Continued Need of Sexuality Education in Medical Schools

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In 2011, Dr. Keith Ablow (psychiatrist and graduate of Johns Hopkins Medical School) of Fox News compared homosexuality to pedophilia when referencing transgender. He continued on to state parents should use caution when allowing their children to watch “Dancing with the Stars” since watching Chaz Bono will result in their child wanting to become transgender (Mazo, 2011). During his interview on Fox News regarding his editorial, Dr. Ablow states if he had been asked by Chaz Bono if Chaz was a man, he would reply “no you’re not”. Misinformation regarding human sexuality is everywhere including: the media, social media, and even from medical providers themselves. So how can we expect to get accurate information if those we rely on are the ones providing misinformation? And furthermore, if sexuality education is limited for medical students, then what answers are patients receiving from their doctors when asking questions regarding sex? One can only hope it is not answers and responses such as the ones provided above. 

The Liaison Committee on Medical Education (LCME) provides accreditation to over 100 medical colleges in the United States and Canada (LCME, 2015). The LCME 2014-2015 standards, published in 2013, do not specifically have human sexuality as a requirement. However, they do require many topics related to human sexuality including: behavioral, socioeconomic, each phase of the human life cycle, as well as gender and cultural biases in self and patients. But patients have to wonder, if there are not specific requirements, how can you guarantee your doctor received the proper education to be able to answer your questions?

The topic of sexuality education is one that continues to cause controversy. It is for this reason that sexuality education might vary from state to state, from county to county, and even school district to school district (Percival & Sharpe, 2012). Therefore, college level sexuality education often duplicates the topics covered in secondary education (Bruess & Schroeder, 2014, pg. 209). Bruess and Schroeder (2014) continue on to state that universities often have the freedom to approach sexuality from an honest and thorough perspective, which is frequently restricted in earlier education levels. This leads to the ability to have a more fluid and broader sexuality education program. However, sexuality education often does not continue beyond the college level. Medical students, for example, have had limited exposure to sexuality education and this often occurs only in their first year. The amount of education they receive is thought to have decreased in recent years, typically leaving them with 10 hours or less of sexuality education (Leiblum, 2001).

Adult Learning Styles

As mentioned previously, the limited consistency of sexuality education in primary and secondary schools continues to show throughout America. This inconsistency has also trickled into the education medical students receive. As a result, there is a growing need to explore best practices in the education of medical students and the need for a developed, standardized nationwide curriculum that caters to the learning styles of adults.

Malcolm Knowles (1970) theory of andragogy is the most recognized adult learning theory. This theory helps educators recognize and know the 4 assumptions of adult learners. Adult learners are/have:

  1. Self directed
  2. Life experiences and knowledge
  3. Goal oriented
  4. Immediate application of knowledge

(Knowles, 1970)

Gilbert, Sawyer, and McNeill (2011) explore the theory developed by Robert Pike in 2003, “Pike’s Laws of Adult Learning”. Within this theory there a few principles that are thought to be universal for most learners, such as:

  1. Adult learning is enhanced by experiential learning – For medical students this could be done by having them observe a mock intake of a new patient where sexuality questions are being asked.
  2. Allowing participants to create ideas, concepts, and techniques (self-directed learning) – An example of this would be having medical students break into small groups and review their take on a case study with their peers. Each group could then bring their ideas back to the larger classroom.
  3. The amount of learning and the amount of fun should be equal – Let’s be honest, no one enjoys a course that is straight lecture, so adding additional activities (small groups, case studies, panel discussions, videos, etc.) adds more dynamics to the classroom enriching the learning experience.
  4. Change in behavior shows learning occurred – This is most often shown through quizzes and tests at the end of the material. However the use of a paper will allow students to show their ability to self-reflect not just memorize and repeat information.

(Gilbert, Sawyer & McNeill, 2011)

Both of these theories show similarities in how adults learn, but it should be noted that there is still a wide range of learning styles among students, especially among adults. With this in mind, let’s begin to explore some best practices for educating medical students.

Alternative Methods to Lecture Style Classroom

We turn to our doctors to be our experts in all things related to the human body, including sexuality, but if they are not receiving an adequate sexuality based education in medical school, are they providing accurate information to their patients? The solution is simple; we need to make sexuality education more attractive to students. Silberman (1998) presented 7 alternative methods that could help to potentially increase the dynamic in the classroom and engage the students.

  • Classroom Survey – One way to collect this information is through an anonymous survey presented prior to or at the beginning of class. The survey would ask questions such as sexual experiences and sexual preferences, sexual orientation, religion and religious beliefs about sex and sexuality, gender and how one identifies, etc. The results of this survey could then be shared with the class anonymously to help each student better understand the variety of backgrounds, education, and beliefs of their classmates and soon to be medical providers.
  • Small group activities – This can formulate the Cooperative Learning Model allowing students to learn from peers (Gilbert, Sawyer, & McNeill, 2011). These interactions will give medical students the opportunity to practice asking and answering the difficult questions, exploring challenging cases, and challenging their own thoughts, myths, and beliefs, while identifying additional areas of concern or lack of knowledge. However due to the often large size of medical students classrooms, instructors should have easy and quick ways to identify and break into small groups.

