Asthma Exacerbation Triggered by Wildfire: A Standardized Patient Case to Integrate Climate Change Into Medical Curricula

INTRODUCTION

Climate change presents unprecedented health threats. It is imperative that medical trainees understand the implications of climate change/planetary health on the physical and mental health and well-being of their patients. Medical professionals generally are not trained to consider climate change impacts in patient encounters. Hence, there is a need to train climate-aware providers who will be at the forefront of patient care in managing these current and emerging health impacts.

METHODS

We created a standardized patient (SP) case enhanced with details of risks and health impacts due to exposure to wildfire smoke. This session was deployed to 11 internal medicine clerkship students as part of a standard OSCE already included in our curriculum to evaluate core clinical and communication skills. Two cohorts, a group activity, and a one-on-one encounter were deployed and followed with a faculty debrief and learner assessments.

RESULTS

Students had increased awareness and knowledge of health impacts of climate change and potential actions for adaptation and mitigation. The improvements were statistically significant for the one-on-one cohort (p = .006). Postsimulation comments were favorable; students were more inclined to consider health impacts, risks, and vulnerabilities exacerbated by climate change.

DISCUSSION

Students had an increased recognition of climate change as a force impacting their patients' health which should be considered in patient care. This format allowed retention of well established curricular content, but also the inclusion of other crucial emerging issues that will impact public health locally and globally and foster the development of climate-aware health care providers.

Best Practices in North American Pre-Clinical Medical Education in Sexual History Taking: Consensus From the Summits in Medical Education in Sexual Health

INTRODUCTION

This article discusses a blueprint for a sexual health communication curriculum to facilitate undergraduate medical student acquisition of sexual history taking skills and includes recommendations for important elements of a thorough sexual history script for undergraduate medical students.

AIM

To outline the fundamentals, objectives, content, timing, and teaching methods of a gold standard curriculum in sexual health communication.

METHODS

Consensus expert opinion was documented at the 2012, 2014, and 2016 Summits in Medical Education in Sexual Health. Additionally, the existing literature was reviewed regarding undergraduate medical education in sexual health.

MAIN OUTCOME MEASURES

This article reports expert opinion and a review of the literature on the development of a sexual history taking curriculum.

RESULTS

First-year curricula should be focused on acquiring satisfactory basic sexual history taking skills, including both assessment of sexual risk via the 5 Ps (partners, practices, protection from sexually transmitted infections, past history of sexually transmitted infections, and prevention of pregnancy) as well as assessment of sexual wellness-described here as a sixth P (plus), which encompasses the assessment of trauma, violence, sexual satisfaction, sexual health concerns/problems, and support for gender identity and sexual orientation. Second-year curricula should be focused on incorporating improved clinical reasoning, emphasizing sexual history taking for diverse populations and practices, and including the impact of illness on sexual health. Teaching methods must include varied formats. Evaluation may be best as a formative objective structured clinical examination in the first year and summative in the second year. Barriers for curriculum development may be reduced by identifying faculty champions of sexual health/medicine.

CLINICAL IMPLICATIONS

Medical students will improve their skills in sexual history taking, which will ultimately impact patient satisfaction and clinical outcomes. Future research is needed to validate this proposed curriculum and assess the impact on clinical skills.

STRENGTHS & LIMITATIONS

This article assimilates expert consensus and existing clinical guidelines to provide a novel structured approach to curriculum development in sexual health interviewing in the pre-clinical years.

CONCLUSION

The blueprint for developing sexual history taking skills includes a spiral curriculum with varied teaching formats, incorporation of a sexual history script that incorporates inquiry about sexual wellness, and longitudinal assessment across the pre-clinical years. Ideally, sexual health communication content should be incorporated into existing clinical interviewing and physical examination courses. Rubin ES, Rullo J, Tsai P, et al. Best Practices in North American Pre-Clinical Medical Education in Sexual History Taking: Consensus From the Summits in Medical Education in Sexual Health. J Sex Med 2018;15:1414-1425.

Difficult Interpersonal Encounters with Medical Students and Residents: Two Objective Standardized Teaching Encounters

INTRODUCTION

Objective standardized teaching exercises (OSTEs) are widely used to develop professional competencies, especially in the health care professions. An OSTE involves exposing different providers to the same, time-limited scenario that is concurrently observed and/or recorded for either formative or summative evaluation. As there are limited resources available for creating a resident-specific OSTE, especially those applicable to family and community medicine residents, we created and evaluated a resident OSTE (R-OSTE) for second- and third-year family and community medicine residents.

METHODS

This R-OSTE involved two cases. The first featured Taylor, a third-year medical student resistant to feedback. The second featured Kris, a first-year resident nervous about approaching the attending on duty. Our R-OSTE had residents teaching interpersonal skills to trained actors in a standardized learner role.

RESULTS

Residents in the teaching role were formatively evaluated by peer observers (fellow residents) and standardized learners on interpersonal domains such as communication and professionalism. Learners gave residents an average performance rating of 4.9 on a 1 to 6 scale with 1 = Very Poor and 6 = Excellent. Residents also evaluated the OSTE itself, rating their experience on multiple teaching-related statements. Eighty-six percent of residents agreed this exercise was an appropriate development activity for family medicine residents. Overall, our R-OSTE was rated highly for relevance to teaching by the residents.

DISCUSSION

The residents were rated highly by both peer observers and standardized learners. However, there was little variability in peer observer scores, indicating the need for an alternative method of measurement.