The Sex Education Practicum: Medical Students in the Elementary School Classroom Denice Cora-Bramble, Mary Ellen Bradshaw, Bruce Sklarew
B
etween January 31, 1989 and February 1, 1990, the number of AIDS cases among individuals ages 13-19 increased by 40Vo.' As of May 31, 1991, 691 cases of AIDS among adolescents were reported to the Centers for Disease Controle2In addition, many young adults ages 20-24 may have acquired HIV infection as teen-agers due to the latency period between HIV infection and onset of symptoms. Experts believe a combination of risk-taking behavior and lack of knowledge increases the likelihood of infection.' In recent surveys of senior high school students,' as well as junior high school stud e n t ~ , many ~ respondents demonstrated general knowledge about AIDS. However, many continue to hold misconceptions about the disease. Furthermore, students more anxious about AIDS were more likely to hold these misconceptions and less likely to feel students with AIDS should be allowed to attend school. Other sexually transmitted diseases (STDs) threaten this vulnerable group. Every year, 2.5 million U.S. teen-agers are infected with a STD, representing approximately one of every six sexually active teens.6 Adolescents record the highest rate for any age group of chlamydia1 infection and its associated complications, such as pelvic inflammatory disease, ectopic pregnancy, and infertility.' Furthermore, of sexually active U.S. females, those ages 10-19 record the highest rate of gonorrhea.' Problems associated with sexual activity by adolescents intensified in the 1980s. Recent data suggest more adolescents are becoming sexually active at younger ages. Among young women ages 15-19, the number claiming to have had sexual intercourse grew from 47% in 1982 to 53% in 1988; among young urban men ages 17-19, the proportion rose from 66% in 1979 to 76% in 1988, the most recent year for which data are a ~ a i l a b l e . ~ J ~ A successful approach to the enormous task of reducing high risk sexual behavior and its consequences among adolescents must involve various modalities. Sexuality education presented during early adolescence provides an important tool in reducing high-risk sexual behavior. Imparting relevant information is an important step in helping youth make health-promoting decisions. The role of skilled, experienced health professionals, particularly physicians, in providing information to patients and to the community is of paramount importance. Denice Cora-Bramble, MD, FAA P, Pediatrician, Bureau of School Health Services; and Mary Ellen Bradsha w. MD, Chief, Bureau of School Health Services, D.C. Dept. of Humon Services, 1660 L Street, N W, Suite 905, Washington, DC 20036; and Bruce Sklarew, MD, Clinical Associate Professor of Psychiatry, Howard University, Washington, DC 200059, and Faculty, BaltimoreWashington Institute for Psychoanalysis, 5480 Wisconsin Ave., #211, Chevy Chase, MD 20815. This article was submitted July 22, 1991, and revised and accepted for publication December 23, 1991.
32
Journal of School Health
January 1992, Vol. 62, No. 1
Though medical students and physicians may be equipped to teach human sexuality on the level of anatomy and physiology, they need practical training to develop teaching skills and to address their own values and attitudes regarding sexuality education." Elementary schools provide an optimal setting to accomplish this task since students are an accessible audience. Groups can be targeted so students can be reached prior to becoming sexually active.
