Sexual Health in Undergraduate Medical Education: Existing and Future Needs and Platforms

The Vulvodynia Primary Care Toolkit: results of a mixed-method evaluation with community-based family physicians in British Columbia

BACKGROUND

Healthcare providers often lack awareness, knowledge, and confidence in managing vulvodynia, which can lead to difficulties with diagnosis and treatment for individuals with the condition.

OBJECTIVE

To develop and test an educational online toolkit tailored to supporting community-based primary care providers with diagnosis, treatment, and patient support for vulvodynia.

METHODS

A sample of 19 community-based family physicians completed online surveys before and after testing the Vulvodynia Primary Care Toolkit (the toolkit hereafter) in their practice for 6 months. Nine physicians also completed a semi-structured interview to describe their experiences using the toolkit.

RESULTS

The toolkit was adopted into clinical care, being used an average of 4.1 times per physician (SD = 2.7) during the test period. The toolkit demonstrated high acceptability, as evidenced by a high level of reported satisfaction with the toolkit and the amount of information it contained. The toolkit increased self-reported knowledge and confidence in diagnosing (P = .003), treating (P < .001), and supporting (P < .001) patients with vulvodynia. Through reflexive thematic analysis, we generated five themes from interview data that represented physicians' experiences: (i) There are facilitators and barriers to toolkit use in practice, (ii) the toolkit is valued by family physicians, (iii) the toolkit is educational, (iv) the toolkit is empowering, and (v) the toolkit improves vulvodynia management and referrals.

CONCLUSION

An online educational toolkit tailored to community-based primary care settings supports the management of patients with vulvodynia by family physicians. Our findings lay the foundation for the upscaling of this tool.

What are future doctors learning about sex? An assessment of sexual health curricula across medical schools in the Northeastern United States

BACKGROUND

Sexual health is an imperative area of study in medical school education, yet many medical schools do not offer a comprehensive curriculum nor is it standardized across the United States (US).

AIM

This study aims to assess written curriculum materials from sexual health curricula in medical schools across the northeast region of the US and compare the current teachings to suggested standards.

METHODS

A compilation of academic resources including lecture materials and syllabi were systematically reviewed utilizing a standardized and validated rubric with variables assessed including: biological and psychological aspects of human sexual development, anatomy and physiology of the human sexual response cycle, sexual health in relation to human reproduction, and contraceptive options. We analyzed our data from the document analysis to look at the frequency of inclusion and exclusion of the sexual health topics included in our rubric.

OUTCOMES

The outcomes of our data set were in line with our hypothesis that there is significant variance between sexual health curricula across institutions as well as an overall lack in material covering sexual health topics.

RESULTS

The data show significant sex specific differences such that male-specific topics were covered more frequently than female-specific information. Additionally, only one of the 10 schools examined taught about vulvar conditions. There was also a paucity of information about sexuality in the post-partum period.

CLINICAL IMPLICATIONS

The clinical implications of this study aim to highlight the discrepancy between an ideal sexual health curriculum and what is actually being taught in medical schools and help to guide future work of creating a comprehensive and standardized sexual medicine education in US. medical schools.

STRENGTHS AND LIMITATIONS

The validity of this study was strengthened by analyzing direct curricula materials as opposed to previous use of subjective, self-reported questionnaires. However, the sample location being restricted to the Northeast was a limitation to generalize findings across the country. Future studies would aim to analyze medical school curricula across different regions in the US.

CONCLUSION

This study shows that there is a lack of comprehensive and standardized sexual health curriculum in medical schools in the Northeastern US and serves as initial evidence for further investigation of this topic across American medical schools.

A model curriculum in sexual medicine for undergraduate education in Europe

Sexual health has been recognized as an essential component of the overall health and wellbeing. The current article aims, first, to review the current state of sexual health education in undergraduate medical curricula, identifying gaps, needs and challenges. The main part of this paper describes the development and content of an undergraduate sexual medicine curriculum based on a clear concept of the competencies students should learn regarding knowledge, skills and attitudes. The content is based on a biopsychosocial understanding of human sexuality elaborated by international experts from different European countries integrating basic knowledge in biology, psychology, sociocultural and political sciences, preventive medicine, and the various therapeutic approaches to help women, men and couples with sexual health problems on a primary care level. In order to enable students to learn the basic skills of sexual history taking and sexual basic counselling two educational videos were produced. The material presented is part of the European Collaboration in Science and Technology (COST) supported project European Sexual Medicine Network (ESMN). The material provided can serve universities to give the training as a 25-30 hours course equivalent to 1 ECTS.

Improving sexual health through medical education

This editorial comments on the article by Burton et al. in this issue.

Teaching of sexual medicine and gender issues in medical courses: students' perception

INTRODUCTION

In addition to reproductive purposes, human sexuality and sexual health are matters of great importance in the medical office. Despite this, there is still a deficiency in the training of Brazilian medical students regarding sexual medicine and gender issues.

OBJECTIVE

The objective of this study was to analyze the perception of fifth- and sixth-year students in relation to the teaching of sexual medicine and gender issues in medical courses.

METHODS

This is a descriptive and cross-sectional study with students from the last 2 years of medical schools in the State of Santa Catarina (internship classes), through the application of a self-administered, semi-structured online questionnaire.

RESULTS

A total of 164 students answered the questionnaire, with 83.5% (137/164) saying they had taken classes on sexual medicine and 47% (77/164) saying they had taken classes on gender issues. The participants judged the teaching inadequate in most of the topics addressed, and there was no significant difference between students from public and private schools. Notably, 79.9% (131/164) of the students considered the teaching of sexual medicine insufficient or inadequate, while 87.8% (144/164) considered the teaching of gender issues insufficient or inadequate.

CONCLUSION

The vast majority of students consider the teaching of sexual medicine and gender issues insufficient and inadequate.

Sexual dysfunction: a study on learning experience of Australian medical students

BACKGROUND

Research has shown that clinicians are not comfortable managing sexual dysfunction (SD), and there are gaps in the SD-specific training of medical students in the US and the UK. However, there is little research into the extent of SD-specific training needs and learning experiences of Australian medical students. This study aims to explore the extent of students' learning experiences and training gaps in the postgraduate medical curriculum at one Australian university.

METHODS

The study was completed as part of the Doctor of Medicine program requirement, and due ethics approval was obtained. An anonymous 10-item online questionnaire, including one open-ended question was created and distributed to all final-year medical students at the University of Sydney. Data were analysed using descriptive and analytical statistical measures, and a thematic analysis was used for the open-ended question.

RESULTS

There are 252 final-year medical students at the University of Sydney, of which 31 students completed the questionnaire, giving a 12% response rate. Of the 31 respondents, the majority of students reported that they never (n =7; 23%) or rarely (n =16; 52%) had opportunities to interact with patients presenting with SD throughout their training. Erectile dysfunction was the topic that all students had some training, whereas female orgasmic disorder was the topic that students had the least training. Of all the students who reported receiving training in the medication/substance-induced SD (n =26), one in two (n =14, 54%) reported feeling unprepared. Only 55% of students (n =17) felt comfortable to initiate discussions around SD with patients, whereas 84% of students (n =26) felt comfortable to discuss SD when the patient initiated the conversation. Students expressed a need for training on how to address these sensitive topics with patients, with more emphasis on the management of SD.

