http://informahealthcare.com/jic ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, 2014; 28(4): 317–322 ! 2014 Informa UK Ltd. DOI: 10.3109/13561820.2014.884553
ORIGINAL ARTICLE
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Student perspectives on sexual health: implications for interprofessional education Lauren Penwell-Waines1, Christina K. Wilson2, Kathryn R. Macapagal1, Abbey K. Valvano1, Jennifer L. Waller3,4, Lindsey M. West5 and Lara M. Stepleman1,3 1
Department of Psychiatry and Health Behavior, Georgia Regents University Medical College of Georgia, Augusta, GA, USA, Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, Atlanta, GA, USA, 3Educational Innovation Institute, Georgia Regents University Medical College of Georgia, Augusta, GA, USA, 4Department of Biostatistics, Georgia Regents University Medical College of Georgia, Augusta, GA, USA, and 5Department of Psychology, Georgia Regents University, Augusta, GA, USA
2
Abstract
Keywords
Interprofessional collaboration requires that health professionals think holistically about presenting concerns, particularly for multimodal problems like sexual dysfunction. However, health professions students appear to receive relatively little sexual health education, and generally none is offered on an interprofessional basis. To assess current degree of interprofessional thinking in sexual health care, 472 health professions students in Georgia, United States, were presented with a sexual dysfunction vignette and asked to rate the relevance of, and their familiarity with, interventions offered by several professionals. They also were asked to identify the most likely cause of the sexual dysfunction. Students rated relevance and familiarity with interventions as highest for physicians and lowest for dentists, with higher ratings of nurses by nursing students. More advanced students reported greater familiarity with mental health, physician, and physical therapy interventions. Finally, nursing students were less likely to attribute the dysfunction to a physical cause. These findings indicate that students may prioritize biomedical approaches in their initial assessment and may need additional supports to consider the spectrum of biopsychosocial factors contributing to sexual functioning. To encourage interprofessional critical thinking and prepare students for interprofessional care, sexual health curricula may be improved with the inclusion of interprofessional training. Specific recommendations for curriculum development are offered.
Interprofessional care, interprofessional education, sexual health, survey
Introduction The widespread adoption of an integrated care paradigm necessitates a reconsideration of current models of health professions education with a focus on innovative training models to prepare current and future generations of health professionals to work effectively as a team. Current research indicates that teams operate more effectively and collegially when team members actively engage in interprofessional learning activities (Bluestein & Cubic, 2009; Curran, Mugford, Law, & MacDonald, 2005; Fronek, Booth, Kendall, Miller, & Geraghty, 2005). Further, interprofessional courses have been associated with a deeper understanding of topics, enhanced generalization of knowledge, and improved critical thinking skills (Ivanitskaya, Clark, Montgomery, & Primeau, 2002). Interprofessional education (IPE) has been identified by organizations across health professions as an effective method of training different professions on working collaboratively, as it involves health professions students learning with and from one another in the context of patient care (Interprofessional Education Collaborative, 2011).
Correspondence: Lauren Penwell-Waines, PhD, Department of Psychiatry and Health Behavior, Georgia Regents University Medical College of Georgia, 997 St Sebastian Way, Augusta 30912, GA, USA. E-mail: [email protected]
History Received 10 June 2013 Revised 15 November 2013 Accepted 14 January 2014 Published online 18 February 2014
Though interprofessional competencies are transferable across settings, health professionals, and disease states by design, some health issues (i.e. sexual health) may benefit from targeted interprofessional education. Presenting sexual health concerns may be addressed by providers across numerous specialties (urology, reproductive health, psychiatry, neurology, etc.) and within primary care and often involve physiological, behavioral, cultural, interpersonal, and intrapersonal features (Parish & Clayton, 2007; Shindel & Parish, 2013). Thus, the ability to think critically and comprehensively about sexual health concerns is facilitated using an interprofessional approach to training. Though sexual health is inherently interprofessional in nature, it historically has received little attention in health professions education (Ford, Barnes, Rompalo, & Hook, 2013; Parish & Clayton, 2007; Shindel & Parish, 2013). Even among researchers who advocate for more comprehensive sexual health training, the recommendations often are focused on training in the medical professions, without specific mention of an interprofessional approach (e.g. Ford et al., 2013). Many health professionals acknowledge the importance of their patients’ sexual health, but report feeling undertrained and/or uncomfortable to assess and treat sexual concerns (Parish & Clayton, 2007; Wittenberg & Gerber, 2009). As such, the World Health Organization has proposed curriculum standards that are designed to encourage an interprofessional conceptualization of sexual health, targeting the
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skills, attitudes, and knowledge of future healthcare providers (Mace, Bannerman, & Burton, 1974; and reiterated in Parish & Clayton, 2007). Curriculum content includes such topics as biopsychosocial aspects of sexual development, reproductive physiology, recognizing sexual dysfunction, and cultural and interpersonal aspects of sex, among others. When a model of this curriculum was implemented within an interprofessional group of health professionals providing care for individuals with spinal cord injuries, providers receiving the training reported improvements in their skills, attitude, and knowledge surrounding sexual health care (Fronek et al., 2005). Though this curriculum was proposed decades ago and has been shown to be effective when utilized, recent evaluations of this interprofessional model still indicate a lack of comprehensive sexual health education, leaving students and providers continuing to feel underprepared to deal with many sexual health topics (Shindel & Parish, 2013). Given that the superordinate goal of IPE is ‘‘to have health professions students interact to improve collaborative practice and overall care of patients’’ (Reeves et al., 2008, p. 3), sexual health education presents itself as an exciting opportunity to implement and advance interprofessional critical thinking and competencybuilding around sexual health care. The present study sought to assess the extent to which health profession students differ in their conceptualization of sexual health concerns and the role of other health professionals in sexual health care, reflecting their proclivity (or lack thereof) for collaborative thought. To assess conceptualizations of sexual dysfunction, we used a clinical vignette to elicit diagnostic considerations, similar to what might be used in problem-based learning. We expected that students would offer intraprofessional conceptualizations of sexual dysfunction (e.g. students in a medically-oriented field such as medicine or dentistry would classify the problem as a physical issue, whereas students in mental health would be more likely to identify a psychosocial cause for the dysfunction). Next, to assess the potential for referral to and/or collaboration with another provider, we examined students’ perceived relevance of and familiarity with interventions offered by several health professions. Again, we hypothesized that students would be most likely to be familiar with and perceive as relevant the interventions offered in their own field of study, given the current lack of interprofessional training in sexual health. We believe that the results of the study could help identify training gaps within and across health professions education and inform the development of interprofessional sexual health curricula.