PROGRAM DEVELOPMENT The Sex Education Practicum was developed in 1975 as a community collaborative effort to offer medical students in their psychiatry clerkship practical learning experiences in human sexuality, and to provide sexuality education in the District of Columbia public schools. The D.C. Dept. of Human Resources attempted to address the need for sexuality education programs in the D.C. public schools but found the demand for their services exceeded the supply of trained personnel. Planned Parenthood of Metropolitan Washington, a private agency, joined the effort to answer the need. Agency members appealed to the Howard University Dept. of Psychiatry for coordination in training medical students for the task. I Subsequently, the Dept. of Psychiatry and the Bureau of Maternal and Child Health and, since 1980, the Bureau of School Health Services collaborated to present a program of sexuality education to elementary school students in selected D.C. public schools. The program was expanded in 1987 to include junior medical students during their psychiatry clerkship at the George Washington University School of Medicine. In 1986, the program received the Secretary's Award for Excellence in Community Health Promotion from the U.S. Dept. of Health and Human Services' Center for Health Promotion and Education. In 1989, it received the Organizational Award for Outstanding Dedication and Achievement in Fostering Health Standards in the Metropolitan Washington Area presented by the Metropolitan Washington Public Health Association. PROGRAM IMPLEMENTATION The goals of the Sex Education Practicum are to increase the students' knowledge about human sexuality and the consequences of risk-taking behavior, to increase the level of awareness about current sexual issues, and to enhance communication skills, comfort, and sensitivity to the needs of youth among physicians in training. The program offers a cost-effective model using an innovative approach to increase knowledge among elementary school students while enhancing medical students' communication skills. The format for the Sex Education Practicum fol-
lows guidelines outlined by Quinn and Sklarew, ’* but some revisions occurred since 1980 when the Bureau of School Health Services entered into an agreement with the Dept. of Psychiatry at Howard University. Initially, a school nurse or pediatric nurse practitioner assumed the supervisory role, but during the past five years, a school physician has assumed this responsibility, introducing a stronger medical education component for the physicians-in-training. The on-site supervisor, a National Health Service Corps pediatrician assigned to health manpower shortage areas in the District of Columbia, has since completed the tour of duty with the U.S. Public Health Service and joined the staff of the Bureau of School Health Services. Due to that particularly sensitive assignment, and the coincidence of the District’s highest teen-age pregnancy rate and high infant mortality rate in this area, the Bureau of School Health Services focused implementation of the Sex Education Practicum in schools where this physician was assigned. The project has joint sponsorship by the Chief of the Bureau of School Health Services, project coordinators at the Howard University Dept. of Psychiatry, and the George Washington University Dept. of Psychiatry. During the first or second week of each third-year psychiatry clerkship, the pediatrician meets with medical students who expressed an interest in the practicum as initially presented by the project coordinator. This initial session introduces the practicum as well as answers questions. In addition, program introductory meetings are scheduled with the principal or designee to disseminate parent consent forms and to discuss the program curriculum. Sample letters and curriculum copies are available from the authors. The program format is as follows: 1) Medical students meet with the pediatrician at a designated public elementary school at 1 p.m. on designated weekdays for four-six weeks. All of the elementary schools initially chosen were located in areas with high teen pregnancy and infant mortality rates. The project later expanded to include schools with a high percentage of Hispanic students. Hispanic students were targeted because Hispanics and African-Americans with HIV/AIDS infection are over-represented relative to their distribution in the general p o p ~ l a t i o n .Language ~ barriers were overcome by the bilingual language skills of the on-site supervisor. 2) Each program begins with a 30-minute medical training session between the medical students and the pediatrician. A film for the day is introduced and students discuss questions which have arisen in the past. Students are encouraged to reflect on their experiences and discuss the issues. I I 3) Medical students meet weekly with a combined group of 50-125 fifth and sixth grade students in a large multipurpose room at the elementary school to view a sexuality education film, developed specifically for this age group. This film may cover topics such as puberty in boys and girls, menstruation, reproduction, sexually transmitted diseases including HIV/ AIDS infection, and others. Films include Then One
Year, Am I Normal? VD: Old Bugs, New Problems, and Young People and AIDS. 4) Following the film, medical students are assigned to small discussison groups with an average of eight fifth and sixth grade students, where they answer questions, correct misinformation, and encourage discussion under the direct supervision of the pediatrician who rotates among discussion groups. 5 ) Medical students then meet with the pediatrician for 15 minutes at 2:45 p.m. to address specific problems and to comment on their communication skills. Difficult or unusual questions are discussed at this time, such as “How much does it cost to have sex with a prostitute?” “HOWdo women masturbate?’’ “Can you get AIDS from snorting cocaine?,” and “What happens when at 18-year-old boy has sex with a 12-year-old girl?” Periodic meetings of medical student participants, project coordinators, pediatrician, and other interested staff are held for program monitoring and assessment.
PROGRAM IMPACT In the late 1970s and early 1980s, all participants - medical students, pupils, and teachers - completed feedback assessment forms. Results were extremely positive.I* In the past four years, approximately 2,146 pupils and 167 medical students were involved in the practicum. Questionnaires were completed by the medical students and results also were positive. Some answers were revealing: 1) What was the most meaningful learning experienced gained from the Sex Education Practicum? “. . . realizing my own inabilities in dealing with some parts of sex education . . . improved my skills in interacting with children . . learned how to communicate difficult concepts to children . . . learned how much misinformation is out there . . .” 2) How do you expect to use the knowledge and experience gained in your medical career? “. . . teaching and leading groups will be an inherent part of being a doctor . . . it will help me in my ability to break down information for my patients . . . enable me to use knowledge already learned in a practical manner . . . it taught me to be a good listener . . . to branch out into other facets of health care such as community-oriented practice
.