CONCLUSION

The data suggests that the current medical curriculum at the University of Sydney does offer some training in SD, but it is not adequate enough to confidently and comfortably manage SD. Considerations should be made to the curriculum to facilitate a broader recognition and understanding of SD and to prepare future clinicians to adequately address and manage SD.

Gaps in sexual health content of healthcare professional curriculum: a systematic review of educational interventions

BACKGROUND

Sexual health care, including assessment and patient teaching, is part of comprehensive patient care. Health professional (medical and nursing) students' education in sexual health lacks uniformity in content and assessment skills.

OBJECTIVES

The current systematic review aimed to assess sexual health educational curriculum for health professional students regarding the educational content, duration, and evaluation of these educational interventions.

METHODS

This systematic review followed the preferred reporting guidelines for systematic reviews. A comprehensive search was conducted between May-August, 2023 across four databases (PubMed, Scopus, CINAHL, EMBASE), outlining 614 sources. Following the screening process, 36 educational intervention studies were deemed eligible for inclusion. The quality assessment of these studies was conducted using The Effective Public Health Project tool, which was found appropriate for evaluating this type of research.

RESULTS

The studies had a global representation, with most studies conducted in the US. Limited nursing educational interventions were found. Three main categories emerged from the analysis of the educational interventions: one-time interventions, workshops, and semester courses. These categories differed in terms of their duration. Upon evaluating the educational intervention programs, it was found that the majority relied on participant self-reporting, while only a few included objective evaluations.

CONCLUSIONS

This review revealed inconsistencies in educational content for healthcare professional students and may impact their clinical skills, particularly in sexual health. The variation in content, duration, and evaluation methods created challenges in assessing the interventions. The lack of standardized sexual health education highlighted a significant gap, raising concerns about students' ultimate proficiency in this area. Bridging this divide is essential by integrating comprehensive sexual health content and assessment skills into the health professional curriculum.

Female sexual medicine: an assessment of medical school curricula in a major United States city

Background

Although approximately 41% of women experience sexual dysfunction, limited education on female sexual medicine (FSM) in medical school results in underpreparedness among physicians when addressing these bothersome conditions.

Aim

This study aims to evaluate the extent to which FSM is represented in medical education by examining current preclinical and clinical curricula.

Methods

Preclinical curriculum materials on female sexual anatomy, physiology, and pathology, as well as obstetrics and gynecology clinical materials (syllabi, lecture materials, and supplemental resources), were collected from medical schools in the Chicago area. We utilized previous literature to identify specific components of medical school content to evaluate.

Outcomes

Upon reviewing each institution's curricula, we evaluated materials for topic saturation and assessed goals of each syllabus in terms of required content.

Results

Curriculum materials were collected from 7 medical schools. In the preclinical assessment, 1 institution identified all anatomic components of the clitoris in our review, 4 discussed the physiology of the female orgasm, 3 highlighted the prevalence and epidemiology of female sexual dysfunction (FSD), 3 addressed treatments for FSD, and 1 instructed a genitourinary physical exam specific to assessing FSD. When assessing obstetrics and gynecology clinical materials, 5 institutions included topics related to FSM. Of these, only 1 institution had corresponding required synchronous clerkship time dedicated to these topics as a 1-hour lecture, in addition to an optional online training to third-year clinical students in comprehensive sexual history-taking practices, including screening for FSD. One other institution offered supplemental case-based gynecology modules including vulvovaginal diseases and chronic pelvic pain, though sexual pleasure, arousal, and libido were not included.

Clinical Implications

The results of this study highlight the need for the inclusion of standardized curricula related to FSM in medical education to equip future physicians to treat patients with sexual dysfunction.

Strengths and Limitations

The strengths of this study include that it is the first of its kind to complete a comprehensive review of FSM curricula at a cohort of undergraduate medical institutions. Its limitations include a small sample size of 7 medical schools limited to 1 geographical area.

Conclusion

Our focused needs assessment of medical schools in the Chicago area reveals inconsistencies in outlined institution-specific course goals related to FSM and thus highlights the need for restructuring the curricula to prepare future physicians to recognize and treat patients with sexual dysfunction.

Comparison Between the Effect of the Information-Motivation-Behavioral (IMB) Model and Psychoeducational Counseling on Sexual Satisfaction and Contraception Method Used Under the Coercion of the Spouse in Iranian Women: A Randomized, Clinical Trial

OBJECTIVE

 Women play an essential role in maintaining the family's health, and family planning is part of women's and families' health. The couple's mutual understanding of family planning methods is essential in selecting contraception. Acceptance of and satisfaction with different contraception methods can impact sexual satisfaction. The present study aimed to compare the effect of the information-motivation-behavioral (IMB) model and psychoeducational counseling on sexual satisfaction and contraception methods of women referring to health centers in Kerman.

METHODS

 This trial was conducted on 81 women aged 18 to 45, in Kerman health centers, from 2021 to 2022. Participants were randomly divided into 3 groups of 27 people (control, psychoeducational counseling, and IMB method). Three online counseling sessions were held for the psychoeducational group, and four were held for the IMB group. The control group received routine care. The IBM SPSS Statistics for Windows, version 22 (IBM Corp. Armonk, NY, USA) was used for data analysis using nonparametric Friedman and Kruskal-Wallis tests.

RESULTS

 The mean age of participants was 32.59 ± 7.04, and the majority of them had university degrees and were homemakers. The mean sexual satisfaction score significantly increased immediately after the intervention and 1 month later in the 2 interventional groups (p < 0.0). Changes in contraception methods after intervention were significant in the psychoeducational group (p = 0.0) CONCLUSION:  The results indicate the positive impact of psychological counseling on women's sexual satisfaction and contraception method. The IMB method also impacted men's sexual satisfaction but did not lead to any changes in the contraceptive method.

Effect of Participative Web-Based Educational Modules on HIV and Sexually Transmitted Infection Prevention Competency Among Medical Students: Single-Arm Interventional Study

BACKGROUND

The number of new HIV diagnoses in the United States continues to slowly decline; yet, transgender women and men who have sex with men remain disproportionately affected. Key to improving the quality of prevention services are providers who are comfortable broaching the subjects of sexual health and HIV prevention with people across the spectrum of gender identities and sexual orientations. Preservice training is a critical point to establish HIV prevention and sexual health education practices before providers' practice habits are established.

OBJECTIVE

The study aimed to develop participative web-based educational modules and test their impact on HIV prevention knowledge and awareness in future providers.

METHODS

Sexual health providers at an academic hospital, research clinicians, community engagement professionals, and New York City community members were consulted to develop 7 web-based educational modules, which were then piloted among medical students. We assessed knowledge of HIV and sexually transmitted infection prevention and comfort assessing the prevention needs of various patients via web-based questionnaires administered before and after our educational intervention. We conducted exploratory factor analysis of the items in the questionnaire.