Methods Participants Of the approximately 1600 students sent the survey, 496 at least partially completed it (a response rate of 31%). Participants providing complete information for the current analyses were 472 health professions students from degree-granting programs in the colleges of allied health sciences (physical therapy, occupational therapy, physician assistant, n ¼ 93), dentistry (n ¼ 48), nursing (n ¼ 31), medicine (n ¼ 269), and psychology graduate programs (n ¼ 31). Demographic information about the sample is presented in Table I. Activities and measures Sexual dysfunction vignette Participants were presented with a case vignette and asked to name the one most likely cause for the patient’s sexual dysfunction in a free-text format, as students are taught to begin with one diagnosis to determine etiology and treatment. The vignette was based on research indicating the utility of using
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Table I. Demographics of student participants (n ¼ 472). Characteristics Gender Female Male Ethnicity White Asian Black Other Sexual Orientation Heterosexual Not heterosexual
Age Proportion of current degree program completed
n
%
288 181
61.41 38.59
340 61 43 20
73.28 13.15 9.27 4.31
443 24
94.86 5.14
M
SD
25.8 0.47
4.7 0.29
such vignettes in interprofessional training (Allan, Campbell, Guptill, Stephenson, & Campbell, 2006; Curran et al., 2005; Reeves et al., 2008) and was developed with input from a faculty member from each health profession represented in the student sample to ensure relevance of content across health professions and experience level. The vignette was specifically designed to offer case-related information evoking both medical and psychosocial diagnostic possibilities. The vignette was as follows: A 55-year-old married woman requests an appointment because ‘‘I’m just not interested in sex anymore.’’ She works full-time as an engineer and is the primary caregiver to her aging mother. She reports no major health problems except for chronic headaches and a lower back injury for which she had surgery six months ago. She states that she still has mild back pain but with less frequency and intensity than before the surgery. Since her surgery, she reports some bladder control problems. She takes no medications except for a daily multivitamin and Tylenol with codeine as needed for pain.
Relevance and familiarity ratings Following presentation of the case vignette, participants were asked to rate their understanding of relevance of each identified provider in the treatment of the patient presented in the vignette (e.g. ‘‘Mental health providers have a relevant role in the treatment of sexual health issues with this patient’’). They also were asked to rate their familiarity with each provider’s role in treatment (e.g. ‘‘I am familiar with the interventions a nurse could offer to improve health issues impacting sexual dysfunction’’). Participants responded to items using a Likert-type scale with response options ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). Procedure Students of medicine, dentistry, nursing, and allied health1 at a public southeastern health sciences university were recruited voluntarily and completed their surveys within the university’s 1
Allied health sciences generally refers to a group of professions which provide a wider ‘‘spectrum of care,’’ often in conjunction with traditional medical care and may include such professionals as occupational therapists, physical therapists, and dietitians, among others (Upton & Upton, 2006). At the health sciences university in the present study, the College of Allied Health Sciences includes such majors as occupational therapy, physical therapy, and physician assistant among others.
IPE for sexual health
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Results
online evaluation system. Because mental health is a key component of sexual health and the university has no graduate programs in psychology, graduate psychology students were invited to participate voluntarily in the study via e-mails sent to program chairs in mental health, counseling, and psychology programs in the state, as well as two listservs of mental health professionals and students maintained by statewide professional organizations (to reduce regional differences); they submitted their responses using SurveyMonkey. Given the number of specialties and majors possible within the health sciences university, data were collected for comparison at the college level. Participants were given the option to provide additional information about specialization within their programs; however, only about one-third of the sample elected to do so. All study participants provided informed consent electronically prior to beginning the survey. Participants then completed the measures described herein, which were part of a larger study of attitudes and experience with various sexual health training issues. Data were collected anonymously for six weeks beginning in January 2012. Upon completion of the study, participants were invited to enter into a raffle for one of the fifteen $50 Amazon.com gift cards. Approval for the study was obtained by the university’s institutional review board in November 2011.
Sexual dysfunction vignette Controlling for the proportion of the current degree program completed, student profession was significantly associated with classification of the vignette as physical (p ¼ 0.039), such that nursing students were less likely to identify a physical problem in the vignette (OR ¼ 0.25, CI ¼ 0.08–0.80). Allied health (OR ¼ 0.42, CI ¼ 0.17–1.07), dentistry (OR ¼ 0.83, CI ¼ 0.29–2.44), and medicine (OR ¼ 0.69, CI ¼ 0.29–1.65) students did not differ from MH graduate students in identifying a physical or psychological cause for the case presented. Across the sample, physical causes were listed in 59.9% of responses. Relevance and familiarity ratings Across student group, there were significant differences among students’ overall ratings of each profession’s relevance to treatment. Specifically, physicians’ roles were rated as being the most relevant to treatment of sexual dysfunction, followed by mental health, then nurses, PT, OT, and finally dentists with post hoc pair-wise comparisons being significant at p50.0001 (overall mean ratings provided in the last column of Table II); only PT and OT mean relevance ratings did not differ significantly from each other. In the examination of relevance ratings within each student group, interaction effects indicated that nursing students rated nurses as more relevant than they rated other providers; they also rated nurses as more relevant than did the other student groups (Table II). There also were significant differences in mean ratings for familiarity with provider intervention when collapsing across student group (overall mean ratings provided in last column of Table III). The order of highest to lowest familiarity ratings mirrored those observed in the relevance ratings (i.e. health professions students were most familiar with interventions provided by physicians, followed by familiarity with MH interventions, etc.), with post hoc pair-wise comparisons significant at p50.0001. Across student group, familiarity ratings did not differ between nurses and PT providers. As with the relevance ratings, nursing students rated their familiarity as higher with interventions offered by nurses than with interventions offered by other health professionals; they also rated their familiarity with nursing interventions higher than other student groups rated their familiarity with this profession’s interventions (Table III). Pearson correlation coefficients were determined between relevance and familiarity ratings for each provider type (Table IV). All correlations were in the moderate range and were significantly different from zero. Finally, linear regression was used to examine the relationship of the proportion of training completed in students’ current degree programs on relevance and familiarity ratings. There were no
Data analysis Responses to the sexual dysfunction vignette were coded as to whether the initial diagnostic assessment indicated primarily a physical or psychological cause. If respondents listed more than one cause, only the first response was coded (n ¼ 37). Examples of a physical cause for sexual dysfunction in the patient presented included injury, menopause, neurological causes, bladder control problems, or medication side effects, among others. Examples of psychological causes for sexual dysfunction included stress and depression. Logistic regression was employed to examine differences in endorsement of psychological or physical cause by student field of study. Psychological explanations of dysfunction were set as the comparison group to compute an odds ratio by student field of study. Proportion of current health sciences program completed was used as a control variable in the logistic regression, as it was associated with greater familiarity of mental health (MH) interventions, and greater familiarity with these interventions could impact identification of cause as psychological. A one-way ANOVA was performed separately for relevance ratings and familiarity ratings to examine differences in relevance and familiarity of various providers to the treatment described in the case vignette. Post hoc multiple comparisons were performed using a Tukey–Kramer multiple comparison procedure to control the overall alpha level. Statistical analyses were performed using SAS 9.3 (Cary, NC).