...
9,
3) In what ways were the medical enrichment sessions helpful? “. . . stimulated to pursue excellence in understanding human illness, disease, and sexuality . . . to be able to analyze medical and social problems . . . practice case presentations with ungraded criticism . . . experience feeling of actually functioning and thinking like practicing physicians rather than students . . .” 4) Would you recommend the practicum to your colleagues? Approximately 98% of the responses were positive. Responses from teachers and principals also have
Journal of School Health
January 1992, Vol. 62, No. 1
33
been positive with requests to repeat the program, as well as to extend it to other schools. Some comments received from principals and teachers include: ". . . very impressed with the program . . . the best human sexuality program in the area . . . it reaches elementary school students at an optimal age . . the kids have learned a great deal about their body parts . . . the children's vocabulary related to sexuality has changed significantly, and they are proud of the knowledge gained . . . there is such a huge need for programs such as this one . . . many of our students do not receive any sexuality related education at home and the program helps to fill the void . . ." Though aspects of the program which were assessed have yielded favorable results, the difficulty in evaluating the impact on future behavior of the elementary school students and the future professional lives of the medical students is recognized. Furthermore, debate continues regarding the impact or lack of impact of sexuality education on sexual behavior." This dilemma, with regard to the impact on sexuality of teen-agers was discussed by Kirby" who found that when students evaluate sexuality education classes, many express personal insights acquired during the courses, insights that cannot be measured quantitatively. Despite this inherent difficulty, evidence suggests programs such as the Sex Education Practicum can help increase sexuality related know1edge.l' The authors plan to study the effectiveness of the program on knowledge, misconceptions, and attitudes through pretests, posttests, and follow-up. Likewise, its long-term impact in the lives of the health professionals is delayed until after residency training. Assessment, therefore, would involve a survey of medical students who completed the program and are now in practice. An evaluative study using interviews and questionnaires with the participating physicians is planned.
CONCLUSION Though most medical schools offer some form of organized sexuality program, most emphasize didactic learning. In this program, medical students have the opportunity to reverse roles from passive learner to active teacher, carry primary teaching responsibility, and translate knowledge they mastered into terms useful to others. They are challenged to discover and interpret the sometimes hidden or unconscious meanings behind pupil's questions. The brief training focuses on helping medical students learn to deal with their own concerns about discussing sexuality,
value-laden issues and personal questions, differences in language, developmental struggles of children, and discipline in the classroom.ll Costs for implementing the program are minimal, since existing personnel are used. Three education1 films that cost approximately $900 were purchased by the Bureau of School Health Services. The program needs to expand into more schools, which could be accomplished if other medical schools expanded their community outreach efforts and incorporated a similar elective into their educational curriculum. Furthermore, a need exists to obtain or produce culturally sensitive materials in Spanish to effectively reach this rapidly growing population. Given the relatively low cost of the program, the Sex Education Practicum offers a cost-effective method to approach a complex problem. It can be duplicated in other urban settings with interested and cooperative centers of medical education.
