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Teaching Sexual-History-Taking Skills to Psychiatry Residents Donald Fidler, MD, FRCP-I, Justin Petri, MD, Mark Chapman, MSIII Department of Behavioral Medicine and Psychiatry West Virginia University School of Medicine Purpose The Sexual Events Classification System Methods
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Donald Fidler, MD, FRCP-I, Justin Petri, MD, Mark Chapman, MSIIIDepartment of Behavioral Medicine and Psychiatry
West Virginia University School of Medicine
The Sexual Events Classification System
Psychiatry residents should be competent in taking a sexual history. We introduced psychiatry residents to a comprehensive and systematic method of sexual history taking, the Sexual Events Classification System (SECS), as part of a short course on sexual-history-taking skills. To determine the value of the course and the SECS, we asked the residents to complete an anonymous survey.
Seven PGY-II general psychiatry residents at West Virginia University were enrolled in a brief sexual-history-taking course. The course outline (Figure 2) contains the components of the course in the order in which the residents’ completed them. Following the course, residents were supplied with anonymous surveys to assess their perceptions of the usefulness of the course for improving their sexual-history-taking skills.
3. Individual meeting between the course instructor and each resident to offer feedback on the resident’s video recorded interview
4. Lecture Two: Residents watch actors’ renditions of “Bad” sexual interviewing techniques and then discuss ways to avoid these common mistakes
5. Outside of class the residents individually watch a simulated interview that employs “Good” sexual history taking techniques; while watching the video the residents “score” the interview using a Competency Score Sheet
The results suggest that the residents had minimal experience taking sexual histories prior to this course. The majority of the residents indicated that they found the course to be helpful in improving their abilities to be “comprehensive” and “comfortable” while taking detailed sexual histories. We were surprised to see that only 50% of the residents felt that they had made “good” improvement at being non-judgmental while taking a sexual history. The majority of the residents indicated that the SECS represented an improvement over their previous methods of taking sexual histories.
Limitations include 1) small sample size 2) resident response bias due to acquaintance with SECS creators and due to survey being an optional part of the course 4) non-specific responses to the survey questions 5) non-validation of the SECS as an instrument for sexual history taking.
In conclusion, the results of this small pilot study indicate that the SECS construct may offer a useful method for teaching residents to take in-depth and non-judgmental sexual histories. We believe that this will ultimately lead to more effective communication between clinicians and patients with improved clinical outcomes. In order to draw more definitive conclusions, it will be necessary to repeat this study at multiple training sites.
Classification and Dimensions for Gathering Information for the Sexual Events Classification System (SECS)
Sexual events are classified on six dimensions as listed below:
Dimension One: General Sexual Assessment
Dimension Two: Initial Descriptive Summary of Sexual Thoughts and Behaviors which are of Clinical Focus
Dimension Three: Characteristics of Sexual Behaviors and Fantasies of a Sexual Event or Series of Sexual Events which are of Clinical Focus
Dimension Four: Motivations and Emotions Related to a Sexual Event or Series of Sexual Events which are the Clinical Focus
Dimension Five: Factors which Impact Subject's Sexual Experiences
Dimension Six: Summary and Assessment
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4Solursh DS, Ernst JL, Lewis, RW, et al. “The human sexuality education of physicians in North American medical schools.” International Journal of Impotence Research. 2003; 15, Suppl 5, S41–S45.
Of the seven residents originally enrolled in the sexual-history-taking course, six filled out anonymous surveys of their experiences. The anonymous survey consisted of 14 items. The averaged results of the resident post-course survey are represented in Figure 3. The question options and corresponding assigned values are listed below the table.