Table II. Mean relevance ratings for healthcare provider by student field of study. Student participant field of study Medicine
Nursing
Allied Health
Dentistry
Mental Health
Provider profession being rated
Mean
SD
Mean
SD
Mean
SD
Mean
SD
Mean
SD
F-value
Mental Health Nurse OT Physician PT Dentist
4.23 3.69 3.43 4.37 3.52 2.27
0.78 0.89 0.98 0.64 1.05 1.09
4.16 4.35 3.39 4.35 3.58 2.33
0.90 0.61 1.12 0.71 1.09 1.15
4.16 3.83 3.66 4.45 3.53 2.09
0.74 0.75 1.02 0.60 1.05 1.00
3.90 3.81 3.35 4.23 3.50 2.94
0.86 0.82 0.85 0.67 0.90 1.00
4.22 3.88 2.59 4.31 3.56 1.75
0.66 1.13 0.95 1.00 0.95 0.84
1.95 4.55* 7.03** 0.83 0.04 7.49**
*p50.05; **p50.0001.
Overall mean rating (SD) 4.18 3.78 3.41 4.36 3.53 2.27
(0.78) (0.87) (1.01) (0.67) (1.03) (1.08)
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Table III. Mean familiarity ratings for healthcare provider by student field of study. Student Participant Field of Study Medicine
Nursing
Allied Health
Dentistry
Mental Health
Provider profession being rated
Mean
SD
Mean
SD
Mean
SD
Mean
SD
Mean
SD
F-value
Mental Health Nurse OT Physician PT Dentist
3.03 2.58 2.43 3.64 2.54 1.93
1.13 1.07 1.03 0.99 1.07 0.99
3.10 3.94 2.32 3.32 2.77 1.87
1.01 0.93 0.87 0.94 1.15 0.85
3.15 2.91 3.09 3.63 3.25 2.05
1.11 0.92 1.03 0.98 1.09 0.98
2.89 2.85 2.47 3.28 2.64 2.74
1.07 0.98 0.91 1.08 0.92 0.97
3.03 2.65 2.13 3.12 2.58 1.74
1.17 1.31 0.92 1.18 1.15 0.86
0.45 12.45* 9.30* 3.37** 7.61* 7.93*
Overall mean rating (SD) 3.05 2.77 2.54 3.55 2.71 2.02
(1.12) (1.09) (1.04) (1.01) (1.10) (1.00)
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*p50.0001; **p50.05. Table IV. Correlation between relevance and familiarity by provider type. Provider type
Pearson’s r
Mental Health Nurses PT Physicians OT Dentists
0.29 0.32 0.34 0.35 0.38 0.47
All p50.0001.
statistically significant associations with proportion of program completed and relevance ratings. However, familiarity with interventions offered by MH professionals, physicians, and PTs showed significant positive associations with the proportion of the program completed, indicating that with more training, students were more familiar with MH, physician and PT professionals (R2 ¼ 0.05, t ¼ 4.81, p50.001 for MH professionals; R2 ¼ 0.05, t ¼ 4.90, p50.001 for physicians; R2 ¼ 0.01, t ¼ 2.24, p50.05 for PT).
Discussion Sexual health issues typically necessitate an interprofessional approach to diagnosis and care, which often is not offered within health professions education (McCabe et al., 2010; Parish & Clayton, 2007). Thus, the purpose of the present study was to assess the current level of interprofessional conceptualizations of sexual dysfunction among health professions students by examining their responses to a diagnostic case vignette and their level of familiarity and relevance with sexual health interventions provided by other professionals. With regard to conceptualization of a sexual dysfunction vignette, nursing students were less likely to identify a physical cause for sexual dysfunction compared to other students; there were no differences in identification of a physical cause among other health professions students. This finding indicates that most health professions students may be more likely to prioritize the physical aspects of sexuality over psychosocial aspects in initial case conceptualizations. A narrow focus on physiology and lack of interprofessional care is a common criticism of sexual health education and treatment as it currently stands (e.g. Allan et al., 2006; Ford et al., 2013; Parish & Clayton, 2007), though possibly less so in the nursing field (Allan et al., 2006). The results of the current study provide further support for this observation, though they should be considered in the context of study design limitations discussed herein. Overall, health professions students were most familiar with the interventions that would be provided by physicians,
MH providers, and nurses, in that order, and also rated these professionals as being most relevant to the care of the patient in the vignette. This finding suggests that there may be a particular need for training regarding the roles of professions rated lower (e.g. OT and PT), as their interventions can be fundamental to sexual health care. Relevance and familiarity ratings were modestly correlated across groups. This finding may indicate that students who are more familiar with interventions offered by other professions are more likely to view them as relevant in the treatment of sexual dysfunction. This suggests a need to familiarize students with interventions offered by other professionals to encourage more holistic thinking in the diagnosis and treatment of sexual dysfunction. Additionally, more advanced students were more familiar with physician, MH, and PT professionals’ interventions, suggesting that greater exposure to or awareness of other professions likely occurs with more training. This also is consistent with the literature; for example, previous attempts to employ an interprofessional education approach to HIV/AIDS care resulted in students’ increased knowledge of roles of various providers in the care of HIV/AIDS patients and how to collaborate with providers more effectively (Curran et al., 2005). A similar approach could be beneficial in increasing the potential for effective collaboration in the treatment of sexual dysfunction. That the majority of students identified as their first choice a physical cause for sexual dysfunction and were most familiar with or perceived as most relevant medical interventions suggests students may at times need to be prompted to think beyond their initial case conceptualizations and consider additional aspects of sexuality in order to provide holistic treatment. There is a clear emphasis on the biomedical contributions to problems in the instruction of clinical reasoning skills, particularly in medical schools (Fulks, Boudreau, & Cassell, 2009), which may at times lead to a restricted list of differential diagnoses being considered. Of course, medical causes often need to be ruled out before proceeding with any intervention, though there has been a call to move away from a strictly disease-focused paradigm (Ford et al., 2013). The familiarity and relevance ratings do reflect a need to familiarize students with the multidimensional nature of sexual dysfunction and how various providers’ expertise can be utilized to effectively treat the patient as a whole. Restated here is the idea that before providers can adopt an interprofessional approach to care, they must receive adequate training about the roles of other professional and how to work effectively with them as a team. Current thought is that IPE can be an effective means in which to acquire this training and promote more holistic critical thinking (IPEC, 2011; Ivanitskaya et al., 2002). Although several studies emphasize the importance of an interprofessional approach in sexual health education, fewer have provided specific recommendations for a comprehensive, interprofessional sexual health curriculum.
