Friday, February 19, 2010

Sexuality Education for ALL Medical Students

A conversation I had recently with my dentist spurred me to consider this topic. She approached me and said, “Hey… you’re an expert on this, so I challenge you to get people thinking about the importance of sex education for physicians. That includes general practitioners, OB/GYN, and yes, even dentists.” I looked at her quizzically as she continued, “You have no idea how difficult it is, as a dentist, to know how to approach people who have been sexually traumatized in their lives. I know that some of the things I do have the ability to trigger them, yet I don’t fully understand what’s happening.” Enter the bright light and music as it dawns on me what she’s really talking about. She’s talking about how to work with a patient who has been traumatized and that her training involved zero sexuality education therefore she had no idea how to approach it. Consider someone who has been forced to have oral sex... the dentist working from above and within the mouth has the potential to be an absolutely terrifying experience. You know, I never even thought of it that way. I have been challenged to look at the situation and the act of going to the dentist, or to any doctor, in an entirely new way.

It is necessary to equip students with the knowledge, skills, and attitudes regarding sexuality for them to be an effective practitioner. Some schools stress the knowledge, but cover the rest sparingly, if at all (Solursh et al., 2003). I began to examine online course catalogues for various medical and dental schools to see how much human sexuality education a student could expect in their schooling. I found that many schools provided courses in functional anatomy and physiology, but the courses appear to be just that, structure and function. The dental schools I looked at did not provide sexuality education at all. I could go on for days about the variations found and which schools had what, but that’s not the goal here.
In an effort to address the lack of quality sexuality education for American medical students, the American Medical Student Association recently launched their Sexual Health Scholars Program. It is a small group of dedicated students who enter a six month online course aimed at giving participants increased knowledge and skills toward “encouraging healthy sexualities, managing sexual concerns, and will help students bring these tools to their individual schools” (AMSA, 2010).

It is definitely a step in the right direction, and I encourage all of us to consider ways to make it more mainstream in the education process of physicians of all disciplines.


Resources:
Solursh, D.L.,Ernst, J.L., Lewis, R.W., Prisant, L.M., Solursh, P.L., Jarvis, R.G., & Salazar, W.H (2003). The human sexuality education of physicians in North American medical schools. International Journal of Impotence Research, 15, S41-S45.

American Medical Student Association, www.amsa.org

Chris

13 comments:

  1. It is not just doctors who are lacking sexuality training within the medical field. My mom is the director of the physician assistant program at USP, University of the Sciences in Philadelphia, as well as the liaison to the graduate physician assistant program at PCOM, Philadelphia College of Osteopathic Medicine (http://www.usp.edu/academics/programs/pa/faculty/desipio.aspx). Although according to the American Academy of Physician Assistants (http://www.aapa.org) PA’s pride themselves on patient centered care and innovative health care solutions, they too receive little to no education on human sexuality issues. The curriculum at both USP and PCOM is lacking any human sexuality classes (http://www.pcom.edu/Academic_Programs/aca_pa/Degree_Programs_Physician_Assi/PA_Courses/pa_courses.html). My mom constantly has students who have graduated from the program and are now working in the medical field as PA’s and they are confronted with sexuality questions that they are unprepared for and unable to answer. These students have expressed a desire and need for some training in human sexuality issues. My mom’s experience with her students indicates that human sexuality training is needed in several areas of the medical community not just doctorate programs.

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  2. Another concern medical professionals should have regarding sexual health is how a treatment may impact the patient’s sexual life. Although it is necessary and admirable to aggressively treat conditions such as cancer, the medical community may not often discuss what will occur after the patient has gone through treatment. Sexual functioning is an important aspect of individual’s lives, but is often overlooked when discussing treatment.

    The American Cancer Society is a great resource, which provides information on “ways to keep your sex life going” during treatments. The link provides great suggestions on how to address your sexual concerns with medical professionals.

    http://www.cancer.org/docroot/MIT/content/MIT_7_2x_Keys_for_Staying_Sexually_Healthy_Despite_Cancer_Treatment.asp?sitearea=MIT

    -Alicia

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  3. . I went to a chiropractic neurologist and he was talking about the brain being the largest organ in dysfunction even in seemingly non related illnesses (skeletal issues, adhd, etc). I’ve heard in classes that the brain is the greatest sex organ and the brain is obviously important for other things. This got me thinking that the importance of the brain could be how we can provide our services to the medical profession. I think that having sex education is important in any medical setting and providing ways that neurology, dentistry, etc can be linked to sexuality. Maybe playing on the importance of the brain in ALL functioning would be the way to go.