RESULTS

Pre- and postmodule surveys were completed by 125 students and 89 students, respectively, from all 4 years of training. Before the intervention, the majority of students had heard of HIV pre-exposure prophylaxis (122/123, 99.2%) and postexposure prophylaxis (114/123, 92.7%). Before the training, 30.9% (38/123) of the students agreed that they could confidently identify a patient who is a candidate for pre-exposure prophylaxis or postexposure prophylaxis; this increased to 91% (81/89) after the intervention.

CONCLUSIONS

Our findings highlight a need for increased HIV and sexually transmitted infection prevention training in medical school curricula to enable future providers to identify and care for diverse at-risk populations. Participative web-based modules offer an effective way to teach these concepts.

Let's talk about sexuality - A web-based survey of self-reported competence in sexual problems among obstetrician-gynecologists in Finland

INTRODUCTION

Sexual health is an important aspect of quality of life, yet both healthcare professionals and patients might hesitate to bring up the topic during appointments. Our study investigated obstetrician-gynecologists' (OB/GYNs') self-reported competences in discussing and treating sexual problems, as well as the barriers to bringing up the subject. An additional aim was to evaluate the need for continuing education in sexual medicine.

MATERIAL AND METHODS

A web-based questionnaire was sent to the members of The Finnish Society of Obstetrics and Gynecology (n = 1212). The survey was completed by 328 respondents (275 specialists and 53 OB/GYN residents). Their background information (gender, age, education, occupational status, daily number of patients, and daily number of patients with sexual health issues) was assessed. The questionnaire included four fields: (A) self-reported competence in discussing and treating patients with sexual problems (three questions), (B) the barriers to bringing up sexual problems with patients (nine questions), (C) the source of education in sexual medicine (two questions), and (D) the need for education in sexual medicine (two questions).

RESULTS

Most of the OB/GYNs self-reported their competence to be good in discussing sexual problems, but poor in treating patients' sexual problems. The male OB/GYNs reported better competence than did the females. Several barriers were identified-most frequently, "shortness of the appointment time" (76%), "lack of knowledge about sexual medicine" (75%), and "lack of experience with sexual medicine" (74%). Older OB/GYNs and male OB/GYNs reported fewer barriers. The majority of the respondents considered their previous education in sexual medicine to be insufficient, especially in medical school (95%), but also in residency (83%), and they reported a need for additional education.

CONCLUSIONS

Our study indicated several barriers that hindered OB/GYNs from assessing sexual problems during appointments. Although OB/GYNs reported a good competence in discussing sexual problems, they reported a poor competence in treating them. Their previous education in sexual medicine was rated as insufficient, and continuing education was desired. The information provided by our study can be used for improving and organizing education in sexual medicine, which is crucial for diminishing the barriers to discussing and treating sexual problems.

"It's completely erasure": A Qualitative Exploration of Experiences of Transgender, Nonbinary, Gender Nonconforming, and Questioning Students in Biology Courses

Biology is the study of the diversity of life, which includes diversity in sex, gender, and sexual, romantic, and related orientations. However, a small body of literature suggests that undergraduate biology courses focus on only a narrow representation of this diversity (binary sexes, heterosexual orientations, etc.). In this study, we interviewed students with queer genders to understand the messages about sex, gender, and orientation they encountered in biology and the impact of these messages on them. We found five overarching themes in these interviews. Students described two narratives about sex, gender, and orientation in their biology classes that made biology implicitly exclusionary. These narratives harmed students by impacting their sense of belonging, career preparation, and interest in biology content. However, students employed a range of resilience strategies to resist these harms. Finally, students described the currently unrealized potential for biology and biology courses to validate queer identities by representing the diversity in sex and orientation in biology. We provide teaching suggestions derived from student interviews for making biology more queer-inclusive.

Positive patient-provider relationships among transgender and nonbinary individuals in New York City

Background: Transgender and nonbinary (TGNB) individuals have diverse health needs and may face disproportionate barriers to healthcare, including developing positive patient-provider relationships. While there is mounting evidence of gender-based stigma and discrimination in healthcare, little is known about how TGNB individuals develop positive patient-provider relationships. Aims: To examine TGNB individuals' interactions with healthcare providers and identify main characteristics of positive patient-providers relationships. Methods: We conducted semi-structured interviews with a purposive sample of 13 TGNB individuals in New York, NY. Interviews were transcribed verbatim and analyzed inductively for themes related to characteristics of positive and trusting relationships with healthcare providers. Results: Participants' mean age was 30 years (IQR = 13 years) and most participants were nonwhite (n = 12, 92%). Receiving peer referrals to specific clinics or providers helped many participants find providers perceived to be competent and created initial grounds for positive patient-provider relationships. Providers with whom participants had positive relationships commonly managed primary care and gender-affirming care and relied on a network of interdisciplinary providers for other specialized care. Providers who were positively evaluated were perceived to possess in-depth clinical knowledge on the issues they were responsible for managing, including gender-affirming interventions, particularly for TGNB patients who perceived themselves to be knowledgeable about TGNB-specific care. Provider and staff cultural competence and a TGNB-affirming clinic environment were also important, particularly early in the patient-provider relationship, and if combined with TGNB clinical competence. Discussion: Provider-focused training and education programs should combine components of TGNB clinical and cultural competence to facilitate development of positive relationships between TGNB patients and providers, thereby improving the health and wellbeing of TGNB people.

"We Are Not Truly Friendly Faces": Primary Health Care Doctors' Reflections on Sexual History Taking in North West Province

INTRODUCTION

Doctors experience barriers in consultations that compromise engaging with patients on sensitive topics and impede history taking for sexual dysfunction.

AIM

The aim of the study was to identify barriers to and facilitators of sexual history taking that primary care doctors experience during consultations involving patients with chronic illnesses.

METHODS

This qualitative study formed part of a grounded theory study and represents individual interviews with 20 primary care doctors working in the rural North West Province, South Africa. The doctors were interviewed on the barriers and facilitators of sexual history taking they experienced during 151 recorded consultations with patients at risk of sexual dysfunction. Interviews were transcribed and line-by-line verbatim coding was done. A thematic analysis was performed using MaxQDA 2018 software for qualitative research. The study complied with COREQ requirements.

OUTCOME

Doctors' reflections on sexual history taking.

RESULTS

Three themes identifying barriers to sexual history taking emerged, namely personal and health system limitations, presuppositions and assumptions, and socio-cultural barriers. The fourth theme that emerged was the patient-doctor relationship as a facilitator of sexual history taking. Doctors experienced personal limitations such as a lack of training and not thinking about taking a history for sexual dysfunction. Consultations were compromised by too many competing priorities and socio-cultural differences between doctors and patients. The doctors believed that the patients had to take the responsibility to initiate the discussion on sexual challenges. Competencies mentioned that could improve the patient-doctor relationship to promote sexual history taking, include rapport building and cultural sensitivity.

CLINICAL IMPLICATIONS

Doctors do not provide holistic patient care at primary health care settings if they do not screen for sexual dysfunction.

STRENGTH AND LIMITATIONS

The strength in this study is that recall bias was limited as interviews took place in a real-world setting, which was the context of clinical care. As this is a qualitative study, results will apply to primary care in rural settings in South Africa.