IPE for sexual health
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DOI: 10.3109/13561820.2014.884553
The recommendations for interprofessional curricula generally can be categorized into process and content factors. With regard to process, previous evaluations of IPE have indicated that the frequency and quality of contact among professions is important. For example, health professions students have expressed a preference and greater perceived benefit of regular (though not necessarily weekly) contact with other students in small groups that allow for meaningful discussions about content presented in classes (Rosenfield, Oandasan, & Reeves, 2011). Direct contact between professions on sexual health education is warranted since there is not solid evidence for transfer of learning from one member of a team to another member who did not complete training (Fronek et al., 2005). This point underscores the importance of process factors, as learning how to interact professionally and effectively is as critical in facilitating interprofessional referrals and teamwork as is having content knowledge of other specialties’ interventions for sexual dysfunction (Foley, Wittmann, & Balon, 2010; IPEC, 2011). Structured activities in which interprofessional learning can occur may include problem-based learning (e.g. similar to the vignette used in the present study and in Allan et al., 2006), use of a standardized patient presenting with sexual dysfunction, role playing interactions focusing on sexual health, or small group discussion of video clips or cases (Curran et al., 2005; Parish & Rubio-Aurioles, 2010; Reeves et al., 2008). The standardized patient and role-play methods have been rated favorably by students (Curran et al., 2005; Parish & Rubio-Aurioles, 2010). Throughout the activities, scenarios and content presented should model realistic scenarios as closely as possible (Luke et al., 2009; Rosenfield, Oandasan, & Reeves, 2011). Following interactions, critical reflection is important for all group members regarding their own professional identity and values, reactions to sexual health discussions, and peer feedback to facilitate ongoing intrapersonal and interpersonal growth (Luke et al., 2009; Sargeant, 2009). Within these activities, there are several key content areas that must be covered in a comprehensive sexual health curriculum. Students must understand the multiple determinants of sexual health and sexual dysfunction, including but not limited to basic anatomy and physiology, endocrinology, common medical comorbidities, and intrapersonal, interpersonal, and cultural aspects of sexuality, as well as issues unique to working with individuals across the lifespan, sexual orientations, and gender identities (Dunn & Abulu, 2010; Dixon-Woods et al., 2002; Foley et al., 2010; Parish & Rubio-Aurioles, 2010). These areas are important factors for consideration in a thorough sexual history taking, which must be taught explicitly given patient reports about the significance of having a provider who is comfortable discussing sexual health (Foley et al., 2010; Wittenberg & Gerber, 2009). Education about the roles and responsibilities of team members (e.g. interventions typically provided to improve sexual health) also must be part of the curriculum (Frenk et al., 2010). Finally, in addition to being modeled and practiced in the process component, factors for effective teamwork and communication should be presented in curriculum content (e.g. using health informatics, how to give feedback, using language about sexuality appropriately and comfortably) (Foley et al., 2010; IPEC, 2011; Parish & Clayton, 2007; Parish & Rubio-Aurioles, 2010). This study was novel in that it used a sizeable and diverse health professions student sample to compare clinical assessment and perceptions of familiarity and relevancy of different types of health professions in the care of a patient with sexual health concerns. Yet, there are several limitations in the present study that must be acknowledged when interpreting the results. Generalizability may be somewhat limited given the relative regional homogeneity of the sample and the possibility that
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participants who most value sexual health and/or interprofessional studies may be more likely to participate in a voluntary study such as this. Also regarding generalizability, the sample size within some health professions categories was quite small and there were other health professions students who were not queried (such as pharmacy students, as there is not a degree-granting pharmaceutical sciences program on campus). Further, not all participants provided information on majors or specialty areas within their respective programs, precluding a more specific analysis of relevance and familiarity ratings (particularly within the College of Allied Health Sciences). Future studies should consider a multi-site design to ensure more robust and diverse health profession student samples. There are several additional limitations in study design that must be acknowledged. Recruitment and survey administration mechanism did differ between psychology students and other health professions students (i.e. SurveyMonkey link sent via listservs versus an e-mail directed to a self-contained research system in the health sciences university); it is unknown how these different methods may have affected study participation. Also, the cross-sectional nature of the study limits conclusions that can be drawn about the impact of relevance and familiarity ratings on interprofessional thought processes (e.g. diagnostic assessment of sexual dysfunction and potential for interprofessional collaboration). Finally, although the vignette was designed to encourage medical and psychosocial explanations for sexual dysfunction (a strength of the study), students were asked to identify the one most likely cause; thus, the results must be interpreted in light of this limitation. Future studies can extend this research by examining more specifically the influence of IPE on diagnostic assessment, attitudes about other providers, and frequency of collaboration.
Concluding comments Health professions students and providers generally have limited training in sexual health and may be underequipped to treat sexual dysfunction using an interprofessional approach that can more broadly address patient needs. The present study indicated that health professions students are most likely to prioritize a physical cause for sexual dysfunction, and they are most familiar with and perceive as most relevant the medical interventions that would be provided. This is consistent with the literature that suggests a lack of IPE and treatment in sexual health. IPE for sexual health has the potential to provide an innovative way to address the gaps in knowledge, skills, and attitudes that may act as barriers to interprofessional care.