References 1. HIV/AIDS Surveillance Report. Atlanta, Ga: Centers for
Disease Control; Feb 19, 1989:ll-12, February 1990:12. 2. HIV/AIDS Surveillance Report. Atlanta, Ga: Centers for Disease Control; June 1991. 3. D'Angelo L,Getson P, Luban N, et al. Human innmunodeficiency virus infection in urban adolescents: Can we predict who is at risk? Pediatrics. 1991;88(5):982-986. 4. HIV-related beliefs, knowledge, and behaviors among school students. MMWR. 1988;37(47):717-721. 5 . Siege1 D, Lazarus N, Kransnovsky F, et al. AIDS knowledge, attitudes, and behavior among inner city, junior high school students. J Sch Health. 1991;61(4):160-165. 6. Annual Report, Division of STD/HIV Prevention. Atlanta, Ga: Centers for Disease Control; 1989. 7. Randolph AG, Washington AE. Screening for chlamydia trachomatis in adolescent males: A cost-based decision analysis. A m J Public Health. 1990;80(5):545-550. 8. Hein K . AIDS in adolescents: Explaining the challenge. J Ado1 Health Care. 1989;10:20-21. 9. Forrest J, Singh S. The sexual and reproductive behavior of American women, 1982-1988. Fam Plann Perspecr. 1990;22(5): 206-214. 10. Sonenstein F, Pleck J, Ku L. Sexual activity, condom use and AIDS awareness among adolescent males. Fam Plunn Perspect. 1989;21:152. 11. Sklarew B. Medical students as sex educators. SEICUS Rep. 1982;10(4):6-7. 12. Quinn J , Sklarew B. Practice meets theory: A new approach to medical sex education. J Med Educ. 1978;53:916. 13. Stout J, Rivara F. Schools and sex education: Does it work? Pediatrics. 1989;83(3):375-379. 14. Kirby D. Sexuality education: A more realistic view of its effects. J Sch Health. 1985;55( 10):421-424. 15. Kirby D. The effects of school sex education programs: A review of the literature. J Sch Heulth. 1980;50(10):559-563.
Statement of Purpose The Journal of Srhool Health. an official publication of the American School Health Association, publishes material related to health promotion in school settings. loztrnal readership includes administrators, educators, nurses, physicians, dentists, dental hygienists, psychologists, counselors, social workers, nutritionists, dietitians, and other health professionals. These individuals work cooperatively with parents and the community to achieve the common goal of providing children and adolescents with the programs, services, and environment necessary to promote health and to improve learning. Contributed manuscripts are considered for publication in the following categories: general articles, research papers, commentaries, teaching techniques, and health service applications. Primary consideration is given to manuscripts related to the health of children and adolescents, and to the health of employees, in public and private pre-schools and child day care centers, kindergartens, elementary schools, middle level schools, and senior high schools. Manuscripts related to college-age young adults will be considered if the topic has implications for health programs in preschools through grade 12. Relevant international manuscripts also will be considered. Prior to submitting a manuscript, prospective authors should review the most recent "Guidelines for Authors." The guidelines are printed periodically in the ]ournal: copies also may be obtained from the lournal office, P.O. Box 708, Kent, OH 44240.
34
Journal of School Health
January 1992, Vol. 62, No. 1
B
etween January 31, 1989 and February 1, 1990, the number of AIDS cases among individuals ages 13-19 increased by 40Vo.' As of May 31, 1991, 691 cases of AIDS among adolescents were reported to the Centers for Disease Controle2In addition, many young adults ages 20-24 may have acquired HIV infection as teen-agers due to the latency period between HIV infection and onset of symptoms. Experts believe a combination of risk-taking behavior and lack of knowledge increases the likelihood of infection.' In recent surveys of senior high school students,' as well as junior high school stud e n t ~ , many ~ respondents demonstrated general knowledge about AIDS. However, many continue to hold misconceptions about the disease. Furthermore, students more anxious about AIDS were more likely to hold these misconceptions and less likely to feel students with AIDS should be allowed to attend school. Other sexually transmitted diseases (STDs) threaten this vulnerable group. Every year, 2.5 million U.S. teen-agers are infected with a STD, representing approximately one of every six sexually active teens.6 Adolescents record the highest rate for any age group of chlamydia1 infection and its associated complications, such as pelvic inflammatory disease, ectopic pregnancy, and infertility.' Furthermore, of sexually active U.S. females, those ages 10-19 record the highest rate of gonorrhea.' Problems associated with sexual activity by adolescents intensified in the 1980s. Recent data suggest more adolescents are becoming sexually active at younger ages. Among young women ages 15-19, the number claiming to have had sexual intercourse grew from 47% in 1982 to 53% in 1988; among young urban men ages 17-19, the proportion rose from 66% in 1979 to 76% in 1988, the most recent year for which data are a ~ a i l a b l e . ~ J ~ A successful approach to the enormous task of reducing high risk sexual behavior and its consequences among adolescents must involve various modalities. Sexuality education presented during early adolescence provides an important tool in reducing high-risk sexual behavior. Imparting relevant information is an important step in helping youth make health-promoting decisions. The role of skilled, experienced health professionals, particularly physicians, in providing information to patients and to the community is of paramount importance. Denice Cora-Bramble, MD, FAA P, Pediatrician, Bureau of School Health Services; and Mary Ellen Bradsha w. MD, Chief, Bureau of School Health Services, D.C. Dept. of Humon Services, 1660 L Street, N W, Suite 905, Washington, DC 20036; and Bruce Sklarew, MD, Clinical Associate Professor of Psychiatry, Howard University, Washington, DC 200059, and Faculty, BaltimoreWashington Institute for Psychoanalysis, 5480 Wisconsin Ave., #211, Chevy Chase, MD 20815. This article was submitted July 22, 1991, and revised and accepted for publication December 23, 1991.
