Core learning outcomes in sexual and reproductive health and HIV for medical undergraduates: improving skills of future providers

Tools to measure HIV knowledge, attitudes & practices (KAPs) in healthcare providers: a systematic review

Healthcare providers' knowledge, attitudes and practices (KAPs) related to HIV are important determinants of quality of care provided to HIV/AIDS patients. Most studies have focussed on low- and middle-income countries (LMIC) with far fewer conducted within high-income countries, where the epidemiology of HIV is typically distinct from low- and middle-income countries. As part of a larger study, we wanted to measure HIV-KAPs in healthcare providers in Australia. A systematic search was conducted to identify and evaluate existing tools designed to measure HIV-related KAPs among healthcare providers in higher-income countries. In total, eight instruments were identified. The instruments drew upon adapted forms of existing HIV-related KAPs and stigma theories and were developed based on a range of methodological designs and for different cadre of healthcare workers. The extent to which psychometric properties for each tool were evaluated varied widely. Further research with more robust methodological and psychometric rigour is required for adequate measurement of KAP among health professionals specific to HIV, so associated training needs, patient experiences and health outcomes can potentially be enhanced.

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.

How do UK medical graduates rate their knowledge and skills in sexual health and HIV medicine? A national survey

The objectives of this study are to determine self-assessed knowledge and skills in sexual health and HIV medicine in preregistration house officers and to explore undergraduate experiences of teaching and assessment in these subjects prior to the launch of National Core Learning Outcomes in Sexual and Reproductive Health and HIV. The study was designed as a postal questionnaire survey. The participants were all UK medical graduates of August 2004. The response rate 1737/4746 (36%). The main outcome measures were Doctors' views on their preparedness to manage patients with sexual health and HIV-related problems. Since graduation, 90% of respondents had seen at least one patient with a sexually transmitted infection or HIV-related issue. Seventy-six percent felt confident to take a sexual history. In all, 63% and 53% felt competent in male and female genital examination, respectively. Forty-three percent felt they could conduct an appropriate HIV pretest discussion and 59% felt they could recognize clinical indicators suggestive of HIV. Seventy-eight percent had been formally assessed in sexual health and 55% in HIV medicine. Increased confidence in sexual history taking, HIV pretest discussion and recognition of HIV indicators was associated with a longer duration of teaching and formal examination. In conclusion, although the proportion of recent graduates confident in sexual history taking is encouraging, their lack of skill in discussing HIV testing, risk assessment and recognition of possible HIV presentations must be addressed. Integration of National Core Learning Outcomes into all undergraduate curricula is a key step in reducing inconsistencies in undergraduate training.

Does the sexually transmitted infections foundation course deliver and change practice? Feedback from delegates 2002–2006

Attendees at Newcastle sexually transmitted infections foundation (STIF) courses since 2002 were sent a postal questionnaire to ascertain views about the course, its effect on practice and the desire for further education. Totally 156 forms were returned (48% response). The majority 97% were satisfied with the course, 97% wanted updates, 57% annually and 33% biennially. Following a STIF course, 69% provided HIV testing (only 14% of those, prior to attendance). However, only 39% routinely offered HIV testing and only 34% routinely offered syphilis testing to patients whom they considered to be at risk of a sexually transmitted infection. Common reasons for not offering testing were lack of time for counselling, lack of confidence, no perceived need or anonymity concerns resulting in referral to genitourinary medicine. This was despite training, which encourages routine HIV testing with a pretest discussion rather than ‘counselling’ and education about recent outbreaks of syphilis.