CONCLUSION

Doctors need a socio-cognitive paradigm shift in terms of knowledge and awareness of sexual dysfunction in patients with chronic illness. Pretorius D, Mlambo MG, Couper ID. "We Are Not Truly Friendly Faces": Primary Health Care Doctors' Reflections on Sexual History Taking in North West Province. Sex Med 2022;10:100565.

Characteristics of Female Sexual Health Programs and Providers in the United States

Background

Female sexual dysfunction is a prevalent condition affecting 12% of women, yet few academic centers in the US have female sexual medicine programs.

Aim

To characterize female sexual health programs in the United States, services offered, and training of female sexual health providers.

Methods

We performed an internet search to identify female sexual health programs and clinics in the US. From each programs’ website we abstracted the location, clinic setting (academic vs private), training of providers, and whether the clinic provided investigational services (ie, PRP injections, laser/radiofrequency therapy). We categorized clinics as specialized in sexual medicine, specialized with a focus on cancer patients, general, aesthetics-focused, general & aesthetic, or specialized & aesthetic. We used Chi-square and Fisher's exact test to evaluate association between practice setting and provision of investigational therapies with a Bonferroni-adjusted critical P-value of 0.017.

Outcomes

Our outcomes were the number of clinics in each setting, in each category, and each state, as well as the number of providers by training type.

Results

We identified 235 female sexual medicine programs in the United States. Seventeen percent were in the academic setting. Clinics in the non-academic setting were significantly (α = 0.017) more likely to offer PRP injections (0% vs 47%, P < .001), laser/radiofrequency therapy (14% vs 56%, P < .0001), and shockwave therapy (0% vs 14%, P = .011). Among all clinics, 22% provided specialized care, 2% provided care for cancer patients, 29% were more general clinics that advertised female sexual healthcare, 23% were aesthetics-focused, 22% were general practices that provided aesthetics services, and 2% were specialized clinics that offered aesthetics services. 81% of aesthetics-focused clinics advertised PRP injections. Seven states had no clinics and 26 states lacked a clinic specializing in female sexual health. The most frequent providers were OB/Gyns (40%), nurse practitioners (22%), urologists (13%), and physicians assistants (10%).

Clinical Implications

The geographic distribution of clinics and pervasiveness of clinics offering investigational services for female sexual dysfunction may be a barrier for patients seeking care.

Limitations

As a result of our internet search methodology, we likely did not capture all clinics providing female sexual health services. Further, the accuracy of our data depends on the level of detail provided on each clinics’ website.

Conclusion

Online search identified few clinics providing female sexual healthcare in academic medicine: development of such clinics could benefit patients by improving access to evidence-based care and promoting training of future providers.

Elizabeth E. Stanley and Rachel J. Pope, Characteristics of Female Sexual Health Programs and Providers in the United States. Sex Med 2022;10:100524.

The Ethics of Medical Sexual Health Education and Its Provision

Purpose of Review

The purpose of this paper is to open a discussion of the ethics of medical sexual health education (SHE) and its provision in medical education. The paper utilizes a qualitative analysis of currently available literature on medical SHE and a medical ethics framework of the four prima facie principles of (1) respect for autonomy, (2) beneficence, (3) non-maleficence, and (4) justice, together with expert opinion. The result is a review of the ethics of medical SHE as well as the ethics of the decision to provide, or not to provide, comprehensive SHE.

Recent Findings

Recent literature has underscored the many ways in which comprehensive medical SHE supports trainees’ ability to provide sexual health care and improve their delivery of general health care, as well as the many ways sexual health is correlated with systemic health. The literature also provides evidence that the provision of comprehensive SHE is limited in undergraduate and graduate medical education. There is a dearth of literature specifically examining the ethics of medical SHE provision.

Summary

This analysis demonstrates the ways in which comprehensive medical SHE and its provision conforms with the principles of the ethical practice of medicine. The analysis also supports that a lack of inclusion of SHE in medical education programs may be a violation of these principles and increases the risk of future unethical practice by medical professionals.

MESH Headings: Ethics, Medical, Social justice, Sexual health, Sexuality, Human, Education, Medical, Undergraduate, Education, Medical, Graduate

Assumptions about patients seeking PrEP: Exploring the effects of patient and sexual partner race and gender identity and the moderating role of implicit racism

Introduction

Daily pre-exposure prophylaxis (PrEP) for HIV-prevention is an essential component of national plans to end the HIV epidemic. Despite its well-documented safety and effectiveness, PrEP prescription has not met the public health need. Significant disparities between White and Black people exist with respect to PrEP prescription, as do disparities between men and women. One factor contributing to these disparities is clinicians’ assumptions about patients seeking PrEP.

Methods

The present study sought to investigate medical students’ assumptions about patients seeking PrEP (anticipated increased condomless sex, extra-relational sex, and adherence to PrEP), and assumed HIV risk when presenting with their sexual partner. We systematically varied the race (Black or White) and gender (man or woman) of a fictional patient and their sexual partner. All were in serodifferent relationships including men who have sex with men (MSM), women (MSW), and women who have sex with men (WSM). Participants also completed an implicit association test measuring implicit racism against Black people. We evaluated the moderation effects of patient and partner race on assumptions as well as the moderated moderation effects of implicit racism.

Results

A total of 1,472 students participated. For MSM patients, having a Black partner was associated with higher assumed patient non-adherence to PrEP compared to a White partner, however a White partner was associated with higher assumed HIV risk. For MSW patients, a White male patient was viewed as being more likely to engage in more extra-relational sex compared to a Black male patient. For WSM patients, White women were assumed to be more likely to have condomless and extra-relational sex, be nonadherent to PrEP, and were at higher HIV risk. Overall, implicit racism was not related to negative assumptions about Black patients as compared to White patients based on patient/partner race.

Discussion

Medical education about PrEP for HIV prevention must ensure future health professionals understand the full range of patients who are at risk for HIV, as well as how implicit racial biases may affect assumptions about patients in serodifferent couples seeking PrEP for HIV prevention. As gatekeepers for PrEP prescription, clinicians’ assumptions about patients seeking PrEP represent a barrier to access. Consistent with prior research, we identified minimal effects of race and implicit racism in an experimental setting.

Attitudes Toward Transgender Persons Among Medical Students of a Tertiary Health-Care Center: A Cross-Sectional Exploratory Study

Background:

Inadequate knowledge and awareness about transgenderism among doctors can lead to inadequate health-care services to transgender persons.

Objective:

To assess the prevalent attitudes and beliefs toward transgender persons amongst medical undergraduates.

Materials and Methods:

The present cross-sectional observational study included medical undergraduates of both gender in a tertiary care hospital. The students belonged to “early clinical phase” (yet to start clinical postings). The sociodemographic characteristics and academic and social exposure to transgender-related issues were recorded using a semi-structured proforma. Transgender Attitudes and Beliefs Scale was used to assess the attitudes and beliefs toward transgender persons. Statistical significance was set at P < .05.

Results:

Of the 170 second-year medical students, majority reported negligible social exposure (71.3%) and academic exposure (81.6%) to transgenderism. Female students displayed better attitudes and beliefs toward transgender persons than their male counterparts.