32
Journal of School Health
January 1992, Vol. 62, No. 1
Though medical students and physicians may be equipped to teach human sexuality on the level of anatomy and physiology, they need practical training to develop teaching skills and to address their own values and attitudes regarding sexuality education." Elementary schools provide an optimal setting to accomplish this task since students are an accessible audience. Groups can be targeted so students can be reached prior to becoming sexually active.
PROGRAM DEVELOPMENT The Sex Education Practicum was developed in 1975 as a community collaborative effort to offer medical students in their psychiatry clerkship practical learning experiences in human sexuality, and to provide sexuality education in the District of Columbia public schools. The D.C. Dept. of Human Resources attempted to address the need for sexuality education programs in the D.C. public schools but found the demand for their services exceeded the supply of trained personnel. Planned Parenthood of Metropolitan Washington, a private agency, joined the effort to answer the need. Agency members appealed to the Howard University Dept. of Psychiatry for coordination in training medical students for the task. I Subsequently, the Dept. of Psychiatry and the Bureau of Maternal and Child Health and, since 1980, the Bureau of School Health Services collaborated to present a program of sexuality education to elementary school students in selected D.C. public schools. The program was expanded in 1987 to include junior medical students during their psychiatry clerkship at the George Washington University School of Medicine. In 1986, the program received the Secretary's Award for Excellence in Community Health Promotion from the U.S. Dept. of Health and Human Services' Center for Health Promotion and Education. In 1989, it received the Organizational Award for Outstanding Dedication and Achievement in Fostering Health Standards in the Metropolitan Washington Area presented by the Metropolitan Washington Public Health Association. PROGRAM IMPLEMENTATION The goals of the Sex Education Practicum are to increase the students' knowledge about human sexuality and the consequences of risk-taking behavior, to increase the level of awareness about current sexual issues, and to enhance communication skills, comfort, and sensitivity to the needs of youth among physicians in training. The program offers a cost-effective model using an innovative approach to increase knowledge among elementary school students while enhancing medical students' communication skills. The format for the Sex Education Practicum fol-
lows guidelines outlined by Quinn and Sklarew, ’* but some revisions occurred since 1980 when the Bureau of School Health Services entered into an agreement with the Dept. of Psychiatry at Howard University. Initially, a school nurse or pediatric nurse practitioner assumed the supervisory role, but during the past five years, a school physician has assumed this responsibility, introducing a stronger medical education component for the physicians-in-training. The on-site supervisor, a National Health Service Corps pediatrician assigned to health manpower shortage areas in the District of Columbia, has since completed the tour of duty with the U.S. Public Health Service and joined the staff of the Bureau of School Health Services. Due to that particularly sensitive assignment, and the coincidence of the District’s highest teen-age pregnancy rate and high infant mortality rate in this area, the Bureau of School Health Services focused implementation of the Sex Education Practicum in schools where this physician was assigned. The project has joint sponsorship by the Chief of the Bureau of School Health Services, project coordinators at the Howard University Dept. of Psychiatry, and the George Washington University Dept. of Psychiatry. During the first or second week of each third-year psychiatry clerkship, the pediatrician meets with medical students who expressed an interest in the practicum as initially presented by the project coordinator. This initial session introduces the practicum as well as answers questions. In addition, program introductory meetings are scheduled with the principal or designee to disseminate parent consent forms and to discuss the program curriculum. Sample letters and curriculum copies are available from the authors. The program format is as follows: 1) Medical students meet with the pediatrician at a designated public elementary school at 1 p.m. on designated weekdays for four-six weeks. All of the elementary schools initially chosen were located in areas with high teen pregnancy and infant mortality rates. The project later expanded to include schools with a high percentage of Hispanic students. Hispanic students were targeted because Hispanics and African-Americans with HIV/AIDS infection are over-represented relative to their distribution in the general p o p ~ l a t i o n .Language ~ barriers were overcome by the bilingual language skills of the on-site supervisor. 2) Each program begins with a 30-minute medical training session between the medical students and the pediatrician. A film for the day is introduced and students discuss questions which have arisen in the past. Students are encouraged to reflect on their experiences and discuss the issues. I I 3) Medical students meet weekly with a combined group of 50-125 fifth and sixth grade students in a large multipurpose room at the elementary school to view a sexuality education film, developed specifically for this age group. This film may cover topics such as puberty in boys and girls, menstruation, reproduction, sexually transmitted diseases including HIV/ AIDS infection, and others. Films include Then One
