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.

Sexual Health Competencies for Undergraduate Medical Education in North America.

INTRODUCTION: The number of hours spent teaching sexual health content and skills in medical education continues to decrease despite the increase in sexual health issues faced by patients across the lifespan. In 2012 and 2014, experts across sexuality disciplines convened for the Summits on Medical School Education and Sexual Health to strategize and recommend approaches to improve sexual health education in medical education systems and practice settings. One of the summit recommendations was to develop sexual health competencies that could be implemented in undergraduate medical education curricula. AIM: To discuss the process of developing sexual health competencies for undergraduate medical education in North America and present the resulting competencies. METHODS: From 2014 to 2016, a summit multidisciplinary subcommittee met through face-to-face, phone conference, and email meetings to review prior competency-based guidelines and then draft and vet general sexual health competencies for integration into undergraduate medical school curricula. The process built off the Association of American Medical Colleges' competency development process for training medical students to care for lesbian, gay, bisexual, transgender, and gender non-conforming patients and individuals born with differences of sex development. MAIN OUTCOME MEASURES: This report presents the final 20 sexual health competencies and 34 qualifiers aligned with the 8 overall domains of competence. RESULTS: Development of a comprehensive set of sexual health competencies is a necessary first step in standardizing learning expectations for medical students upon completion of undergraduate training. CONCLUSIONS: It is hoped that these competencies will guide the development of sexual health curricula and assessment tools that can be shared across medical schools to ensure that all medical school graduates will be adequately trained and comfortable addressing the different sexual health concerns presented by patients across the lifespan. Bayer CR, Eckstrand KL, Knudson G, et al. Sexual Health Competencies for Undergraduate Medical Education in North America. J Sex Med 2017;14:535-540.

Summit on medical school education in sexual health: report of an expert consultation.

INTRODUCTION.: Medical education in sexual health in the United States and Canada is lacking. Medical students and practicing physicians report being underprepared to adequately address their patients' sexual health needs. Recent studies have shown little instruction on sexual health in medical schools and little consensus around the type of material medical students should learn. To address and manage sexual health issues, medical students need improved education and training. AIM.: This meeting report aims to present findings from a summit on the current state of medical school education in sexual health and provides recommended strategies to better train physicians to address sexual health. METHODS.: To catalyze improvements in sexual health education in medical schools, the summit brought together key U.S. and Canadian medical school educators, sexual health educators, and other experts. Attendees reviewed and discussed relevant data and potential recommendations in plenary sessions and then developed key recommendations in smaller breakout groups. RESULTS.: Findings presented at the summit demonstrate that the United States and Canada have high rates of poor sexual health outcomes and that sexual health education in medical schools is variable and in some settings diminished. To address these issues, government, professional, and student organizations are working on efforts to promote sexual health. Several universities already have sexual health curricula in place. Evaluation mechanisms will be essential for developing and refining sexual health education. CONCLUSIONS.: To be effective, sexual health curricula need to be integrated longitudinally throughout medical training. Identifying faculty champions and supporting student efforts are strategies to increase sexual health education. Sexual health requires a multidisciplinary approach, and cross-sector interaction between various public and private entities can help facilitate change. Areas important to address include: core content and placement in the curriculum; interprofessional education and training for integrated care; evaluation mechanisms; faculty development and cooperative strategies. Initial recommendations were drafted for each.

Health Policy Training for Health Equity Leaders.

Health professional training programs increasingly recognize the importance of health policy training. Despite integration of this training into health professional education, there have been limited published studies about health policy training and few studies that meaningfully measure and evaluate learner outcomes. The Satcher Health Leadership Institute at Morehouse School of Medicine developed a multidisciplinary, post-doctoral, health policy fellowship program in 2009, uniquely focused at the intersections of health policy, health equity, and leadership development. The program curriculum was intentionally designed with desired learner outcomes, aligning training and learner experiences with these outcomes, and meaningfully capturing and measuring outcomes in program evaluation. We present our training approach as well as results from an alumni survey assessing learner outcomes one to five years post fellowship completion. To our knowledge, this is the first study that evaluates the longitudinal impact of health policy training on the career trajectories of program graduates. We believe this offers a number of opportunities for replication and translation across health professional training programs.

Curriculum Mapping and Needs Assessment to Inform the Training of Health Policy Leaders.