    I plan on leading this crusade next time I go to the chiropractor. Who’s with me!?!

    Concordmedical.org

    http://articles.sfgate.com/2004-03-16/news/17416119_1_amygdala-arousal-sexual-desire


    Darcie

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  4. One medical school,UMDNJ, offers their students a week-long sexuality education program called Sex Week. This January, several Widener students and alumni (Eli Green, Courtney Weaver, Danielle Ruggles, Brianna Booth, and others I am forgetting at the moment – sorry!) presented and led discussion groups for second –year med students. I had the opportunity to attend and present a values clarification lesson from Taking Sides with Bill Taverner. We could tell that the students were really benefiting from the work Dr Bertha and staff at UMDNJ had put in. They were intelligent and thoughtful, and working with them was a lot of fun.

    I'm not sure if they have offered workshops that address this particular topic (screening for trauma and how to ease anxiety). Sounds like a good proposal for Sex Week 2011!

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  5. Issues in human sexuality are increasing in number and complexity. Human sexuality has no boundaries in regards to gender, sex, age or culture. Physician and patient education in sexual health is not universal and each may be hesitant to discuss issues of human sexuality. Both physicians and patients suffer the negative consequences of variable, non-standardized sexuality-based education. Physician's attitudes, knowledge, skills and comfort in addressing sexual health are important to explore. Patient's perception of provider knowledge and provider confidence, as well as provider and self comfort in discussing of sexual issues should also be addressed.

    Physician exposure to human sexuality training is an ambiguous issue. Promoting an awareness of the barriers that physicians and patients encounter in human sexuality can assist in developing standards to meet the sexual health needs of individuals and improve the physician-patient relationship. Physicians should receive standardized training in human sexuality to assist in the process of considering and possibly altering their attitudes and values in relation t human sexuality. Physician attitudes, knowledge, skills and comfort with human sexuality and patient perception of provider knowledge, confidence and comfort are of equal importance. A balanced approach is necessary to guarantee teamwork with the best possible outcome for both physician and patient.

    "Health Care Without Shame" is a handbook for patients and their caregivers. It is a must read for all helping professions. Author Charles Moser, PhD., MD has made his book available on-line for free at http://www2.huberlin.de/sexology/BIB/hcws/hcws.html

    Alice

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  6. Great topic Chris although I am biased because this is what I am writing my curriculum on. Health professionals in many specialties need to be able to communicate effectively with patients who have concerns about sexual health. There have been surveys that have found that many health professionals feel uncomfortable and/or inadequate when discussing sexual health issues with patients.

    There is a great study by Faulder, Riley, Stone & Glassier (2004) that had medical students teach sexual health classes to undergraduates or secondary education students and it greatly improved the medical students’ confidence in dealing with sexual health issues. This is great because not only does it help the medical students but it increases the education in undergraduate courses as well as high schools. It kills two sexual health birds with one stone.

    If you want to check it out the article is below.
    Faulder, C.G., Riley, S. C., Stone, N., & Glasier, A. (2004). Teaching Sex Education Improves Medical Students' Confidence in Dealing with Sexual Health Issues. Contraception, 70, 135-139.

    Danielle

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  7. While it is true that by changing the attitudes of professionals at the primary care level we will meet the needs of a larger group of patients and not just the small minority who take the risk to ask for help, it is also true that sexual counseling requires an interdisciplinary approach (Schover & Jensen, 1988). Schover & Jensen, in their work with patients who have chronic illness, advocate an integrative model that unites scientific and clinical approaches by viewing a disease as an outcome of interactions within a system.

    It is not enough to train front line medical professionals to include sexual health in their assessments and treatment plans, they also need to learn what other specialists in the field do and how to work as a team towards the goal of sexual health.

    For example, one of the most common psychological complaints in medical patients is depression. If the clinician does not explore the psychosocial factors contributing to the patient’s depressed mood, he or she may in fact prescribe a medication that will further impair sexual functioning and exacerbate the problem (Schover & Jensen, 1988).

