Academic journal article The Canadian Journal of Human Sexuality

Training in Sexual Health and STD Prevention in Canadian Medical Schools

Academic journal article The Canadian Journal of Human Sexuality

Training in Sexual Health and STD Prevention in Canadian Medical Schools

Article excerpt

ABSTRACT: This is the first national study to provide detailed documentation and analysis of the extent and content of sexual health topic coverage in Canadian medical school programs in undergraduate medicine, family medicine, obstetrics and gynecology, urology and psychiatry. Respondents representing 62 programs from 16 universities indicated the emphasis (topic not taught, minimal, considerable, heavy) that their training in sexuality gave to each of 19 different sexual health/STD topics. These ratings were used to identify for each field the topics that its programs might reasonably be expected to give "considerable" or "heavy" emphasis. Some programs greatly exceeded such expectation but there was considerably more program variability within each field than might have been expected given the medical relevance of the topics to their specialty. The six topics most heavily covered overall dealt with STD/HIV prevention and treatment, sexual assault/abuse, and pregnancy prevention. Other topics, such as the role of sexuality in couple relationships, sexuality and aging, sexual orientation, sexuality and disability, adolescent sexuality, and social/cultural differences in sexual beliefs and customs, received less emphasis than seemed warranted. In the fields where comparison was possible, programs with required sexuality courses generally had stronger overall coverage of all topics and of their field's expected topics in particular. The field-specific standards developed here offer a basis for assessing and strengthening sexuality education in medical training.

Key words: Sexual health STDs Medical training

INTRODUCTION

Physicians encounter a range of opportunities to address sexual health issues in practice and their medical training should therefore prepare them to recognize and respond to their patients' needs and expectations in this area of medical care (Cohen, 1995). Such training in sexuality is important because physicians are often identified by adults of both sexes as a desired source of consultation regarding sexual concerns (Metz & Siefert, 1993) and by young women as their preferred source for consultation regarding STDs, HIV/AIDS and reproductive health (Beazley, Langille, & Schmidt, 1996). The link between medicine and sexual health has been highlighted in recent years by the advent of HIV/ AIDS, ongoing concern about sexual abuse, the emergence of new biomedical treatments for sexual dysfunction (Casey, 1998; Holzapfel, 1998), greater knowledge of the various sexual side effects of commonly prescribed medications (Crenshaw, 1996; Gajewski, 1998) and by many other such factors. The Canadian Guidelines for Sexual Health Education (Health Canada, 1994) also acknowledged the role that physicians can play in sexual health protection and the importance of training in this aspect of medical care.

Physicians who incorporate information and counseling into their primary care preventive interventions do, in fact, have an impact on patients' health-related behavior (Langdon, Lazaro, & Meier, 1989) and there is evidence that physicians trained to address sexual health topics can have similar effects on sexual health behavior. For example, a study of STD prevention practices of recent graduates of family practice residency programs in Quebec found that physicians whose university provided the most extensive training in human sexuality felt better prepared to deal with patient discomfort in discussing sexual issues and felt more confident about their own preparation for such discussions (Maheaux, Haley, Rivard, & Gervais, 1995). Training may also influence the likelihood that physicians will raise sexual health topics. For example, Fisher et al. (1988) found a relationship between medical students' attitudes and their self-identified willingness to address the sexual concerns of patients. This finding is consistent with the expectation that pre-service training in sexuality has an impact on in-service practice. …

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