| کلیدواژههای انگلیسی مقاله |
Medical students, Curriculum, Gender and sexual minorities, Sexual health, Sexuality, Gender identity, IntroductionNational surveys of medical students reveal students perceive that they receive insufficient training on gender and sexual health topics in medical school ( 1,- 5, ). Data from a 2008 survey of U.S. medical schools reports that schools provide between three and ten hours of training in gender and sexual health across their entire curriculum ( 1, ). This amount of training may be insufficient to adequately train medical students to address patient needs, and some authors suggest that more effort be made to incorporate topics of gender and sexuality in medicine into medical student curricula ( 4, , 5, ). The relative lack of formal education on sexual health may explain why medical students report feeling underprepared to effectively address their patients&,rsquo sexual health ( 1, , 2, ), and why few physicians routinely ask patients about sexual well-being ( 3, , 6, ). Previous studies have demonstrated an increase in student comfort addressing these topics with patients when they received formal education on these subjects ( 1, , 7, ). Although some medical schools have attempted to increase the sexual health content in their curricula ( 2, , 8, ), diverse approaches to revise and supplement medical school curricula are still needed ( 4, ). Some authors suggest that in order to be successful, novel curricular changes should approach sexual health topics through an intersectional lens, and address sexual health across multiple life stages, and in racially and ethnically diverse populations ( 4, , 9, ). Other research suggests that informal, student-initiated curricula may be another vehicle to effectively influence curriculum change in this area ( 10, ). While medical school curricula have been shown to be broadly lacking in a variety of sexual health topics, studies have demonstrated that content related to gender and sexual minorities (GSM) is especially limited ( 5, ). In a study by Obeldin-Maliver, et al, one third of U.S. medical schools do not require any curriculum content specific to GSM ( 11, ). This finding may be linked to a perception of a lack of competence in treating GSM patients among medical students, which is compounded by the urgent health care needs of these populations. Specifically, in one study, 70% of gender minorities and over 50% of sexual minorities report that they have experienced discrimination while seeking healthcare ( 5, ). Other studies have demonstrated that discrimination contributes to healthcare avoidance and subsequent health disparities in GSM patient populations, including increased rates of cardiovascular conditions, psychiatric illnesses, and lifestyle comorbidities ( 12, , 13, ).Additional training gaps exist with regard to education in intimate partner violence ( 7, ), sexuality of older adults and individuals with disabilities ( 4, ), and the inclusivity of discussions about contraception, abortion education, and prevention of sexually transmitted infections (STI) ( 3, , 4, ). In fact, only 75% of primary care physicians feel comfortable talking about sexual health and an even smaller 28% of primary care physicians feel comfortable prescribing Pre-exposure Prophylaxis (PrEP) ( 14, ). These findings support that increased attention to sexual health training during early medical education is needed to address these disparities. The goal of this study was to evaluate the effectiveness of a student-initiated lecture series to improve medical student comfort with diverse sexual health content. It also informs best practices with regard to curriculum implementation in this subject area. MethodsStudy DesignNew York Medical College School of Medicine (NYMC SOM), located in Valhalla, New York, is one of the nation&,rsquo s oldest private health sciences universities (est. 1860). The SOM provides a comprehensive educational program whose goal is to develop well-rounded medical students who will become resilient, compassionate, and skilled physicians. The SOM is proud of its strong foundational science education, diverse affiliated clinical training sites, and the commitment of its faculty and administration to medical student education. All medical students matriculated in the SOM were invited to participate in a &,lsquo Gender and Sexuality in Medicine&,rsquo seminar series via email during the 2018-2019 (n=847) and 2019-2020 (n=862) academic years. Attendance for the series was voluntary. Students who attended at least five lectures were recognized with a &,ldquo certificate of completion.