    Another integrative approach is to view the patient in the context of his or her relationship to a partner or partners. While there are protocols surrounding patient confidentiality, viewing the sexual health of the patient as relative to the sexual health of the couple acknowledges a model of health that is the integration of somatic, emotional, intellectual and social aspects (World Health Organization, 1975).

    Since 1988 when Schover & Jensen published their book Sexuality and Chronic Illness the integration of various aspects of patients’ lives has received attention. There are clinics that include a variety of practitioners and approaches (WebMD). And there is even a popular television show that uses a team approach to obstetrics and gynecology (Private Practice). Whether this show is mirroring modern medicine or is creating an image of an ideal, it does put into our minds the benefits of such an integration.

    I am not sure medical school training includes this aspect of running a practice, but I suspect it does not. I speak from personal experience having been married to a family practice physician for many years and seeing the actual training in medical school. Family practice by nature did take a more holistic, inclusive approach, however it did this through the framing that the sole practitioner was able to see the patient through the lens of several specialties.

    So in addition to training a variety of medical professionals about the complexities of human sexuality and the various courses of care available, I hope they are also being trained on how to use a biopsychosocial model where they would team with other professionals to provide patients with a body-mind-spirit experience.

    References:
    Schoever, L. & Jensen, S. (1988). Sexuality and Chronic Illness:A Comprehensive Approach. New York, New York. The Guilford Press

    Kam, K. (2009). What Is Integrative Medicine? Retrieved from http://www.webmd.com/a-to-z-guides/features/alternative-medicine-integrative-medicine

    World Health Organization (1975) as cited by Schover & Jensen (1988).

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  10. Chris, this is a great topic - and an important too! Not only is it important for the medical professionals to have at least some sexuality education background, but it's important for these individuals to be culturally competent when address human sexuality concerns of patients/clients. The Association of American Medical Colleges (AAMC) provides information on how to create a culturally competent curriculum for medical students (the link to this resource is copied below).

    I understand that it's not possible to learn everything about every cultural but as professionals we need to at least do our homework before consulting with patients, especially regarding sexuality. Although I don't consider myself a medical professional I do consider myself to be a professional who works in a medical setting. Several areas that I need to consider when talking to patients about birth control/contraception options is their age, race, socioeconomic background and ethnic beliefs and values. To give the best advice/information, I need to know what my patients cultural beliefs are about birth control and if these beliefs are indeed part of the patients belief system. If I can't understand their values then I won't be able to educate and communicate with them effectively and therefore I won't be able to meet their needs regarding their sexual health. As educators or medical professionals it's important to remember that needs of the individuals we are serving should be a high priority.

    The organization that I work for, Planned Parenthood, has made efforts to make the medical staff become more culturally competent by having monthly emails providing us with general information about a particular culture or ethnic group, as well as information on the beliefs/values on human sexuality and reproductive health. Doing my homework and getting support from my employer has definitely made it easier to start and make a conversation more meaningful when I'm meeting with patients who have different cultural beliefs than me.

    AAMC. (2005). Cultural Competence Education for Medical Students [PDF document].
    Retrieved from http://www.aamc.org/meded/tacct/culturalcomped.pdf

    - pg 16-17 provide models for cross-cultural communication and negotiation, which could be used when discussing issues with sexuality.

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  11. I was waiting to reply to this blog because I knew I had a dentist appointment coming up. Unfortunately, I do not have a positive story to tell you. Perhaps it’s better than I’m making it out to be, but I asked my dentist what she would do if she had a patient that was sexually abused in the past. She simply stated that she would refer her patient to a therapist.

    “But what if she didn’t know where to find a therapist?” I asked.

    “There are internet sources for that. All she would need to do is Google it. “

    When I reminded her that there are invalid sources online, she said she’d go talk to the librarian at her medical school, University of Medicine and Dentistry of New Jersey (UMDNJ).

    To be honest, I think she was telling me what she wanted to hear. Chris, after reading your blog and speaking with her, I now believe that there is a serious issue regarding medical professionals and sexuality. Hopefully, the topic of sexuality will eventually be introduced to every professional in medicine. In the meantime, let’s hope Google has the answers.

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