  • Demonstrations – This method would allow medical students to gain a better understanding of problems, concerns, and questions patients may present in practice potentially easing concerns or uncertainties of students.
  • Panel discussion/Personal stories – One method shown to be effective with adult learners (not just medical students) is the use of personal experiences and stories. Instructors could incorporate panel discussions and guest speakers into the curriculum. It should be noted however that those people sharing personal information should be completely comfortable in doing so and that there are a variety of speakers to ensure most questions can be answered.
  • Workshops – This method of teaching can simply be having resources in the community where workshops are offered and instructors are able to refer students to. If there is a strong enough interest from the students coordination of an after hours, non-mandatory workshop private to the class would also greatly enhance the learning without the pressure of having their learning tested.
  • Case Studies – This will present medical students with real examples giving them a better idea of what they may experience in their own practice which will ultimately help them be better prepared when educating the public.
  • Role Play – This teaching method will allow students the opportunity to identify how it feels to be asking and to be asked specific questions. The role play scenarios should be developed prior to class and should fit with the specific topic being address (sexual difficulties/dysfunction, STI’s, LGBT, etc.)

All of the examples above will allow students the opportunity to take their learning past the textbook and to practice applying what they are learning from the readings and lectures. These methods will also allow instructors to test learning through the use of essays and self-reflection and less on content memorization. However it should also be noted, to aid in the development of a successful program, the instructors have to be willing and open to constantly updating the material based on the changing needs and background of the students (Leiblum, 2001).

The sexuality educational needs of medical students are apparent. Restructuring, reformatting, and providing an expectation of material is vital for medical students education. This will help prepare them to be honest and truthful when answering their patient’s questions related to sexuality and decrease misinformation and biases. This increased focus in sexuality education will allow patients to feel comfortable gaining accurate information from their doctors instead of researching potentially inaccurate facts from the internet, their peers, or other unreliable resources such as Dr. Ablow.

 

References

Bruess, C. E., & Schroeder, E. (2014). Sexuality education: Theory and practice (6th Ed.). Sudury, MA: Jones & Bartlett.

Gilbert, G. G., Sawyer, R. G., and McNeill, E. B. (2011). Health education creating strategies for school and community health (3rd Ed). Boston: Jones & Bartlett.

Knowles, M. S. (1970). The modern practice of adult education: From pedagogy to andragogy. Englewood Cliffs, NJ: Cambridge.

LCME (2015). Medical school directory. Retrieved from http://www.lcme.org/directory.htm

LCME (2013, June). Functions and structures of a medical school: Standards for accreditation of medical education programs leading to the M.D. degree. Liaison Committee on Medical Education. Retrieved from http://www.lcme.org/publications.htm

Leiblum, S. R. (2001). An established medical school human sexuality curriculum: Description and evaluation. Sexual and Relationship Therapy, 16(1). doi: 10.1080/14681990020021566

Mazo, C (2011, September 26). Meet Dr. Keith Ablow, Fox News anti-LGBT pop psychologist. Equality Matters: A Campaign for full LGBT Equality. Retrieved from: http://equalitymatters.org/blog/201109260010#Section1

Percival, K. and Sharpe, E. (2012). Sex education in schools. Geo. J. Gender & L., 13, 425.

Silberman, M. (1998). Active training: A handbook of techniques, designs, case examples, and tips (2nd Ed). San Francisco, CA: Jossey-Bass/Pfeiffer.

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3 responses to “Continued Need of Sexuality Education in Medical Schools

  1. This is quite scary. I would guess that most people go to their doctor or OBGYN when they have a question about an aspect of sexuality. Sexuality is multi-faceted. Asking the doc about physical pleasure or lack thereof, and the doc answers the question through a medical lens… Is the question really answered? There is so much that goes into sexuality. Maybe, med students and doctors don’t need more sexuality specific education but rather having the knowledge to refer out. They did not go to school to be a sexuality educator neither should we expect them to know all about sexuality. In my opinion, refer out docs!

    • Thanks for the comment. I agree doctors need to explore what it means to not have all of the information and the importance of referring (just as any helping profession needs to be able to do). I am unaware of the education they receive on how to appropriately refer patients in the proper direction, but I do hope it is something they learn.

  2. I agree, this is a little terrifying. Maybe it’s just me, but I expect doctors to know everything. The fact that there is little sexuality training is a little unnerving, because sexuality ties in to so much as a person. Now, if I have a problem related to something sexual, the first person I would go to is my Ob/Gyn, or a urologist, but I am also a girl and know I have a “girly” doctor who can attend to my “girly” needs. What happens if you are a male bodied person? Who do you see then? How can you make sure that your doctor has had accurate and appropriate training?

    Reading about Dr. Ablow’s comments made me think, “If the front office staff is getting training on LGBT and sensitivity maybe the DOCTORS should be trained as well.” Going to the doctor’s office is already nerve wracking, but to have a doctor handle a delicate situation indelicately makes it even more uncomfortable. Teacher’s are told not to give out misinformation under ANY circumstances, perhaps that message should be extended to doctors as well. It’s okay if you don’t know everything, there are people who know what you don’t and can help you out.

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