Thomson Jantien, Ross Michael W, van Deventer Heidi, Poelsma Mieke, Pienaar Marie E, du Toit Marlena, Botha Matthys H
Department of Obstetrics and Gynecology, Stellenbosch University Medical School, Cape Town 7505, South Africa.
Institute for Sexual and Gender Health, Department of Family Medicine, University of Minnesota Medical School, Minneapolis, MN 55454, United States.
Sex Med. 2023 Jul 11;11(3):qfad035. doi: 10.1093/sexmed/qfad035. eCollection 2023 Jun.
Sexual history-taking competence in medical students is an essential skill that they need to acquire. It requires them to learn to develop comfort in using sexuality-related language and raising the subject with patients. Sexual history exploration skills are inadequately taught in a significant number of medical schools.
We studied comfort levels in using sexuality-related language in medical students who had no training yet in history taking.
First-year medical students in a South African university engaged in an exercise in pairs-a dyad-alternating the role of interviewer and interviewee. Provided questions and answers were offered to the students, who videotaped their dyad interview and uploaded it to a safe university environment for peer review.
As part of the exercise, students rated their comfort in the interview for 35 questions on a 5-point Likert scale. Students then participated in online discussion forums with fellow students and tutors on their experience.
Students posing the questions, the interviewers, were significantly more comfortable with the questions than interviewees. Total comfort scores over the 35 questions showed a roughly normal distribution for both. Questions with explicit sexual behavior or vocabulary were rated more uncomfortable by interviewers as well as interviewees. The total scores for interviewers showed a distribution with a longer tail toward discomfort. Female interviewees were significantly more uncomfortable than male interviewees, but this was not the case for interviewers. Dyads of 2 females were significantly more uncomfortable than mixed-gender and 2-male dyads. Qualitative data showed wide acceptance of the exercise by students, with increasing confidence and comfort in using sexually explicit terms in strong appreciation of the responder's perspective in the exercise, as well as awareness that receiving a question-the patient's position-is more uncomfortable.
Data indicate that comfort assessment in asking sexuality-related questions with expected different levels of comfort and discomfort is a valuable measure that can evaluate progress in this skill. The data also suggest the need for students to select profiles and questions to provide a trauma-informed approach, knowing that some of the medical students will have experienced sexually related trauma, as in the general population.
This study provides a method and student feedback in teaching sexual history elicitation and increasing comfort with sexual language in a clinical context. The study is limited to first-year medical students.
Histories with provided questions and answers allow for rating of comfort and provision of trauma-informed education in developing sexual history exploration clinical skills.
医学生的性史询问能力是他们需要掌握的一项基本技能。这要求他们学会自如地运用与性相关的语言，并向患者提出相关问题。然而，相当数量的医学院校在性史探索技能方面的教学并不充分。
我们研究了尚未接受病史询问培训的医学生在使用与性相关语言时的自在程度。
南非一所大学的一年级医学生两人一组进行练习——即二元组，轮流扮演采访者和受访者的角色。为学生提供了问题及答案，他们对二元组访谈进行录像，并上传至安全的大学环境以供同伴评审。
作为练习的一部分，学生们就35个问题在5点李克特量表上对自己在访谈中的自在程度进行评分。随后，学生们与同学和导师参与了关于此次经历的在线讨论论坛。
提出问题的学生，即采访者，对这些问题的自在程度明显高于受访者。35个问题的总自在得分在两者中大致呈正态分布。涉及明确性行为或词汇的问题，采访者和受访者都认为更令人不自在。采访者的总分分布显示，在不自在方面有更长的尾巴。女性受访者比男性受访者明显更不自在，但采访者并非如此。两名女性组成的二元组比男女混合组和两名男性组成的二元组明显更不自在。定性数据表明学生对该练习广泛接受，在强烈赞赏练习中回应者观点的情况下，对使用露骨的性术语越来越有信心且更自在，同时也意识到作为接受问题的一方——即患者的立场——会更不自在。
数据表明，对询问与性相关问题时预期的不同自在和不自在程度进行自在程度评估，是一项有价值的衡量标准，可用于评估这项技能的进展情况。数据还表明，鉴于一些医学生如同普通人群一样可能经历过与性相关的创伤，学生需要选择案例和问题，以提供一种创伤知情的方法。
本研究提供了一种在临床环境中教授性史引出及提高对性语言自在程度的方法和学生反馈。该研究仅限于一年级医学生。
带有提供的问题及答案的病史可用于自在程度评分，并在培养性史探索临床技能时提供创伤知情教育。