Declaration of interest The authors declare no conflicts of interest. The authors are responsible for the writing and content of this paper
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ORIGINAL ARTICLE
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Student perspectives on sexual health: implications for interprofessional education Lauren Penwell-Waines1, Christina K. Wilson2, Kathryn R. Macapagal1, Abbey K. Valvano1, Jennifer L. Waller3,4, Lindsey M. West5 and Lara M. Stepleman1,3 1
Department of Psychiatry and Health Behavior, Georgia Regents University Medical College of Georgia, Augusta, GA, USA, Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, Atlanta, GA, USA, 3Educational Innovation Institute, Georgia Regents University Medical College of Georgia, Augusta, GA, USA, 4Department of Biostatistics, Georgia Regents University Medical College of Georgia, Augusta, GA, USA, and 5Department of Psychology, Georgia Regents University, Augusta, GA, USA
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Abstract
Keywords
Interprofessional collaboration requires that health professionals think holistically about presenting concerns, particularly for multimodal problems like sexual dysfunction. However, health professions students appear to receive relatively little sexual health education, and generally none is offered on an interprofessional basis. To assess current degree of interprofessional thinking in sexual health care, 472 health professions students in Georgia, United States, were presented with a sexual dysfunction vignette and asked to rate the relevance of, and their familiarity with, interventions offered by several professionals. They also were asked to identify the most likely cause of the sexual dysfunction. Students rated relevance and familiarity with interventions as highest for physicians and lowest for dentists, with higher ratings of nurses by nursing students. More advanced students reported greater familiarity with mental health, physician, and physical therapy interventions. Finally, nursing students were less likely to attribute the dysfunction to a physical cause. These findings indicate that students may prioritize biomedical approaches in their initial assessment and may need additional supports to consider the spectrum of biopsychosocial factors contributing to sexual functioning. To encourage interprofessional critical thinking and prepare students for interprofessional care, sexual health curricula may be improved with the inclusion of interprofessional training. Specific recommendations for curriculum development are offered.
Interprofessional care, interprofessional education, sexual health, survey
Introduction The widespread adoption of an integrated care paradigm necessitates a reconsideration of current models of health professions education with a focus on innovative training models to prepare current and future generations of health professionals to work effectively as a team. Current research indicates that teams operate more effectively and collegially when team members actively engage in interprofessional learning activities (Bluestein & Cubic, 2009; Curran, Mugford, Law, & MacDonald, 2005; Fronek, Booth, Kendall, Miller, & Geraghty, 2005). Further, interprofessional courses have been associated with a deeper understanding of topics, enhanced generalization of knowledge, and improved critical thinking skills (Ivanitskaya, Clark, Montgomery, & Primeau, 2002). Interprofessional education (IPE) has been identified by organizations across health professions as an effective method of training different professions on working collaboratively, as it involves health professions students learning with and from one another in the context of patient care (Interprofessional Education Collaborative, 2011).
Correspondence: Lauren Penwell-Waines, PhD, Department of Psychiatry and Health Behavior, Georgia Regents University Medical College of Georgia, 997 St Sebastian Way, Augusta 30912, GA, USA. E-mail: [email protected]
History Received 10 June 2013 Revised 15 November 2013 Accepted 14 January 2014 Published online 18 February 2014
Though interprofessional competencies are transferable across settings, health professionals, and disease states by design, some health issues (i.e. sexual health) may benefit from targeted interprofessional education. Presenting sexual health concerns may be addressed by providers across numerous specialties (urology, reproductive health, psychiatry, neurology, etc.) and within primary care and often involve physiological, behavioral, cultural, interpersonal, and intrapersonal features (Parish & Clayton, 2007; Shindel & Parish, 2013). Thus, the ability to think critically and comprehensively about sexual health concerns is facilitated using an interprofessional approach to training. Though sexual health is inherently interprofessional in nature, it historically has received little attention in health professions education (Ford, Barnes, Rompalo, & Hook, 2013; Parish & Clayton, 2007; Shindel & Parish, 2013). Even among researchers who advocate for more comprehensive sexual health training, the recommendations often are focused on training in the medical professions, without specific mention of an interprofessional approach (e.g. Ford et al., 2013). Many health professionals acknowledge the importance of their patients’ sexual health, but report feeling undertrained and/or uncomfortable to assess and treat sexual concerns (Parish & Clayton, 2007; Wittenberg & Gerber, 2009). As such, the World Health Organization has proposed curriculum standards that are designed to encourage an interprofessional conceptualization of sexual health, targeting the
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skills, attitudes, and knowledge of future healthcare providers (Mace, Bannerman, & Burton, 1974; and reiterated in Parish & Clayton, 2007). Curriculum content includes such topics as biopsychosocial aspects of sexual development, reproductive physiology, recognizing sexual dysfunction, and cultural and interpersonal aspects of sex, among others. When a model of this curriculum was implemented within an interprofessional group of health professionals providing care for individuals with spinal cord injuries, providers receiving the training reported improvements in their skills, attitude, and knowledge surrounding sexual health care (Fronek et al., 2005). Though this curriculum was proposed decades ago and has been shown to be effective when utilized, recent evaluations of this interprofessional model still indicate a lack of comprehensive sexual health education, leaving students and providers continuing to feel underprepared to deal with many sexual health topics (Shindel & Parish, 2013). Given that the superordinate goal of IPE is ‘‘to have health professions students interact to improve collaborative practice and overall care of patients’’ (Reeves et al., 2008, p. 3), sexual health education presents itself as an exciting opportunity to implement and advance interprofessional critical thinking and competencybuilding around sexual health care. The present study sought to assess the extent to which health profession students differ in their conceptualization of sexual health concerns and the role of other health professionals in sexual health care, reflecting their proclivity (or lack thereof) for collaborative thought. To assess conceptualizations of sexual dysfunction, we used a clinical vignette to elicit diagnostic considerations, similar to what might be used in problem-based learning. We expected that students would offer intraprofessional conceptualizations of sexual dysfunction (e.g. students in a medically-oriented field such as medicine or dentistry would classify the problem as a physical issue, whereas students in mental health would be more likely to identify a psychosocial cause for the dysfunction). Next, to assess the potential for referral to and/or collaboration with another provider, we examined students’ perceived relevance of and familiarity with interventions offered by several health professions. Again, we hypothesized that students would be most likely to be familiar with and perceive as relevant the interventions offered in their own field of study, given the current lack of interprofessional training in sexual health. We believe that the results of the study could help identify training gaps within and across health professions education and inform the development of interprofessional sexual health curricula.