&,rdquo Program assessment was accomplished using a pre-test/post-test design to collect student demographic characteristics and student comfort applying seminar material. Students who conveyed interest in the seminar series were invited to complete voluntary, anonymous pre-lecture series (n=152) and post-lecture series (n=105) surveys via google forms. Only students who attended five or more seminars were invited to complete the post lecture survey. These surveys collected student demographic characteristics and assessed student comfort applying seminar material in a variety of different ways, discussing topics presented with patients and counseling patients on lecture information (see appendix for complete list). All responses were collected with a 5-point rating scale as follows, &,ldquo 1=very uncomfortable,&,rdquo &,ldquo 2=somewhat uncomfortable,&,rdquo &,ldquo 3=neutral,&,rdquo &,ldquo 4=somewhat comfortable,&,rdquo and &,ldquo 5=very comfortable.&,rdquo Additional questions on post-lecture surveys elicited qualitative feedback for the lecture series by asking two open ended questions, &,ldquo please identify what you consider to be the strengths of the seminar series,&,rdquo and &,ldquo please identify what areas of the seminar series could be improved.&,rdquo Questions were adapted from previously published surveys to assess sexual health education amongst medical students ( 15,) .The New York Medical College institutional review board reviewed and deemed this study protocol (#12850) exempt. AnalysisData were analyzed by computing descriptive statistics to examine the demographic characteristics of the students who completed the pre and post-lecture series surveys, the attendance of each lecture in the series and the distribution of self-reported student comfort with lecture material. For each item on both the pre- and post-series surveys, we computed the percentage of students who were &,ldquo somewhat&,rdquo or &,ldquo very&,rdquo comfortable and the associated 95% confidence intervals. The extent of overlap between pre- and post-series confidence intervals was examined to determine whether the percentage of students expressing comfort was higher in post-series vs. pre-series responses. We do not report p-values as respondent questionnaires were anonymous and individual responses were not linked between pre and post surveys. Investigators conducted all analyses using the Statistical Package for the Social Sciences (SPSS IBM version 24). Qualitative responses were also evaluated to identify significant themes. Investigators initially reviewed this information independently and subsequently met as a group to resolve discrepancies in interpretations to reach consensus and final theme interpretation. Qualitative data was reviewed until no new themes emerged from the analysis. Illustrative quotes were collected to represent all salient themes.ResultsThe lecture series included fourteen lectures presented by content area experts, including clinicians, patients, and community stakeholders. Lecture topics included intimate partner violence, STIs and stigma, puberty suppression in transgender children, contraception and family planning, female genital cutting, and mental health in GSM patients (Table 1,). The topics presented were chosen by student leaders from various advocacy and specialty groups across campus including but not limited to, LGBTQ Advocacy in Medicine, Obstetrics and Gynecology Interest Group, and Medical Students for Choice. Subject matter was chosen to address identified gaps in the required medical curriculum, as well as expressed student interest. Year 1, 2018-2019AttendanceBirth Control and Family Planning96Geriatric and Palliative Care Approach of the LGBTQ Population23Perspectives from Intersex Patients54HIV Prevention, PEP and PrEP 51Female Genital Cutting60Care for the Transgender Adolescent70Callen-Lorde, Innovative practices designed for an LGBT health center52Elective Termination of Pregnancy and Miscarriage Management39Year 2, 2019-2020 |
| نویسندگان مقاله |
JASMIN MAHABAMUNUGE |
New York Medical College, Department of Medical Education, School of Medicine, Valhalla, NY, USA
KAYLA MOREL |
New York Medical College, Department of Medical Education, School of Medicine, Valhalla, NY, USA
JOHN BUDROW |
New York Medical College, Department of Medical Education, School of Medicine, Valhalla, NY, USA
INNES TOUNKEL |
New York Medical College, Department of Medical Education, School of Medicine, Valhalla, NY, USA
CASSIDY HART |
New York Medical College, Department of Medical Education, School of Medicine, Valhalla, NY, USA
CAMILLE BRISKIN |
New York Medical College, Department of Medical Education, School of Medicine, Valhalla, NY, USA
MADISON KASOFF |
New York Medical College, Department of Medical Education, School of Medicine, Valhalla, NY, USA
SARAH SPIEGEL |
New York Medical College, Department of Medical Education, School of Medicine, Valhalla, NY, USA
DONALD RISUCCI |
New York Medical College, Department of Medical Education, School of Medicine, Valhalla, NY, USA
JENNIFER KOESTLER |
New York Medical College, Department of Medical Education, School of Medicine, Valhalla, NY, USA
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