Purpose: To identify synergies and gaps in knowledge, skills, and attributes identified by health policy leaders and create a summary measure of congruence with the Health Policy Leadership Fellowship Program curriculum. Methods: We mapped the Health Policy Leadership Fellowship Program curriculum to the most highly ranked knowledge, skills, and attributes identified through the Health Policy Leaders' Training Needs Assessment survey. Results: Overall, the Health Policy curricular elements had the highest percentage of congruence with the needs assessment Knowledge elements (>60%). The lowest levels of congruence (<30%) occurred most frequently within the Attribute elements. Conclusions: Mapping an existing program's content and elements to needs perceptions from professionals practicing in the field may help to both inform and evaluate an existing program's ability to attract and meet the needs of target learners. While needs assessments have traditionally been used to help develop programs, this study also demonstrates their application as a process evaluation tool when mapped to existing programs' curricular elements.

Understanding health policy leaders' training needs.

PURPOSE: We assessed the training needs of health policy leaders and practitioners across career stages; identified areas of core content for health policy training programs; and, identified training modalities for health policy leaders. METHODS: We convened a focus group of health policy leaders at varying career stages to inform the development of the Health Policy Leaders' Training Needs Assessment tool. We piloted and distributed the tool electronically. We used descriptive statistics and thematic coding for analysis. RESULTS: Seventy participants varying in age and stage of career completed the tool. "Cost implications of health policies" ranked highest for personal knowledge development and "intersection of policy and politics" ranked highest for health policy leaders in general. "Effective communication skills" ranked as the highest skill element and "integrity" as the highest attribute element. Format for training varied based on age and career stage. CONCLUSIONS: This study highlighted the training needs of health policy leaders personally as well as their perceptions of the needs for training health policy leaders in general. The findings are applicable for current health policy leadership training programs as well as those in development.

Giving Context to the Physician Competency Reference Set: Adapting to the Needs of Diverse Populations.

Delineating the requisite competencies of a 21st-century physician is the first step in the paradigm shift to competency-based medical education. Over the past two decades, more than 150 lists of competencies have emerged. In a synthesis of these lists, the Physician Competency Reference Set (PCRS) provided a unifying framework of competencies that define the general physician. The PCRS is not context or population specific; however, competently caring for certain underrepresented populations or specific medical conditions can require more specific context. Previously developed competency lists describing care for these populations have been disconnected from an overarching competency framework, limiting their uptake. To address this gap, the Association of American Medical Colleges Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development adapted the PCRS by adding context- and content-specific qualifying statements to existing PCRS competencies to better meet the needs of diverse patient populations. This Article describes the committee's process in developing these qualifiers of competence. To facilitate widespread adoption of the contextualized competencies in U.S. medical schools, the committee used an established competency framework to develop qualifiers of competence to improve the health of individuals who are lesbian, gay, bisexual, transgender; gender nonconforming; or born with differences in sexual development. This process can be applied to other underrepresented populations or medical conditions, ensuring that relevant topics are included in medical education and, ultimately, health care outcomes are improved for all patients inclusive of diversity, background, and ability.

Time out! Is timepiece variability a factor in critical care?

BACKGROUND: Accurate documentation of time is essential in critical care for treatments, interventions, research, and medicolegal and quality improvement activities. OBJECTIVES: To assess use of timepieces in critical care and to determine practical methods for improving their accuracy. METHODS: Providers were surveyed to identify timepieces used during routine and emergency care. Times displayed on standard unit and personal timepieces were compared with coordinated universal time. Four models of atomic clocks were assessed for drift for 6 weeks and for resynchronization for 1 week. Bedside monitors were manually synchronized to coordinated universal time and were assessed for drift. RESULTS: Survey response was 78% (149/190). Nurses (n = 93), physicians (n = 32), and respiratory therapists (n = 24) use wall clocks (50%) and personal timepieces (46%) most frequently during emergencies. The difference from coordinated universal time was a median of -4 minutes (range, -5 minutes to +2 min) for wall clocks, -2.5 minutes (-90 minutes to -1 minute) for monitors, and 0 minutes (-22 minutes to +12 minutes) for personal timepieces. Kruskal-Wallis testing indicated significant variations for all classes of timepieces (P<.001) and for personal timepieces grouped by discipline (P=.02). Atomic clocks were accurate to 30 seconds of coordinated universal time for 6 weeks when manually set but could not be synchronized by radiofrequency signal. Drift of bedside monitors was 1 minute. CONCLUSIONS: Timepieces used in critical care are highly variable and inaccurate. Manually synchronizing timepieces to coordinated universal time improved accuracy for several weeks, but the feasibility of synchronizing all timepieces is undetermined.

Developing health leaders to combat sexual health disparities.

Health disparities, including sexual health disparities, remain pervasive in our society. The Satcher Health Leadership Institute at Morehouse School of Medicine, through its Sexual Health Scholars and Health Policy Leadership Fellowship Programs, is preparing the next generation of health leaders with the necessary knowledge and skills to combat health disparities.