Medical students' perceptions of sexual health issues prior to a curriculum enhancement

Sexual Behaviors Among Lesbian, Gay, Bisexual, Transgender, and Other Sexual and Gender Diverse Medical Students: A National Study of Thai Medical Schools

Objective

This study aims to investigate sexual behaviors among gender diverse (LGBT and other sexual/gender minorities) and nongender-diverse medical students.

Methods

In 2021 academic year, medical students from five Thai medical schools completed questionnaires identifying demographic data, psychosexual factors, sexual experiences, and risks.

Results

Among 1,322 students, 32.1% were gender-diverse students who had lower age at first sexual intercourse and more experiences in solitary and partnered sexual activity.

Conclusions

Use of hookup applications was more frequent among gay and bisexual males. Risky sexual behaviors were significantly higher among bisexual females. Gender-diverse medical students showed higher involvement in sexual activities. Future studies should be addressing sexual health in Thai medical education.

Male Medical Students' Gender-Role Conflict Is Associated With Their Discomfort With Dealing With Patients' Sexual Health Issues

Recommendations suggest that more sexuality education be implemented in medical school curricula to increase students' comfort with regard to dealing with sexual health issues. For male medical students the adherence to masculine gender-role norms may also contribute to discomfort regarding dealing with this intimate topic. The current study analyzed whether male medical students' knowledge or masculine gender-role conflict (GRC) was associated with their comfort with regard to asking future patients about sexual health issues. A total of 164 male medical students (M_age = 24.4, SD = 2.4) participated. A questionnaire assessed students' self-perceived knowledge of sexual health, how prepared they felt with regard to this topic, and their comfort with regard to asking future patients about sexual health issues. The Gender Role Conflict Scale-Short Form (GRCS-SF) was used to assess GRC. Knowledge was positively associated with comfort. Male students who indicated difficulty expressing affection toward men or expressing emotions were likely to report being uncomfortable asking patients about sexual health issues. Students should be made aware of gender-role norms. Alongside knowledge transfer, the discussion of strategies for overcoming the barriers set by gender-role norms should be part of sexuality education.

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

INTRODUCTION

This article explores the evolution and current delivery of undergraduate medical education in human sexuality.

AIM

To make recommendations regarding future educational needs, principles of curricular development, and how the International Society for Sexual Medicine (ISSM) should address the need to enhance and promote human sexuality education around the world.

METHODS

The existing literature was reviewed for sexuality education, curriculum development, learning strategies, educational formats, evaluation of programs, evaluation of students, and faculty development.

MAIN OUTCOME MEASURES

The prevailing theme of most publications in this vein is that sexuality education in undergraduate medical education is currently not adequate to prepare students for future practice.

RESULTS

We identified components of the principles of attitudes, knowledge, and skills that should be contained in a comprehensive curriculum for undergraduate medical education in human sexuality. Management of sexual dysfunction; lesbian, gay, bisexual, and transgender health care; sexuality across genders and lifespan; understanding of non-normative sexual practices; sexually transmitted infections and HIV, contraception; abortion; sexual coercion and violence; and legal aspects were identified as topics meriting particular attention.

CONCLUSION

Curricula should be integrated throughout medical school and based on principles of adult learning. Methods of teaching should be multimodal and evaluations of student performance are critical. To realize much of what needs to be done, faculty development is critical. Thus, the ISSM can play a key role in the provision and dissemination of learning opportunities and materials, it can promote educational programs around the world, and it can articulate a universal curriculum with modules that can be adopted. The ISSM can create chapters, review documents, slide decks, small group and roleplay topics, and video-recorded materials and make all this material easily available. An expert consensus conference would be needed to realize these recommendations and fulfill them.

Views and Experiences of Malaysian Family Medicine Trainees of Female Sexual Dysfunction

Sociocultural factors have been shown to be important influencers of sexual health and sexuality. Hence, the aim of our study was to explore the views and experiences of family medicine trainees regarding female sexual dysfunction (FSD) with a focus on the barriers and facilitators towards the initiation of conversation on this topic. A qualitative study design involving semi-structured focus group discussions (FGDs) was conducted with 19 family medicine trainees in Malaysia. The conceptual framework used was based on the Theory of Planned Behavior. Thematic approach was used to analyze the data. Participants perceived FSD as being uncommon and unimportant. According to our participants, patients often presented with indirect complaints, and doctors were not proactive in asking about FSD. Three main barriers were identified: doctor factors, perceived patient factors, and system factors. Lack of confidence, knowledge, experience, time, and embarrassment were the key barriers identified at the doctors' level. Lack of awareness, among patients regarding FSD, and local cultural and religious norms were the perceived patient barriers. System barriers were lack of time and privacy. Various facilitators, such as continuous medical education and public forums, were suggested as means to encourage family medicine trainees to initiate discussion on sexual matters during consultations. In conclusion, family medicine trainees found it difficult to initiate conversation on FSD with patients. Interventions to encourage conversation on FSD should target this and other identified barriers.