Conclusions:

Medical undergraduates require systematic academic exposure to transgender-related health issues. Gender differences exist among medical undergraduates in the beliefs and attitudes toward transgenderism.

Affirming and Inclusive Care Training for Medical Students and Residents to Reducing Health Disparities Experienced by Sexual and Gender Minorities: A Systematic Review

Purpose

Providing inclusive and comprehensive gender-affirming care is critical to reducing health disparities (gaps in care) experienced by sexual and gender minorities (SGM). Currently, little is known about how medical students and residents are being trained to address the health needs of SGM persons or of the most effective methods.

Methods

We conducted a systematic review of the research literature from 2000 to 2020 on the effectiveness of teaching medical students and residents on knowledge, attitudes, and skills in addressing the health of SGM persons and the strength of the research sample, design, and methods used.

Results

We identified a total of 36 articles that assessed the impact of medical student and resident education on knowledge, comfort, attitudes, confidence, and skills in working with SGM patients. All studies utilized quasi-experimental designs, and found efficacious results. No study examined the impact of training on patient outcomes.

Conclusion

Future studies will need to be powered and designed to assess the impact of training on patient outcomes.

General practitioners' self-reported competence in the management of sexual health issues - a web-based questionnaire study from Finland

Objective Although sexual problems are common, they are rarely brought up in appointments with general practitioners (GPs). We aimed to assess the barriers that hinder GPs from bringing up sexual health issues and to evaluate the need for education on sexual medicine. Design A web-based questionnaire was used. Setting Four fields were included: A) the self-reported competence in discussing sexual health and treating patients with these issues, B) the barriers to bringing up patients' sexual health problems, C) the source of education on sexual medicine and D) the need for education on sexual medicine. Subjects A random sample of 1000 GPs in Finland (a response rate of 43.5%, n = 402). Main outcome measures GPs' self-assessed competence in discussing and treating sexual health issues, related barriers to bringing up the topic and the reported need for education. Results The main reasons reported for not bringing up sexual health issues were shortness of the appointment time (85.6%), a lack of knowledge (83.6%) and a lack of experience with sexual medicine (81.8%). The male GPs reported better competence in discussing the issues and treating male patients, whereas the female GPs reported better competence in discussing the issues with female patients. No differences emerged between genders regarding treating female patients. Nearly 90% of the GPs expressed needing more education about sexual medicine. Conclusions Although the GPs reported good competence in discussing sexual health issues with their patients, several barriers to bringing up sexual health issues emerged. Continuing education was desired and could lessen these barriers.Key pointsOnly a few studies have evaluated the competence of general practitioners (GPs) in addressing sexual health issues with their patients.In our study, the GPs reported a high competence in discussing patients' sexual health issues regardless of the patient's gender.However, several barriers to bringing up sexual health issues in appointments emerged.A majority of the GPs expressed a need for continuing education about sexual medicine.

Comprehensive History of the International Society for Sexual Medicine-Journals and Communication

INTRODUCTION

This is a comprehensive history of the International Society for Sexual Medicine (ISSM) and its founding organizations regarding the publications, including the journals and the publication committee, and the communication tools of the organization since its inception.

OBJECTIVES

The object of this review is to provide a detailed and comprehensive history of the publication and communication tools of the ISSM and the people who have participated in production of these efforts.

METHODS

Recorded Publication Committee minutes, filed letters, the various journals themselves, printed News bulletins, and Publishers reports to the society served as source documents to produce this history. The author has participated in many of the journal establishments and has kept an extensive personnel file of the events related in this history. All written history has not only relied on personal memories of these events but have been verified from the stored personal files. Printed and website stored journal and News bulletin have served as source material for this history. Also, Power Point presentations by the editors of the journals at the Publication Committee meetings have served as source material. Finally, annual, and semi-annual reports of the Publishers presented at Publication Committee meetings of the ISSM are source material.

RESULTS

After extensive review of the historical material listed in the Methods section of this abstract, this comprehensive history of the communication efforts of this society has provided a rich and dynamic historical document for this society.

CONCLUSION

This extensive, detailed, and comprehensive history of the communication tools of this society help us to record and remember the events and the people involved in this process. Sharing scientific information and information regarding the life of the International Society for Sexual Medicine have been an important function of this society from early. Lewis RW. Comprehensive History of the International Society for Sexual Medicine-Journals and Communication. Sex Med Rev 2021;xx:xx-xx.

Evaluating the impact of a medical school cohort sexual health course on knowledge, counseling skills and sexual attitude change

BACKGROUND

Sexual health is generally considered an integral part of medical and allied healthcare professional training. However, many medical schools do not offer this as a mandatory curriculum, or minimize it. Sexual health as an academic area was introduced in the 1970s, but there have been few cohort evaluations of its impact. This was limited by the availability of few psychometric scales for evaluation. We evaluated the full, mandatory, sexual health course in year 1 medicine at a large state university in the Midwest US, including the course with lectures; panels and tutorials; a video app to give students feedback on their sexual history taking skills; and a 3-station sexual history OSCE at the end of the course.

RESULTS

Seventy-four medical students (43% of the course cohort) volunteered, for an incentive, to complete evaluation materials pre- and post-course. We used the Sexual Health Education for Professionals Scale (SHEPS), designed and with appropriate psychometric standardization for such evaluation. The SHEPS data covers 7-point Likert scale ratings of 37 patient situations, asking first how well the student could communicate with such a patient, and on the second part how much knowledge they have to care for such a patient. The third subscale examines personal sexual attitudes and beliefs. Data indicated that the matched pretest-posttest ratings for skills and knowledge were all statistically significant and with very large effect sizes. Few of the attitude subscale items were significant and if so, had small effect sizes. Sexual attitudes and beliefs may be well-formed before entry into medical school, and sexual health teaching and learning has minimal effect on sexual attitudes in this US sample. However, using the 3 sexuality OSCE cases scores as outcomes, two of the 26 attitude-belief items predicted > 24% of the variance.

CONCLUSIONS

The sexual health course produced major changes in Communications with patients sexual health skills and Knowledge of sexual health, but little change in personal Attitudes about sexuality. These data suggest that personal attitude change is not essential for teaching US medical students to learn about sexual health and sexual function and dysfunction, and comfortably take a comprehensive sexual history.

Teaching Sexual History Taking in Health Care Using Online Technology: A PLISSIT-Plus Zoom Approach During the Coronavirus Disease 2019 Shutdown

Aim

Cancellation of university classes during the coronavirus disease 2019 pandemic challenges teaching inperson sexual history–taking skills to medical, physician assistant, and nursing students. We used commercial online electronic services for medical students to learn sexual history–taking skills.

Methods

A total of 174 medical students viewed a lecture on sexual history taking and the PLISSIT model (Permission, Limited Information, Specific Suggestion, Intensive Therapy) and were then randomized into dyads. They arranged a time to meet online on Zoom with their partner, chose a simple sexual history case-history (male or female) from a small selection, and recorded the 5- to 6-minute sexual history within a 1-week time frame. Each student played a “provider” or “patient” and then switched roles with a new case. One of the course tutors, all sexual health practitioners, downloaded 10 videos randomly assigned to them asynchronously and viewed and commented on the interaction of each “provider” along with comments on what to improve in the sexual history. 2 weeks later after the remainder of the lectures in the course, a second, more complex set of 8 cases were provided, so students could move at their comfort pace and choose 1.