Methods Participants Of the approximately 1600 students sent the survey, 496 at least partially completed it (a response rate of 31%). Participants providing complete information for the current analyses were 472 health professions students from degree-granting programs in the colleges of allied health sciences (physical therapy, occupational therapy, physician assistant, n ¼ 93), dentistry (n ¼ 48), nursing (n ¼ 31), medicine (n ¼ 269), and psychology graduate programs (n ¼ 31). Demographic information about the sample is presented in Table I. Activities and measures Sexual dysfunction vignette Participants were presented with a case vignette and asked to name the one most likely cause for the patient’s sexual dysfunction in a free-text format, as students are taught to begin with one diagnosis to determine etiology and treatment. The vignette was based on research indicating the utility of using
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Table I. Demographics of student participants (n ¼ 472). Characteristics Gender Female Male Ethnicity White Asian Black Other Sexual Orientation Heterosexual Not heterosexual
Age Proportion of current degree program completed
n
%
288 181
61.41 38.59
340 61 43 20
73.28 13.15 9.27 4.31
443 24
94.86 5.14
M
SD
25.8 0.47
4.7 0.29
such vignettes in interprofessional training (Allan, Campbell, Guptill, Stephenson, & Campbell, 2006; Curran et al., 2005; Reeves et al., 2008) and was developed with input from a faculty member from each health profession represented in the student sample to ensure relevance of content across health professions and experience level. The vignette was specifically designed to offer case-related information evoking both medical and psychosocial diagnostic possibilities. The vignette was as follows: A 55-year-old married woman requests an appointment because ‘‘I’m just not interested in sex anymore.’’ She works full-time as an engineer and is the primary caregiver to her aging mother. She reports no major health problems except for chronic headaches and a lower back injury for which she had surgery six months ago. She states that she still has mild back pain but with less frequency and intensity than before the surgery. Since her surgery, she reports some bladder control problems. She takes no medications except for a daily multivitamin and Tylenol with codeine as needed for pain.
Relevance and familiarity ratings Following presentation of the case vignette, participants were asked to rate their understanding of relevance of each identified provider in the treatment of the patient presented in the vignette (e.g. ‘‘Mental health providers have a relevant role in the treatment of sexual health issues with this patient’’). They also were asked to rate their familiarity with each provider’s role in treatment (e.g. ‘‘I am familiar with the interventions a nurse could offer to improve health issues impacting sexual dysfunction’’). Participants responded to items using a Likert-type scale with response options ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). Procedure Students of medicine, dentistry, nursing, and allied health1 at a public southeastern health sciences university were recruited voluntarily and completed their surveys within the university’s 1
Allied health sciences generally refers to a group of professions which provide a wider ‘‘spectrum of care,’’ often in conjunction with traditional medical care and may include such professionals as occupational therapists, physical therapists, and dietitians, among others (Upton & Upton, 2006). At the health sciences university in the present study, the College of Allied Health Sciences includes such majors as occupational therapy, physical therapy, and physician assistant among others.
IPE for sexual health
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online evaluation system. Because mental health is a key component of sexual health and the university has no graduate programs in psychology, graduate psychology students were invited to participate voluntarily in the study via e-mails sent to program chairs in mental health, counseling, and psychology programs in the state, as well as two listservs of mental health professionals and students maintained by statewide professional organizations (to reduce regional differences); they submitted their responses using SurveyMonkey. Given the number of specialties and majors possible within the health sciences university, data were collected for comparison at the college level. Participants were given the option to provide additional information about specialization within their programs; however, only about one-third of the sample elected to do so. All study participants provided informed consent electronically prior to beginning the survey. Participants then completed the measures described herein, which were part of a larger study of attitudes and experience with various sexual health training issues. Data were collected anonymously for six weeks beginning in January 2012. Upon completion of the study, participants were invited to enter into a raffle for one of the fifteen $50 Amazon.com gift cards. Approval for the study was obtained by the university’s institutional review board in November 2011.
Sexual dysfunction vignette Controlling for the proportion of the current degree program completed, student profession was significantly associated with classification of the vignette as physical (p ¼ 0.039), such that nursing students were less likely to identify a physical problem in the vignette (OR ¼ 0.25, CI ¼ 0.08–0.80). Allied health (OR ¼ 0.42, CI ¼ 0.17–1.07), dentistry (OR ¼ 0.83, CI ¼ 0.29–2.44), and medicine (OR ¼ 0.69, CI ¼ 0.29–1.65) students did not differ from MH graduate students in identifying a physical or psychological cause for the case presented. Across the sample, physical causes were listed in 59.9% of responses. Relevance and familiarity ratings Across student group, there were significant differences among students’ overall ratings of each profession’s relevance to treatment. Specifically, physicians’ roles were rated as being the most relevant to treatment of sexual dysfunction, followed by mental health, then nurses, PT, OT, and finally dentists with post hoc pair-wise comparisons being significant at p50.0001 (overall mean ratings provided in the last column of Table II); only PT and OT mean relevance ratings did not differ significantly from each other. In the examination of relevance ratings within each student group, interaction effects indicated that nursing students rated nurses as more relevant than they rated other providers; they also rated nurses as more relevant than did the other student groups (Table II). There also were significant differences in mean ratings for familiarity with provider intervention when collapsing across student group (overall mean ratings provided in last column of Table III). The order of highest to lowest familiarity ratings mirrored those observed in the relevance ratings (i.e. health professions students were most familiar with interventions provided by physicians, followed by familiarity with MH interventions, etc.), with post hoc pair-wise comparisons significant at p50.0001. Across student group, familiarity ratings did not differ between nurses and PT providers. As with the relevance ratings, nursing students rated their familiarity as higher with interventions offered by nurses than with interventions offered by other health professionals; they also rated their familiarity with nursing interventions higher than other student groups rated their familiarity with this profession’s interventions (Table III). Pearson correlation coefficients were determined between relevance and familiarity ratings for each provider type (Table IV). All correlations were in the moderate range and were significantly different from zero. Finally, linear regression was used to examine the relationship of the proportion of training completed in students’ current degree programs on relevance and familiarity ratings. There were no
Data analysis Responses to the sexual dysfunction vignette were coded as to whether the initial diagnostic assessment indicated primarily a physical or psychological cause. If respondents listed more than one cause, only the first response was coded (n ¼ 37). Examples of a physical cause for sexual dysfunction in the patient presented included injury, menopause, neurological causes, bladder control problems, or medication side effects, among others. Examples of psychological causes for sexual dysfunction included stress and depression. Logistic regression was employed to examine differences in endorsement of psychological or physical cause by student field of study. Psychological explanations of dysfunction were set as the comparison group to compute an odds ratio by student field of study. Proportion of current health sciences program completed was used as a control variable in the logistic regression, as it was associated with greater familiarity of mental health (MH) interventions, and greater familiarity with these interventions could impact identification of cause as psychological. A one-way ANOVA was performed separately for relevance ratings and familiarity ratings to examine differences in relevance and familiarity of various providers to the treatment described in the case vignette. Post hoc multiple comparisons were performed using a Tukey–Kramer multiple comparison procedure to control the overall alpha level. Statistical analyses were performed using SAS 9.3 (Cary, NC).