Tools to Assess Behavioral and Social Science Competencies in Medical Education: A Systematic Review

PURPOSE

Behavioral and social science (BSS) competencies are needed to provide quality health care, but psychometrically validated measures to assess these competencies are difficult to find. Moreover, they have not been mapped to existing frameworks, like those from the Liaison Committee on Medical Education (LCME) and Accreditation Council for Graduate Medical Education (ACGME). This systematic review aimed to identify and evaluate the quality of assessment tools used to measure BSS competencies.

METHOD

The authors searched the literature published between January 2002 and March 2014 for articles reporting psychometric or other validity/reliability testing, using OVID, CINAHL, PubMed, ERIC, Research and Development Resource Base, SOCIOFILE, and PsycINFO. They reviewed 5,104 potentially relevant titles and abstracts. To guide their review, they mapped BSS competencies to existing LCME and ACGME frameworks. The final included articles fell into three categories: instrument development, which were of the highest quality; educational research, which were of the second highest quality; and curriculum evaluation, which were of lower quality.

RESULTS

Of the 114 included articles, 33 (29%) yielded strong evidence supporting tools to assess communication skills, cultural competence, empathy/compassion, behavioral health counseling, professionalism, and teamwork. Sixty-two (54%) articles yielded moderate evidence and 19 (17%) weak evidence. Articles mapped to all LCME standards and ACGME core competencies; the most common was communication skills.

CONCLUSIONS

These findings serve as a valuable resource for medical educators and researchers. More rigorous measurement validation and testing and more robust study designs are needed to understand how educational strategies contribute to BSS competency development.

Produção científica da área da saúde sobre a sexualidade humana

Embasamento: A sexualidade humana é frequentemente tratada de forma limitada na formação acadêmica, prejudicando a construção do conhecimento. A análise da produção científica facilita a compreensão da identidade da área de pesquisa e aponta perspectivas futuras. Objetivo: analisar a produção científica da área da saúde sobre sexualidade humana e discutir focos de atenção e lacunas de conhecimento. Método: três bases de dados eletrônicas foram consultadas: LILACS, SCIELO e PUBMED, utilizando-se os descritores “conhecimento/knowledge”, “atitude/attitude”, “conforto/confort” e “formação acadêmica/curriculum”. Todos esses foram combinados com o termo “sexualidade humana”. Incluíram-se artigos científicos publicados em inglês e português no período entre 2000 e 2010. Resultados : Selecionaram-se 20 artigos dos 2.022 analisados. Do total, 50% foram escritos na área da enfermagem, 45% eram da área de medicina e 5% da Terapia Ocupacional. Dentre os artigos analisados, 65% foram publicados em inglês e 35% em português. Conclusão : Enfermagem e medicina produzem maior número de artigos relacionados à sexualidade humana. Apesar de maior parte dos artigos analisados terem sido produzidos fora do Brasil, o País vem aumentando sua produção, demonstrando crescente preocupação por uma área que cada vez mais evidencia sua importância na prática clínica do profissional da área da saúde.

Medical student sexuality: how sexual experience and sexuality training impact U.S. and Canadian medical students' comfort in dealing with patients' sexuality in clinical practice

PURPOSE

To determine factors associated with students' comfort in addressing patients' sexuality in the clinical context.

METHOD

The authors invited students enrolled in MD-degree-granting and osteopathic medical schools in the United States and Canada to participate in an anonymous Internet survey between February and July 2008. The survey assessed ethnodemographic factors and sexual history. Respondents also completed the Center for Epidemiologic Studies Depression Scale. Male respondents completed the International Index of Erectile Function and the Premature Ejaculation Diagnostic Tool. Female respondents completed the Female Sexual Function Index and the Index of Sex Life. The authors used descriptive statistics, ANOVA, and multivariable logistic regression to analyze responses.

RESULTS

The authors' analyses included 2,261 completed survey responses: 910 from men, 1,343 from women, and 8 from individuals who self-identified as "other" gendered. Over 53% of respondents (n = 1,206) stated that they felt they had not received sufficient training in medical school to address sexual concerns clinically. Despite this, 81% of students (n = 1,827) reported feeling comfortable dealing with their patients' sexuality issues. Students with limited sexual experience, students at risk for sexual problems, and students who felt that they had not been trained adequately were less likely to report being comfortable talking to patients about sexual health issues.

