Sexual History-Taking in a Surgery Clerkship Assessment: A Stubborn Clinical Skills Gap With Reproductive Health Care Implications.

Purpose: Patients present with sexual and reproductive health needs in a variety of clinical settings, so knowing when and how to elicit a relevant sexual history is critical in any specialty. This work examined whether reinforcing the surgical relevance of sexual health with an integrated training improved third-year medical students' sexual history-taking.

Method: Third-year surgery clerkship standardized patient assessments were video coded from a 2021-2022 comparison and 2022-2023 intervention cohort (University of Louisville School of Medicine). The case used for both cohorts involved a 38-year-old patient assigned female at birth presenting with acute right lower abdominal pain. Before the assessment, the intervention cohort received an additional clerkship didactic session focused on evaluation and assessment of the acute abdomen emphasizing the importance of sexual history-taking for surgical patients. The frequency of sexual histories attempted, number of questions, topics discussed, and differential diagnoses were compared.

Results: There was not a significant difference between cohorts' sexual history-taking frequency: 61% (72/119) of students in the comparison cohort, compared to 65% (86/132) in the intervention cohort. On average, students in the intervention group asked 6 questions related to sexual health, compared to 3 questions by students in the comparison group (P < .001). Across cohorts, 66% (104/158) of students who took a sexual history considered sexual diagnoses on their differential, compared to only 23% (21/93) of students who did not take a sexual history (P < .001).

Conclusions: Reinforcing the clinical relevance of sexual history-taking for surgical patients was associated with higher-quality histories and broader differentials but not higher rates of sexual history-taking. Because there is now variability in how reproductive health care can be delivered across the United States, medical educators must refocus on sexual history-taking skills in a variety of settings and work to address barriers preventing students from collecting this information.