The Lack of Sexual Health Education in Medical Training Leaves Students and Residents Feeling Unprepared.

BACKGROUND: Despite physicians frequently caring for patients with sexual health issues, only 50% of United States medical schools require formal education in sexual medicine, and there are currently no guidelines pertaining to this with research which found that medical trainees are ill-equipped to provide sexual healthcare. AIM: This study aims to identify areas to improve sexual health training in order to increase physician confidence and competence in evaluating and training patients with sexual health problems. METHODS: A prospective survey was sent via REDCap to medical students (n = 190, 68.6%), residents (n = 75, 27.1%), and fellows (n = 11, 3.9%) via a known listserv. Participants (N = 276, ∼15% response rate) were asked to provide demographic information, whether they received sexual health training during medical school and rate their confidence in addressing patients' sexual health concerns. OUTCOMES: Medical students and residents currently do not receive sufficient education on sexual health and medicine, particularly in fields outside of OB-GYN and Urology, leaving them underqualified and less confident than needed for adequate patient care. RESULTS: 65.6% of trainees reported receiving formal sexual health education, while 13.9% received informal education, and 20.6% received no education during medical school. Although trainees desire to understand a patients' sexual health (P < .001), only residents in a relevant field (Urology, OB-GYN) felt confident in their ability to assist patients with a sexual health issue (P = .013). All other trainees lacked confidence in attending to sexual health concerns (P < .001), regardless of training level (P > .1). CLINICAL IMPLICATIONS: More efforts should be made to integrate sexual health education into medical school curriculum. STRENGTHS & LIMITATIONS: The strength of this study includes specific evaluation of medical student and resident confidence level with 15 individual sexual health topics. The limitations include that the demographic was regionally confined to the Midwest of the United States and women were more strongly represented among medical students. CONCLUSION: Due to the lack of standardized education, medical trainees (except for Urology and OB-GYN residents) feel unprepared to treat patients with sexual health issues, and medical schools should make sexual health education mandatory. Beebe S, Payne N, Posid T, et al. The Lack of Sexual Health Education in Medical Training Leaves Students and Residents Feeling Unprepared. J Sex Med 2021;18:1998-2004.

Women in hepatopancreaticobiliary surgery: is there a pipeline problem?

BACKGROUND: Women are underrepresented in hepatopancreatobiliary (HPB) surgery. We investigated whether this is a pipeline problem by looking at the percentage of women trainees presenting at Americas Hepato-Pancreato-Biliary Association (AHPBA) and then determining their ultimate career path. METHODS: We extracted gender, level of training, and career path of first authors of abstracts presented at the 2007 and 2012 AHPBA conferences. Chi-square analysis and Fisher's exact test were used to examine gender trends. RESULTS: 85 authors in 2007 and 109 in 2012 met inclusion criteria. 16.5% of presenters were female in 2007 compared to 22.9% in 2012. Just over 50% of authors went into academic medicine in 2007 (55%) and 2012 (59%) which did not differ by gender (p = 0.868 in 2007, p = 0.174 in 2012). 41.2% of first authors from 2007 to 2012 went into an HPB related field which did not differ significantly by gender (p = 0.450 for 2007, p = 0.626 for 2012). CONCLUSION: Similar percentages of men and women who present at AHPBA ultimately obtain an HPB related job, however, more men than women trainees present at AHPBA. More efforts to encourage women to go into HPB surgery early may help eliminate this gender gap.

Mitogen- and Stress-Activated Protein Kinase 1 Regulates Status Epilepticus-Evoked Cell Death in the Hippocampus.

Mitogen-activated protein kinase (MAPK) signaling has been implicated in a wide range of neuronal processes, including development, plasticity, and viability. One of the principal downstream targets of both the extracellular signal-regulated kinase/MAPK pathway and the p38 MAPK pathway is Mitogen- and Stress-activated protein Kinase 1 (MSK1). Here, we sought to understand the role that MSK1 plays in neuroprotection against excitotoxic stimulation in the hippocampus. To this end, we utilized immunohistochemical labeling, a MSK1 null mouse line, cell viability assays, and array-based profiling approaches. Initially, we show that MSK1 is broadly expressed within the major neuronal cell layers of the hippocampus and that status epilepticus drives acute induction of MSK1 activation. In response to the status epilepticus paradigm, MSK1 KO mice exhibited a striking increase in vulnerability to pilocarpine-evoked cell death within the CA1 and CA3 cell layers. Further, cultured MSK1 null neurons exhibited a heighted level of N-methyl-D-aspartate-evoked excitotoxicity relative to wild-type neurons, as assessed using the lactate dehydrogenase assay. Given these findings, we examined the hippocampal transcriptional profile of MSK1 null mice. Affymetrix array profiling revealed that MSK1 deletion led to the significant (>1.25-fold) downregulation of 130 genes and an upregulation of 145 genes. Notably, functional analysis indicated that a subset of these genes contribute to neuroprotective signaling networks. Together, these data provide important new insights into the mechanism by which the MAPK/MSK1 signaling cassette confers neuroprotection against excitotoxic insults. Approaches designed to upregulate or mimic the functional effects of MSK1 may prove beneficial against an array of degenerative processes resulting from excitotoxic insults.

Status epilepticus stimulates NDEL1 expression via the CREB/CRE pathway in the adult mouse brain.

Nuclear distribution element-like 1 (NDEL1/NUDEL) is a mammalian homolog of the Aspergillus nidulans nuclear distribution molecule NudE. NDEL1 plays a critical role in neuronal migration, neurite outgrowth and neuronal positioning during brain development; however within the adult central nervous system, limited information is available regarding NDEL1 expression and functions. Here, the goal was to examine inducible NDEL1 expression in the adult mouse forebrain. Immunolabeling revealed NDEL1 within the forebrain, including the cortex and hippocampus, as well as the midbrain and hypothalamus. Expression was principally localized to perikarya. Using a combination of immunolabeling and RNA seq profiling, we detected a marked and long-lasting upregulation of NDEL1 expression within the hippocampus following a pilocarpine-evoked repetitive seizure paradigm. Chromatin immunoprecipitation (ChIP) analysis identified a cAMP response element-binding protein (CREB) binding site within the CpG island proximal to the NDEL1 gene, and in vivo transgenic repression of CREB led to a marked downregulation of seizure-evoked NDEL1 expression. Together these data indicate that NDEL1 is inducibly expressed in the adult nervous system, and that signaling via the CREB/CRE transcriptional pathway is likely involved. The role of NDEL1 in neuronal migration and neurite outgrowth during development raises the interesting prospect that inducible NDEL1 in the mature nervous system could contribute to the well-characterized structural and functional plasticity resulting from repetitive seizure activity.