CONCLUSIONS

Perception of inadequate sexuality training in medical school and personal issues pertaining to sex may be associated with students' difficulty in addressing patients' sexuality. Adequate training is preeminently associated with feeling comfortable addressing patients' sexuality and should be a priority for medical education.

Continuing Medical Education: Sexual Medicine Education: Review and Commentary (CME)

INTRODUCTION

Sexual medicine education is an important and fundamental topic not adequately represented in most undergraduate and residency training programs.

AIM

The purpose of this article is to better enable the participant to understand the importance of sexual medicine education, and to review existing models and innovations in undergraduate and graduate medical education. This activity is designed for the practicing physician. Methods. A literature review of the topic was performed.

MAIN OUTCOME MEASURE

Current state of, and new developments in, sexual medicine education.

RESULTS

In all countries, medical students, house staff, and practicing physicians currently receive variable, nonstandardized, or inadequate training in sexual history taking and sexual medicine assessment and treatment. There remain significant physician-patient barriers to discussing sexual issues; and patients feel that their physicians are reluctant, disinterested, or unskilled in sexual problem management. There is a knowledge gap between developments in sexual medicine and the clinical skills of practicing physicians.

CONCLUSIONS

The challenge is to create uniform, widely available programs that provide practicing physicians across specialties with the needed skills to meet modern patients' needs in sexual medicine healthcare delivery.

Female Sexuality and Sexual Dysfunction: Are We Stuck on the Learning Curve?

INTRODUCTION

Female sexual dysfunctions (FSDs) are very prevalent, multifaceted problems that continue to be under-recognized and undertreated. Improved recognition and management depend on physicians' inclination and ability to communicate with female patients about their sexual function. Many women hesitate to share sexual complaints due to concerns about physicians' time constraints or their interest in addressing it. Direct questioning by physicians about sexual function is often critical to patients' reporting of sexual concerns.

AIM

To obtain pilot data on physicians' knowledge, perceptions, and practices regarding FSDs, which may help uncover means of facilitating future dialog between physicians and patients.

METHODS

A self-reply questionnaire was used to survey physicians and other health professionals attending the 2004 annual meetings of four major specialty societies.

MAIN OUTCOME MEASURES

Survey questions were included on the prevalence of FSDs; dialog on sexual function/activity; obstacles to appropriate evaluation and management of FSDs; effectiveness of current treatment options; and referral patterns.

RESULTS

A total of 1,946 attendees completed the survey. Most respondents (60%) estimated that one- to three-quarters of their patients had FSDs. Low sexual desire was the most prevalent FSD observed. A total of 58% of participants reported initiating the first discussion of FSDs in one-quarter or less of patients. Obstacles to discussing sexual health included limited time and training, embarrassment, and absence of effective treatment options. Approximately 60% of participants rated both their knowledge of and comfort level with FSDs as only fair or poor. Eighty-six percent rated current treatment options as fair or poor.

CONCLUSION

Healthcare professionals are aware of the high prevalence of FSDs but infrequently initiate a discussion of sexual function with their female patients or conduct a comprehensive evaluation for FSDs. Additional medical education and training are needed to improve the identification and management of FSDs in women.

Clinical Evaluation and Management Strategy for Sexual Dysfunction in Men and Women

INTRODUCTION

The optimal approach for identification and evaluation of the sexual problems in men and women in primary care or general medicine practice has not been consensed.

AIM

To provide recommendations/guidelines concerning state-of-the-art knowledge for clinical evaluation and management strategies in the evaluation and treatment of sexual dysfunction in men and women, emphasizing evidence-based medicine and a patient-centered framework.

METHODS

An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Clinical Evaluation and Management Strategies Committee, there were 12 experts from five countries.

MAIN OUTCOME MEASURE

Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate.

RESULTS

Three concepts underlie sexual medicine management: (i) adoption of a patient-centered framework for evaluation and treatment; (ii) application of the principles of evidence-based medicine in diagnostic and treatment planning; and (iii) use of a unified management approach in men and women. When taken together, these three principles provide a balanced and integrated approach to sexual dysfunction management. Common algorithms for diagnosis and management of men and women with sexual dysfunction, brief sexual symptom checklists, basics in history and physical examination, indications for specialized referral and development of a follow-up strategy are presented.

CONCLUSIONS

More research is needed in understanding the role of evidence-based and patient-centered medicine in the clinical evaluation and management strategies of men and women with sexual dysfunction.