Year, Am I Normal? VD: Old Bugs, New Problems, and Young People and AIDS. 4) Following the film, medical students are assigned to small discussison groups with an average of eight fifth and sixth grade students, where they answer questions, correct misinformation, and encourage discussion under the direct supervision of the pediatrician who rotates among discussion groups. 5 ) Medical students then meet with the pediatrician for 15 minutes at 2:45 p.m. to address specific problems and to comment on their communication skills. Difficult or unusual questions are discussed at this time, such as “How much does it cost to have sex with a prostitute?” “HOWdo women masturbate?’’ “Can you get AIDS from snorting cocaine?,” and “What happens when at 18-year-old boy has sex with a 12-year-old girl?” Periodic meetings of medical student participants, project coordinators, pediatrician, and other interested staff are held for program monitoring and assessment.
PROGRAM IMPACT In the late 1970s and early 1980s, all participants - medical students, pupils, and teachers - completed feedback assessment forms. Results were extremely positive.I* In the past four years, approximately 2,146 pupils and 167 medical students were involved in the practicum. Questionnaires were completed by the medical students and results also were positive. Some answers were revealing: 1) What was the most meaningful learning experienced gained from the Sex Education Practicum? “. . . realizing my own inabilities in dealing with some parts of sex education . . . improved my skills in interacting with children . . learned how to communicate difficult concepts to children . . . learned how much misinformation is out there . . .” 2) How do you expect to use the knowledge and experience gained in your medical career? “. . . teaching and leading groups will be an inherent part of being a doctor . . . it will help me in my ability to break down information for my patients . . . enable me to use knowledge already learned in a practical manner . . . it taught me to be a good listener . . . to branch out into other facets of health care such as community-oriented practice
.
...
9,
3) In what ways were the medical enrichment sessions helpful? “. . . stimulated to pursue excellence in understanding human illness, disease, and sexuality . . . to be able to analyze medical and social problems . . . practice case presentations with ungraded criticism . . . experience feeling of actually functioning and thinking like practicing physicians rather than students . . .” 4) Would you recommend the practicum to your colleagues? Approximately 98% of the responses were positive. Responses from teachers and principals also have
Journal of School Health
January 1992, Vol. 62, No. 1
33
been positive with requests to repeat the program, as well as to extend it to other schools. Some comments received from principals and teachers include: ". . . very impressed with the program . . . the best human sexuality program in the area . . . it reaches elementary school students at an optimal age . . the kids have learned a great deal about their body parts . . . the children's vocabulary related to sexuality has changed significantly, and they are proud of the knowledge gained . . . there is such a huge need for programs such as this one . . . many of our students do not receive any sexuality related education at home and the program helps to fill the void . . ." Though aspects of the program which were assessed have yielded favorable results, the difficulty in evaluating the impact on future behavior of the elementary school students and the future professional lives of the medical students is recognized. Furthermore, debate continues regarding the impact or lack of impact of sexuality education on sexual behavior." This dilemma, with regard to the impact on sexuality of teen-agers was discussed by Kirby" who found that when students evaluate sexuality education classes, many express personal insights acquired during the courses, insights that cannot be measured quantitatively. Despite this inherent difficulty, evidence suggests programs such as the Sex Education Practicum can help increase sexuality related know1edge.l' The authors plan to study the effectiveness of the program on knowledge, misconceptions, and attitudes through pretests, posttests, and follow-up. Likewise, its long-term impact in the lives of the health professionals is delayed until after residency training. Assessment, therefore, would involve a survey of medical students who completed the program and are now in practice. An evaluative study using interviews and questionnaires with the participating physicians is planned.