Main Outcome Measure

Students were required to make 1 online post and 1 comment on another student's post for each case, on the experience, and associated issues arising, positive or negative. All comments were downloaded and analyzed by theme.

Results

Major themes included developing comfort in using sexual language, using simpler sexual terms suitable for patients, feeling confidence and mastery, excitement using technology developing clinical skills, surprise watching their performances and body language, observation of how they appeared to the “patient,” organizing sexual histories and incorporating PLISSIT model, ability to ask about context and relationships, and seeing the exercise as building on existing clinical skills training. Some expressed anxiety and nervousness, which by the second case had largely or completely dissipated.

Conclusion

A readily replicable, secure, cheap cloud-based model to integrate sexual history training asynchronously was provided, with tutors’ comments, and student skills development, and performance evaluated.

Ross MW, Newstrom N, Coleman E. Teaching Sexual History Taking in Health Care Using Online Technology: A PLISSIT-Plus Zoom Approach During the Coronavirus Disease 2019 Shutdown. Sex Med 2021;9:100290

Sexual Health in Child and Adolescent Psychiatry: Multi-Site Implementation Through Synchronized Videoconferencing of an Educational Resource Using Standardized Patients

Objective: Matters of sexuality and sexual health are common in the practice of child and adolescent psychiatry (CAP), yet clinicians can feel ill-equipped to address them with confidence. To address this gap in training and practice, we developed, implemented, and evaluated an educational module enhanced by videotaped depictions of expert clinicians interacting with professional actors performing as standardized patients (SPs). Methods: We developed an educational resource highlighting common issues of sexual health relevant to CAP practice, including sexual development, psychotropic-related side effects, and sexuality in children with autism. We wrote original scripts, based on which two clinicians interacted with three SPs. Digital recordings were edited to yield 5 clips with a cumulative running time of 20 min. The clips were interspersed during a 90-min session comprising didactic and interactive components. Due to the COVID-19 pandemic, we used synchronous videoconferencing, which allowed content dissemination to several training programs across the country. Results: We recruited 125 learners from 16 CAP training programs through the American Academy of CAP's Alliance for Learning and Innovation (AALI). Routine inquiry into adolescent patients' sexual function was uncommon, reported by only 28% of participants, with "awkward" and "uncomfortable" the most common terms mentioned in reference to the clinical task. The didactic intervention led to measurable improvements after 2 weeks in skills and knowledge (p = 0.004) and in attitudes (p < 0.001). The three items with the greatest improvement were: (a) availability of developmentally tailored resources; (b) comfort in addressing sexual development with underage patients; and (c) with parents or guardians of neuroatypical or developmentally disabled patients (p < 0.001 for each). Conclusions: A sexual health curriculum enriched by video-based examples can lead to measurable improvement in outcomes pertinent to the clinical practice of CAP. These educational materials are available for distribution, use and adaptation by local instructors. Our study also provides proof-of-principle for the use of multisite educational initiatives in CAP through synchronized videoconferencing.

The Effect of Interactive Educational Workshops With or Without Standardized Patients on the Clinical Skills of Midwifery Students in Providing Sexual Health Counseling

BACKGROUND AND OBJECTIVES

Insufficient skills among health personnel, including midwives, can lead to failure in evaluating and providing sexual health counseling services to clients. Thus, the purpose of this study was to compare the effect of 2 interactive educational workshops with or without standardized patients (SPs) on midwifery students' clinical skills in providing sexual health counseling at Mashhad University of Medical Sciences, Mashhad, Iran, in 2014 to 2015.

RESEARCH METHODS

In this randomized controlled trial, 62 midwifery students were selected through convenient sampling method and then randomly divided into 2 groups who received 1 of 2 interactive educational workshops, with or without SPs in 10-hour educational programs. The students' skills in providing sexual health counseling were evaluated before and 2 weeks after the education through an Objective Structured Clinical Examination composed of 5 stations using validated checklists. The data were then analyzed using the SPSS Software (Version 16) through descriptive statistics as well as independent t test, paired t test, Mann-Whitney U, χ, and Fisher exact tests. The level of significance was considered by P < 0.05.

RESULTS

There was no significant difference between the mean scores of students' clinical skills in providing sexual health counseling services in the group educated with or without SPs (22.4 ± 7.0 and 23.0 ± 9.4, P = 0.77). However, 2 weeks after the interventions, the mean scores were 75.8 ± 11.2 and 47.0 ± 8.9, respectively, meaning a significant difference between the study groups (P < 0.0001).

CONCLUSIONS

Although both teaching methods could promote clinical skills among the midwifery students, the effect of interactive workshop with SPs was much significantly stronger.

Sexual health education among undergraduate students of medicine

Background

Sexuality occupies a fundamental position in the lives of individuals and is related to general health. However, undergraduate curricula in medical courses address this topic in an incomplete manner. The aim of this study is to investigate sexual health education among undergraduate medical students.

Methods

A descriptive, cross-sectional study was conducted with students 18 years of age and older in the fifth and sixth years of the undergraduate course in medicine in 2018. Data were collected using a self-administered questionnaire addressing the teaching of sexual health in the first four years of the course and how knowledge on this topic affected their relationships with patients.

Results

A total of 125 students answered the questionnaire. Although the majority reported the teaching of sexual medicine during the undergraduate course, the classes were focused on reproduction (70%) and organic diseases (70%). A total of 52% of the respondents reported that the classes did not enhance their knowledge or confidence with regards to discussing the subject with patients. During routine care, the main difficulties the students faced in addressing the sexual health of patients were fear of offending the patient (53.8%) and insufficient knowledge on the subject (33.4%).

Conclusions

The present findings demonstrate that knowledge of students regarding sexual health in undergraduate courses is insufficient, as evidenced by deficiencies in teaching and difficulties in addressing the subject with patients.

Educational Innovation in Higher Education: Use of Role Playing and Educational Video in Future Teachers’ Training

Information and communication technologies (ICTs) have led to the emergence of a variety of active and innovative teaching methods. This is the case in role-playing, which consists of simulating a real-life situation, in this case the school context, in which the student takes on a certain role and interacts with other students in a fictitious situation. Framed in this way, the present study aims to show if the application of the role-playing method promotes the improvement of attitude variables and practical skills. To this end, we advocated the use of a quasi-experimental methodology, with a control and experimental group and the application of a post-test. The sample is composed of 138 students from the Master of Teachers of Compulsory Secondary Education in Ceuta (Spain). The results showed that the students positively valued the application of the method, obtaining better scores in the set of variables studied, especially in motivation, creativity and collaboration. Therefore, it continues to be observed that the application of innovative methodologies through technology promotes the increase of multiple skills in the student body. This study aimed to prove that the use of active methods provides an increase in students’ skills, and that, therefore, we must bet on the use of sustainable pedagogies in order to promote a real innovation in the classrooms.

