Self-assessment of clinical competence on sexual health by Iranian medical interns: a framework for curriculum revision

Background: The sexual medicine education in medical faculties has been a challenging issue worldwide in recent decades. Most of medical students are dissatisfied for their sexual health education which indicates an emergent need for curriculum revision. The nobility of the study was to reveal medical students' competency gaps on sexual medicine. Methods: This cross-sectional study was conducted at a large, public medical school, topped the national ranking for its excellence in education. The target population was medical interns in their 6th and 7th year of their course. With a census sampling approach, all eligible students were included. To develop the questionnaire, the framework of ESSM (European Society for Sexual Medicine) syllabus of sexual medicine 2012 was employed after being examined by an expert panel to meet the criteria of content coverage. Recruiting 10 participants, a pilot was conducted to assess the criterions of validity and reliability. Finally a 35 item questionnaire was developed including three domains; "male sexual problems", "female sexual problems" and "common to both sexes sexual problems” with 17, 9, and 9 items, respectively. Students were asked to answer each item in a five-level Likert scale. The total score was standardized to convert scores to a range of 0-100 making it easy to interpret. In addition, a single question on the general competency was asked. Analytical statistics were used appropriate to data type and distribution (t test, one-way ANOVA). Study protocol was approved by research executive and ethics board of the institution. Results: 152 of 260 eligible students participated, with mean age of 25.0 (SD=2.3), of whom 54% were females. The standardized total competency score was 22.3 (95% CI: 20.4-24.2). Regarding to not only total but also different domains scores, there was no significant difference in different grades (PV>0.05). The female students' competency was significantly higher in the domain of "female sexual problems" and "common sexual problems, but not in the domain of "male sexual problems". None of the interns believed that they are competent enough to manage patients with sexual problems by themselves. Conclusions: We magnificently attained that medical students' clinical competency on sexual medicine is poor. Medical education system of Iran would not be able to deal with this challenge unless it provides with a comprehensive curriculum revision