CONCLUSION Though most medical schools offer some form of organized sexuality program, most emphasize didactic learning. In this program, medical students have the opportunity to reverse roles from passive learner to active teacher, carry primary teaching responsibility, and translate knowledge they mastered into terms useful to others. They are challenged to discover and interpret the sometimes hidden or unconscious meanings behind pupil's questions. The brief training focuses on helping medical students learn to deal with their own concerns about discussing sexuality,
value-laden issues and personal questions, differences in language, developmental struggles of children, and discipline in the classroom.ll Costs for implementing the program are minimal, since existing personnel are used. Three education1 films that cost approximately $900 were purchased by the Bureau of School Health Services. The program needs to expand into more schools, which could be accomplished if other medical schools expanded their community outreach efforts and incorporated a similar elective into their educational curriculum. Furthermore, a need exists to obtain or produce culturally sensitive materials in Spanish to effectively reach this rapidly growing population. Given the relatively low cost of the program, the Sex Education Practicum offers a cost-effective method to approach a complex problem. It can be duplicated in other urban settings with interested and cooperative centers of medical education.
References 1. HIV/AIDS Surveillance Report. Atlanta, Ga: Centers for
Disease Control; Feb 19, 1989:ll-12, February 1990:12. 2. HIV/AIDS Surveillance Report. Atlanta, Ga: Centers for Disease Control; June 1991. 3. D'Angelo L,Getson P, Luban N, et al. Human innmunodeficiency virus infection in urban adolescents: Can we predict who is at risk? Pediatrics. 1991;88(5):982-986. 4. HIV-related beliefs, knowledge, and behaviors among school students. MMWR. 1988;37(47):717-721. 5 . Siege1 D, Lazarus N, Kransnovsky F, et al. AIDS knowledge, attitudes, and behavior among inner city, junior high school students. J Sch Health. 1991;61(4):160-165. 6. Annual Report, Division of STD/HIV Prevention. Atlanta, Ga: Centers for Disease Control; 1989. 7. Randolph AG, Washington AE. Screening for chlamydia trachomatis in adolescent males: A cost-based decision analysis. A m J Public Health. 1990;80(5):545-550. 8. Hein K . AIDS in adolescents: Explaining the challenge. J Ado1 Health Care. 1989;10:20-21. 9. Forrest J, Singh S. The sexual and reproductive behavior of American women, 1982-1988. Fam Plann Perspecr. 1990;22(5): 206-214. 10. Sonenstein F, Pleck J, Ku L. Sexual activity, condom use and AIDS awareness among adolescent males. Fam Plunn Perspect. 1989;21:152. 11. Sklarew B. Medical students as sex educators. SEICUS Rep. 1982;10(4):6-7. 12. Quinn J , Sklarew B. Practice meets theory: A new approach to medical sex education. J Med Educ. 1978;53:916. 13. Stout J, Rivara F. Schools and sex education: Does it work? Pediatrics. 1989;83(3):375-379. 14. Kirby D. Sexuality education: A more realistic view of its effects. J Sch Health. 1985;55( 10):421-424. 15. Kirby D. The effects of school sex education programs: A review of the literature. J Sch Heulth. 1980;50(10):559-563.
Statement of Purpose The Journal of Srhool Health. an official publication of the American School Health Association, publishes material related to health promotion in school settings. loztrnal readership includes administrators, educators, nurses, physicians, dentists, dental hygienists, psychologists, counselors, social workers, nutritionists, dietitians, and other health professionals. These individuals work cooperatively with parents and the community to achieve the common goal of providing children and adolescents with the programs, services, and environment necessary to promote health and to improve learning. Contributed manuscripts are considered for publication in the following categories: general articles, research papers, commentaries, teaching techniques, and health service applications. Primary consideration is given to manuscripts related to the health of children and adolescents, and to the health of employees, in public and private pre-schools and child day care centers, kindergartens, elementary schools, middle level schools, and senior high schools. Manuscripts related to college-age young adults will be considered if the topic has implications for health programs in preschools through grade 12. Relevant international manuscripts also will be considered. Prior to submitting a manuscript, prospective authors should review the most recent "Guidelines for Authors." The guidelines are printed periodically in the ]ournal: copies also may be obtained from the lournal office, P.O. Box 708, Kent, OH 44240.
34
Journal of School Health
January 1992, Vol. 62, No. 1