Understanding Barriers to Contraception Screening and Referral in Female Adolescents and Young Adults with Cancer

Background: Contraception screening and referral occur infrequently in cancer care for young women of reproductive age. Barriers to contraception screening and referral in this setting have not been thoroughly identified. Objectives: We sought to understand oncology clinicians' current practices and perceptions of barriers to screening and referring young women for adequate contraception during cancer treatment. Methods: We conducted individual semi-structured interviews with 19 oncology clinicians whom we recruited from an urban, northeast medical center. Participants included physicians, advanced practice clinicians, and nurses in surgical and medical oncology. The interview guide addressed core components of the Promoting Action on Research Implementation in Health Services framework, and subsequent directed content analysis identified themes indicative of barriers to contraception screening and referral. Findings: Participants varied significantly in their current contraception screening practices; many conflated early pregnancy diagnosis or pregnancy avoidance counseling with contraception, whereas others described inaccurate contraceptive recommendations for specific clinical scenarios. Participants also lacked clarity of roles and responsibilities within the oncologic care team for contraception and assumed that another team member had addressed contraception. Participants perceived themselves to lack adequate education about contraception, which precluded contraception discussions. Conclusion: We recommend cancer centers consider these possible barriers to contraception screening and referral by promoting development of institutional guidelines to standardize contraception screening and referral, clarifying roles and responsibilities for contraception discussions within the care team, and expanding oncology clinician education on contraception. National professional organizations should work to expand guidelines to inform and support this process in clinical practice.

Management of erectile dysfunction after prostate cancer treatment: cross-sectional surveys of the perceptions and experiences of patients and healthcare professionals in the UK

OBJECTIVES

Erectile dysfunction (ED) is known to be a common consequence of radical treatment for prostate cancer (PCa) but is often under-reported and undertreated. This study aimed to explore how ED in patients with PCa is managed in real-life clinical practice, from the perspective of patients and healthcare professionals (HCPs).

DESIGN AND SETTING

This is a UK-wide cross-sectional survey of men with ED after treatment for PCa which covered assessment and discussion of erectile function, provision of supportive care and satisfaction with management. Parallel surveys of primary and secondary HCPs were also conducted.

RESULTS

Responses were received from 546 men with ED after PCa treatment, 167 primary (general practitioners and practice nurses) and 94 secondary care HCPs (urologists and urology clinical nurse specialists). Survey findings revealed inadequate management of ED in primary care, particularly underprescribing of effective management options. A fifth of men (21%) were not offered any ED management, and a similar proportion (23%) were not satisfied with the way HCPs addressed their ED concerns. There was poor communication between HCPs and men, including failure to initiate discussions about ED and/or involve partners, with 12% of men not told that ED was a risk factor of PCa treatment. These issues seemed to reflect poor access to effective ED management or services and lack of primary HCP confidence in managing ED, as well as confusion over the roles and responsibilities among both HCPs and men.

CONCLUSIONS

This study confirms the need for better support for men from HCPs and more tailored and timely access to effective ED management after treatment for PCa. A clearly defined pathway is required for the discussion and management of ED, starting from the planning stage of PCa treatment. Improved adherence to ED management guidelines and better education and training for primary care HCPs are areas of priority.

The Development of Cognitive and Affective Skills Through a Sexual and Reproductive Health Medical Education Unit

INTRODUCTION

Although better medical training on sexual and reproductive health (SRH) is an unquestionable global need, and recent research has emphasized the importance of SRH education, few studies have presented alternative teaching models to conventional approaches.

AIM

To examine the structure and evaluation of a curricular unit that uses an active teaching and learning strategy, and to evaluate both the cognitive and affective student learning outcomes.

METHODS

This study used retrospective and cross-sectional analyses of a curricular unit with 8 weekly lessons structured into individual activities before the class, group activities monitored in class, feedback, and the development of medical empathy.

MAIN OUTCOME MEASURE

Student performance was evaluated through summative and formative activities. The process was evaluated quantitatively by a questionnaire containing Likert-type and open-ended questions with speech analysis and with categorical evaluation.

RESULTS

The final average of the analyzed group was 7.95 ± 0.5 on a scale of 10. Likert-type assessment (Cronbach's α = 0.86) revealed strong student adherence and, through responses to open-ended questions, positive evaluations of the proposed SRH teaching model. The Jefferson Scale of Physician Empathy showed a high index of self-reported general empathy (117.3 ± 11), with a significantly higher index for female students (P = .019) than male students; however, this gender difference disappeared after the intervention (P = .086).

CONCLUSIONS

The curriculum model was developed and continuously adjusted based on grounded theory for teaching SRH and included both cognitive and affective stimuli; the results showed favorable student evaluation of the unit, and it proved feasible to implement in the time available. de Oliveira R, Montagna E, Zaia V, et al. The Development of Cognitive and Affective Skills Through a Sexual and Reproductive Health Medical Education Unit. Sex Med 2019;7:326-336.

Perspectives From Nurses and Physicians on Training Needs and Comfort Working With Transgender and Gender-Diverse Youth

INTRODUCTION

Nurses and physicians receive minimal training about providing competent care to transgender and gender-diverse (TGD) patients, and training specific to TGD youth is particularly lacking. This qualitative study examined health care providers' experiences and attitudes about working with TGD youth to identify specific training needs.

METHOD

Semistructured interviews were conducted with 14 nurses and physicians who work with adolescents. Thematic analysis was used to characterize participants' responses.

RESULTS

Five themes summarized participants' responses to interview questions: Training Regarding Gender Diversity, Discomfort With Gender-Related Topics, Reasons for Not Asking About Gender, Talking About Gender With Patients, and Need for Resources.

DISCUSSION

Findings highlight multiple opportunities to improve provider education and care experiences of TGD youth. Specific training is needed to help providers manage discomfort with gender-related topics and simultaneously develop their knowledge of and skills for discussing gender issues.

Female Sexual Health: Barriers to Optimal Outcomes and a Roadmap for Improved Patient-Clinician Communications

BACKGROUND

Although sexual health can be considered a vital sign for overall health, several barriers prevent women from receiving proper medical counseling, support, and/or care for their sexual health needs and concerns.

METHODS

Experts in sexual health compiled research and experience on the impediments to women receiving adequate assessment and treatment for their sexual health. Specific solutions and a roadmap for overcoming such barriers and improving patient-clinician communication are presented.

RESULTS

Social stigma around female sexuality remains in Western culture and as a result, women often avoid and/or are embarrassed to discuss their sexual health with their health care professionals (HCPs). Moreover, midlife women are typically unaware or have misconceptions about conditions that may adversely impact their sexual life, such as genitourinary syndrome of menopause and hypoactive sexual desire disorder. Without understanding there may be underlying medical conditions, there is also a lack of awareness that safe and effective treatments are available. Lack of training, tools, time, and limited treatment options impede HCPs from providing women with necessary sexual health support. Educating women, training HCPs, and providing communication tools to HCPs can facilitate effective dialog between patients and HCPs. More specifically, HCPs can be trained to initiate and maintain a sexual health conversation in a manner that is comfortable for women to convey sexual health needs and concerns, and for HCPs to correctly identify, diagnose, and treat the sexual problems of their female patients.