Table II. Mean relevance ratings for healthcare provider by student field of study. Student participant field of study Medicine
Nursing
Allied Health
Dentistry
Mental Health
Provider profession being rated
Mean
SD
Mean
SD
Mean
SD
Mean
SD
Mean
SD
F-value
Mental Health Nurse OT Physician PT Dentist
4.23 3.69 3.43 4.37 3.52 2.27
0.78 0.89 0.98 0.64 1.05 1.09
4.16 4.35 3.39 4.35 3.58 2.33
0.90 0.61 1.12 0.71 1.09 1.15
4.16 3.83 3.66 4.45 3.53 2.09
0.74 0.75 1.02 0.60 1.05 1.00
3.90 3.81 3.35 4.23 3.50 2.94
0.86 0.82 0.85 0.67 0.90 1.00
4.22 3.88 2.59 4.31 3.56 1.75
0.66 1.13 0.95 1.00 0.95 0.84
1.95 4.55* 7.03** 0.83 0.04 7.49**
*p50.05; **p50.0001.
Overall mean rating (SD) 4.18 3.78 3.41 4.36 3.53 2.27
(0.78) (0.87) (1.01) (0.67) (1.03) (1.08)
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Table III. Mean familiarity ratings for healthcare provider by student field of study. Student Participant Field of Study Medicine
Nursing
Allied Health
Dentistry
Mental Health
Provider profession being rated
Mean
SD
Mean
SD
Mean
SD
Mean
SD
Mean
SD
F-value
Mental Health Nurse OT Physician PT Dentist
3.03 2.58 2.43 3.64 2.54 1.93
1.13 1.07 1.03 0.99 1.07 0.99
3.10 3.94 2.32 3.32 2.77 1.87
1.01 0.93 0.87 0.94 1.15 0.85
3.15 2.91 3.09 3.63 3.25 2.05
1.11 0.92 1.03 0.98 1.09 0.98
2.89 2.85 2.47 3.28 2.64 2.74
1.07 0.98 0.91 1.08 0.92 0.97
3.03 2.65 2.13 3.12 2.58 1.74
1.17 1.31 0.92 1.18 1.15 0.86
0.45 12.45* 9.30* 3.37** 7.61* 7.93*
Overall mean rating (SD) 3.05 2.77 2.54 3.55 2.71 2.02
(1.12) (1.09) (1.04) (1.01) (1.10) (1.00)
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*p50.0001; **p50.05. Table IV. Correlation between relevance and familiarity by provider type. Provider type
Pearson’s r
Mental Health Nurses PT Physicians OT Dentists
0.29 0.32 0.34 0.35 0.38 0.47
All p50.0001.
statistically significant associations with proportion of program completed and relevance ratings. However, familiarity with interventions offered by MH professionals, physicians, and PTs showed significant positive associations with the proportion of the program completed, indicating that with more training, students were more familiar with MH, physician and PT professionals (R2 ¼ 0.05, t ¼ 4.81, p50.001 for MH professionals; R2 ¼ 0.05, t ¼ 4.90, p50.001 for physicians; R2 ¼ 0.01, t ¼ 2.24, p50.05 for PT).
Discussion Sexual health issues typically necessitate an interprofessional approach to diagnosis and care, which often is not offered within health professions education (McCabe et al., 2010; Parish & Clayton, 2007). Thus, the purpose of the present study was to assess the current level of interprofessional conceptualizations of sexual dysfunction among health professions students by examining their responses to a diagnostic case vignette and their level of familiarity and relevance with sexual health interventions provided by other professionals. With regard to conceptualization of a sexual dysfunction vignette, nursing students were less likely to identify a physical cause for sexual dysfunction compared to other students; there were no differences in identification of a physical cause among other health professions students. This finding indicates that most health professions students may be more likely to prioritize the physical aspects of sexuality over psychosocial aspects in initial case conceptualizations. A narrow focus on physiology and lack of interprofessional care is a common criticism of sexual health education and treatment as it currently stands (e.g. Allan et al., 2006; Ford et al., 2013; Parish & Clayton, 2007), though possibly less so in the nursing field (Allan et al., 2006). The results of the current study provide further support for this observation, though they should be considered in the context of study design limitations discussed herein. Overall, health professions students were most familiar with the interventions that would be provided by physicians,
MH providers, and nurses, in that order, and also rated these professionals as being most relevant to the care of the patient in the vignette. This finding suggests that there may be a particular need for training regarding the roles of professions rated lower (e.g. OT and PT), as their interventions can be fundamental to sexual health care. Relevance and familiarity ratings were modestly correlated across groups. This finding may indicate that students who are more familiar with interventions offered by other professions are more likely to view them as relevant in the treatment of sexual dysfunction. This suggests a need to familiarize students with interventions offered by other professionals to encourage more holistic thinking in the diagnosis and treatment of sexual dysfunction. Additionally, more advanced students were more familiar with physician, MH, and PT professionals’ interventions, suggesting that greater exposure to or awareness of other professions likely occurs with more training. This also is consistent with the literature; for example, previous attempts to employ an interprofessional education approach to HIV/AIDS care resulted in students’ increased knowledge of roles of various providers in the care of HIV/AIDS patients and how to collaborate with providers more effectively (Curran et al., 2005). A similar approach could be beneficial in increasing the potential for effective collaboration in the treatment of sexual dysfunction. That the majority of students identified as their first choice a physical cause for sexual dysfunction and were most familiar with or perceived as most relevant medical interventions suggests students may at times need to be prompted to think beyond their initial case conceptualizations and consider additional aspects of sexuality in order to provide holistic treatment. There is a clear emphasis on the biomedical contributions to problems in the instruction of clinical reasoning skills, particularly in medical schools (Fulks, Boudreau, & Cassell, 2009), which may at times lead to a restricted list of differential diagnoses being considered. Of course, medical causes often need to be ruled out before proceeding with any intervention, though there has been a call to move away from a strictly disease-focused paradigm (Ford et al., 2013). The familiarity and relevance ratings do reflect a need to familiarize students with the multidimensional nature of sexual dysfunction and how various providers’ expertise can be utilized to effectively treat the patient as a whole. Restated here is the idea that before providers can adopt an interprofessional approach to care, they must receive adequate training about the roles of other professional and how to work effectively with them as a team. Current thought is that IPE can be an effective means in which to acquire this training and promote more holistic critical thinking (IPEC, 2011; Ivanitskaya et al., 2002). Although several studies emphasize the importance of an interprofessional approach in sexual health education, fewer have provided specific recommendations for a comprehensive, interprofessional sexual health curriculum.
