across both in-person and online environments.

The review is anticipated to reveal substantial variation in how sexual and gender diversity content is conceptualized and implemented, including differences in the populations represented (eg, emphasis on sexual minority groups compared to gender diverse populations) and the extent to which intersectionality is addressed.

It is expected that many interventions will be underpinned by broad concepts such as cultural competence or cultural humility [16], while fewer studies may explicitly report the use of established pedagogical or theoretical frameworks specific to inclusive or equity-oriented education [24].

In terms of evaluation, the review is likely to identify that outcomes are most commonly focused on short-term measures such as knowledge, attitudes, confidence, and self-reported competence, with limited evidence relating to longer-term impacts on clinical practice or patient outcomes.

The findings are also expected to highlight methodological variability across studies, including differences in study design, sample size, and reporting quality, which may limit comparability. Consistent with the nature of scoping reviews, gaps in evidence are anticipated, particularly in relation to (1) rigorously evaluated educational interventions, (2) inclusion of diverse gender identities (eg, nonbinary and gender diverse populations), (3) representation of midwifery-specific educational contexts, and (4) research conducted outside high-income country settings.

Using the PAGER framework, the review is expected to identify clear patterns in commonly used teaching approaches, advances in innovative or emerging pedagogical practices, gaps in the existing evidence base, implications for educational practice, and priorities for future research.

This scoping review will use established methodological guidance from the JBI Manual for Evidence Synthesis and will be reported in accordance with the PRISMA-ScR checklist, ensuring transparency and reproducibility. A comprehensive search strategy across multiple bibliographic databases will support the identification of a broad range of evidence relating to inclusive pedagogical practices in preregistration nursing and midwifery education. The use of duplicate screening and data charting will enhance methodological rigor and reduce selection bias. In addition, the application of the PAGER framework will enable structured synthesis of patterns, advances, gaps, and implications for practice and future research. The findings of this review will be relevant to nursing and midwifery educators, curriculum developers, academic leaders, regulators, and policymakers involved in preregistration education. By mapping current pedagogical approaches and identifying gaps, the review will support evidence-informed curriculum design and educator development aimed at improving care for SGD populations.

However, several limitations should be acknowledged. The review team has expertise in nursing and midwifery education and equity-oriented research. Reflexive discussions will be undertaken throughout the review process to minimize bias and to ensure that interpretations remain grounded in evidence. Restricting inclusion to English-language publications may result in the exclusion of relevant international evidence and introduce language bias. As a scoping review, this study will not undertake formal critical appraisal of included sources, and therefore the quality of evidence will not be assessed. Heterogeneity in educational contexts, pedagogical approaches, and outcome measures may limit the comparability of findings and preclude conclusions regarding effectiveness. Finally, the focus on published literature may overlook informal or locally implemented educational practices that are not formally documented.