CONCLUSIONS

Solutions exist to address the barriers currently impeding patient-clinician interactions around sexual health.

A new computer application for teaching sexual history taking to medical students: innovation and evaluation in the UfaceMETM program

Background: We developed an app (UfaceME) which simultaneously allows patient and clinician to be viewed on a split screen, then replayed and rated on a series of semantic differential scales and the ratings of the clinician of their own response to the interview, and the patient's response, displayed on a graph. Method: We evaluated the app with trials with 14 medical student volunteers who alternated the roles of patient and clinician, using 2 randomly allocated sexual case histories. Semantic differentials for 10 adjectives were examined pre- and post-exercise. There were significant differences in 8 of the 10 adjectives. A focus group with the 14 subjects was also carried out and transcribed. The exercise was repeated with all 175 first-year medical students taking a sexual history. Results: Qualitative data indicated themes of being surprised and educated by non-verbal and verbal responses; seeing how the patient rated their responses; rating and watching discomfort; differences in clinician/patient perceptions and response; and the advantage of feedback. Quantitative data comparing self vs "patient" showed low correlations between perceptions of being "at ease", moderate for appearing "distracted", and high for appearing "engaged". Conclusion: UfaceME was easily understood and used, and the opportunity to replay and rate performance on key semantic scales, and watch and assess verbal and non-verbal performance, including patient rating, provided valuable insight.

Does a 2-Week Sexual Health in Rehabilitation Course Lead to Sustained Change in Students' Attitudes?-A Pilot Study

This pilot study aimed to explore if healthcare professional students participating in a 2-week elective course, Sexual Health in Rehabilitation (SHR), led to significant and sustained change in experienced competence and attitudes towards addressing sexual health in their future professions, when measured with the Students’ Attitudes towards Sexual Health-Danish version (SA-SH-D). Comparison-group design, using the SA-SH-D at baseline, after the 2 weeks course and 3 months after completing the course. Participation in the SHR course significantly changed the students’ attitudes; decreasing their fears of offending the patients and increasing their feelings of comfort in communicating about sexual health, and the results sustained during the follow-up period of 3 months. The results of the intervention suggest that a 2-week elective SHR course leads to sustained change healthcare students’ attitudes towards addressing sexual health in their future profession. Sexual health education positively changed the students’ attitudes, decreased their fears of offending the patients and increased their feelings of comfort in communicating about sexual health. The SA-SH-D is a useful tool to measure results of educational interventions aiming to change healthcare students’ attitudes towards addressing sexual health in their future profession. Future research is recommended regarding students’ attitudes towards addressing sexual health with persons living with disabilities. There is also a need to further research the effect of elective versus compulsory sexual health education in healthcare programs, to lessen the risk that healthcare students in their future profession will not be able to give equal care due to variation in competence and attitude.

Effect of attitudes towards patients on sexual history taking: a survey of Iranian-American physicians in California, USA

BACKGROUND

Although obtaining sexual history from patients is essential, the attitudes of physicians can become a barrier to sexual health care. Iranian-American physicians may face particular challenges because talking about sexuality is considered a taboo within their culture. Our study examined these physicians' attitudes when taking a sexual history from their patients.

METHODS

In 2013, a self-administrated questionnaire was sent to 1550 Iranian-American physicians in California, USA. Using factor analysis, the principal components approach with a Varimax rotation was used on a set of 12-item questions (five-point Likert scales) to detect latent factors that explain attitudes affecting sexual history taking. Scores are generated to determine physicians' attitudes towards sexual history taking.

RESULTS

In total, 354 questionnaires were returned (23% response rate). Three factors were identified as internally consistent (Cronbach's α=0.84 - 0.94): (1) attitude towards various patients; (2) female sexuality; and (3) age and marriage. Significant association were found between these three factors and some variables such as physicians' gender, country of medical graduation, religion, birthplace and age.

CONCLUSIONS

Results revealed that cultural attitudes are important factors affecting physicians' involvement in sexual history taking. Additional studies from this population and other subpopulations of US physicians are needed. New strategies that reflect on physicians' attitude on sexual healthcare delivery is needed. If confirmed in other studies, our findings could have implications for the training of medical graduates globally.

Sexuality education in Japanese medical schools

The present study aimed to investigate current sexuality education in Japanese medical schools and the impact of position title in the Japanese Society for Sexual Medicine (JSSM). Questionnaires were mailed to urology departments in all Japanese medical schools. The responses were evaluated according to four factors: the number of lecture components, curriculum hours, degree of satisfaction with the components and degree of satisfaction with the curriculum hours. We also investigated differences in these four factors among three groups: Directors, Council members and non-members of the JSSM. The medians of curriculum hours and the number of the lecture components were 90.0 min and 7.0, respectively. The curriculum hours of the Directors (140.0 min) were significantly longer than those of the non-members (90.0 min; P<0.05). The number of lecture components taught by Directors (9.5) was significantly higher than that of the Council (4.0; P<0.01) and non-members (7.0; P<0.05). More than half of the faculties were not satisfied with the lecture components and curriculum hours. This is the first study on sexuality education in Japanese medical schools. It showed the inadequacy of both curriculum hours and lecture components, and that the position title of department chair affects sexuality education in medical schools.

The primary health care of transgender adults

Gender dysphoria is associated with significant health disparity. Gender services perform specialised activities such as diagnosis, endocrine management and liaison with surgical services. Although providing these specialised transition services appears to be safe and improves well-being, significant health disparity remains. Engaging primary care providers is an important part of any strategy to improve the health care of transgender people. The relationships between gender dysphoria and a range of primary care issues such as mental health, cardiovascular disease and cancer are explored.

The role of people living with HIV as patient instructors - reducing stigma and improving interest around HIV care among medical students

People living with HIV/AIDS (PHAs) are increasingly recognized as experts in HIV and their own health. We developed a simulated clinical encounter (SCE) in which medical students provided HIV pre- and post-test counselling and point-of-care HIV testing for PHAs as patient instructors (PHA-PIs) under clinical preceptor supervision. The study assessed the acceptability of this teaching tool with a focus on assessing impact on HIV-related stigma among medical students. University of Toronto pre-clerkship medical students participated in a series of SCEs facilitated by 16 PHA-PIs and 22 clinical preceptors. Pre- and post-SCE students completed the validated Health Care Provider HIV/AIDS Stigma Scale (HPASS). HPASS measures overall stigma, as well as three domains within HIV stigma: stereotyping, discrimination, and prejudice. Higher scores represented higher levels of stigma. An additional questionnaire measured comfort in providing HIV-related care. Mean scores and results of paired t-tests are presented. Post-SCE, students (n   =   62) demonstrated decreased overall stigma (68.74 vs. 61.81, p   <   .001) as well as decreased stigma within each domain. Post-SCE, students (n   =   67) reported increased comfort in providing HIV-related care (10.24 vs. 18.06, p   <   .001). Involving PHA-PIs reduced HIV-related stigma among medical students and increased comfort in providing HIV-related care.