IPE for sexual health
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DOI: 10.3109/13561820.2014.884553
The recommendations for interprofessional curricula generally can be categorized into process and content factors. With regard to process, previous evaluations of IPE have indicated that the frequency and quality of contact among professions is important. For example, health professions students have expressed a preference and greater perceived benefit of regular (though not necessarily weekly) contact with other students in small groups that allow for meaningful discussions about content presented in classes (Rosenfield, Oandasan, & Reeves, 2011). Direct contact between professions on sexual health education is warranted since there is not solid evidence for transfer of learning from one member of a team to another member who did not complete training (Fronek et al., 2005). This point underscores the importance of process factors, as learning how to interact professionally and effectively is as critical in facilitating interprofessional referrals and teamwork as is having content knowledge of other specialties’ interventions for sexual dysfunction (Foley, Wittmann, & Balon, 2010; IPEC, 2011). Structured activities in which interprofessional learning can occur may include problem-based learning (e.g. similar to the vignette used in the present study and in Allan et al., 2006), use of a standardized patient presenting with sexual dysfunction, role playing interactions focusing on sexual health, or small group discussion of video clips or cases (Curran et al., 2005; Parish & Rubio-Aurioles, 2010; Reeves et al., 2008). The standardized patient and role-play methods have been rated favorably by students (Curran et al., 2005; Parish & Rubio-Aurioles, 2010). Throughout the activities, scenarios and content presented should model realistic scenarios as closely as possible (Luke et al., 2009; Rosenfield, Oandasan, & Reeves, 2011). Following interactions, critical reflection is important for all group members regarding their own professional identity and values, reactions to sexual health discussions, and peer feedback to facilitate ongoing intrapersonal and interpersonal growth (Luke et al., 2009; Sargeant, 2009). Within these activities, there are several key content areas that must be covered in a comprehensive sexual health curriculum. Students must understand the multiple determinants of sexual health and sexual dysfunction, including but not limited to basic anatomy and physiology, endocrinology, common medical comorbidities, and intrapersonal, interpersonal, and cultural aspects of sexuality, as well as issues unique to working with individuals across the lifespan, sexual orientations, and gender identities (Dunn & Abulu, 2010; Dixon-Woods et al., 2002; Foley et al., 2010; Parish & Rubio-Aurioles, 2010). These areas are important factors for consideration in a thorough sexual history taking, which must be taught explicitly given patient reports about the significance of having a provider who is comfortable discussing sexual health (Foley et al., 2010; Wittenberg & Gerber, 2009). Education about the roles and responsibilities of team members (e.g. interventions typically provided to improve sexual health) also must be part of the curriculum (Frenk et al., 2010). Finally, in addition to being modeled and practiced in the process component, factors for effective teamwork and communication should be presented in curriculum content (e.g. using health informatics, how to give feedback, using language about sexuality appropriately and comfortably) (Foley et al., 2010; IPEC, 2011; Parish & Clayton, 2007; Parish & Rubio-Aurioles, 2010). This study was novel in that it used a sizeable and diverse health professions student sample to compare clinical assessment and perceptions of familiarity and relevancy of different types of health professions in the care of a patient with sexual health concerns. Yet, there are several limitations in the present study that must be acknowledged when interpreting the results. Generalizability may be somewhat limited given the relative regional homogeneity of the sample and the possibility that
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participants who most value sexual health and/or interprofessional studies may be more likely to participate in a voluntary study such as this. Also regarding generalizability, the sample size within some health professions categories was quite small and there were other health professions students who were not queried (such as pharmacy students, as there is not a degree-granting pharmaceutical sciences program on campus). Further, not all participants provided information on majors or specialty areas within their respective programs, precluding a more specific analysis of relevance and familiarity ratings (particularly within the College of Allied Health Sciences). Future studies should consider a multi-site design to ensure more robust and diverse health profession student samples. There are several additional limitations in study design that must be acknowledged. Recruitment and survey administration mechanism did differ between psychology students and other health professions students (i.e. SurveyMonkey link sent via listservs versus an e-mail directed to a self-contained research system in the health sciences university); it is unknown how these different methods may have affected study participation. Also, the cross-sectional nature of the study limits conclusions that can be drawn about the impact of relevance and familiarity ratings on interprofessional thought processes (e.g. diagnostic assessment of sexual dysfunction and potential for interprofessional collaboration). Finally, although the vignette was designed to encourage medical and psychosocial explanations for sexual dysfunction (a strength of the study), students were asked to identify the one most likely cause; thus, the results must be interpreted in light of this limitation. Future studies can extend this research by examining more specifically the influence of IPE on diagnostic assessment, attitudes about other providers, and frequency of collaboration.
Concluding comments Health professions students and providers generally have limited training in sexual health and may be underequipped to treat sexual dysfunction using an interprofessional approach that can more broadly address patient needs. The present study indicated that health professions students are most likely to prioritize a physical cause for sexual dysfunction, and they are most familiar with and perceive as most relevant the medical interventions that would be provided. This is consistent with the literature that suggests a lack of IPE and treatment in sexual health. IPE for sexual health has the potential to provide an innovative way to address the gaps in knowledge, skills, and attitudes that may act as barriers to interprofessional care.
Declaration of interest The authors declare no conflicts of interest. The authors are responsible for the writing and content of this paper
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