Across the four medical school classes there were 269 respondents. By year in medical school, 89 (33.1%) were first-years, 72 (26.8%) second years, 44 (16.3%) third years, and 64 (23.8%) fourth year students. Of the total students; 17 % (44) had volunteered at least once in PrEP clinic; 52% (123) identified as female, 80% (216) were white and the mean age was 26.5 years. Females (73%) volunteered more in the PrEP clinic. Respondents who did not volunteer were evenly distributed by gender. There was no statistical difference in age between the two groups. With regards to religion, 103 (38.3%) identified as Christian. Of those who identified as Christian, 82 (81%) identified with The Church of Jesus Christ of Latter-day Saints, 11 (11%) as protestant, and 7 (6%) as Catholic. We found a difference in the religious identity between groups. Those who identified as members of The Church of Jesus Christ of Latter-day Saints were less likely to have volunteered. There was no statistical difference between those who volunteered and those who did not on the basis of race, marital status, or parental status. There was also no difference in those who had volunteered and those who had/not participated in supplementary sexual health education. Demographics data are listed in Table 1.
Table 1
Variable | Volunteered (N = 44) | Never Volunteered (N = 225) | Chi square statistic or *TTEST | P value |
Age | | | | |
Age, mean (IQR) Gender identity n (%) | 26.61 (25–28) | 26.5 (24–28) | * | 0.98 |
Female, n (%) | 32 (73%) | 107 (48%) | 8.19 | 0.01 |
Male, n (%) | 12 (27%) | 110 (49%) | | |
0 (0%) | 8 (3%) | | |
Religion n (%) | | | 20.069 | 0.017 |
Atheist | 4 (9%) | 23 (10%) | | |
Later Day Saint (LDS) | 6 (13%) | 78 (34%) | | |
Nothing in particular | 16 (37%) | 51 (23%) | | |
Do not wish to respond | 3 (7%) | 25 (11%) | | |
Agnostic | 4 (9%) | 26 (12%) | | |
Roman Catholic | 2 (4%) | 6 (3%) | | |
Buddhist | 0 (0) | 1 (0.4%) | | |
Protestant | 5 (11%) | 6 (3%) | | |
Muslim | 0 (0) | 2 (0.8%) | | |
Hindu | 1 (2%) | 3 (1%) | | |
Jewish | 2 (4%) | 2 (0.8%) | | |
Other | 1 (2%) | 2 (0.08%) | | |
Racial identity n (%) | | | 9.496 | 0.147 |
Hispanic or Latinx | 1 (2%) | 7(15%) | | |
American Indian | 0 | 0 | | |
Asian | 3 (7%) | 17 (7%) | | |
Native Hawaiian or Pacific Islander | 0 | 1 (0.4%) | | |
Black or African American | 0 | 3 (1%) | | |
White | 39 (88%) | 177 (78%) | | |
Other | 1 (2%) | 7 (3) | | |
Marital status n (%) | | | | |
Single | 24 (55%) | 94 (43%) | 6.618 | 0.08 |
Married | 11 (25%) | 87 (39%) | | |
Partnered | 8 (18%) | 44 (20%) | | |
Divorced | 1 (2%) | 0 | | |
Have children n (%) | | | 1.038 | 0.30 |
Yes | 5 (11%) | 39 (17%) | | |
No | 39 (89%) | 186 (83%) | | |
Any prior training in: n (%) | | | | |
Taking a sexual history | 18 (41%) | 98 (43%) | 1.732 | 0.63 |
Sexual health/education | 12 (27%) | 56 (25%) | | |
Pre-Exposure Prophylaxis (PrEP) | 12 (27%) | 37 (16%) | | |
LGBTQIA + health | 6 (14%) | 28 (12%) | | |
Abbreviations: IQR = interquartile range, PrEP = Pre-exposure prophylaxis, LGBTQIA + = Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual |
Students were asked to report their comfort with 10 sexual health topics. Those students who had volunteered at the PrEP clinic differed significantly in comfort than those who had not volunteered. Students that volunteered had a much higher comfort score on all 10 topics (Table 2.). Those topics were: taking a sexual health history from patients, discussing safe sexual practices with patients, evaluating patients for HIV risk factors, providing counseling to patients on methods to reduce transmission of STIs or HIV, discussing PrEP with patients, using sexual slang when taking a sexual history (i.e. bottom, top, vers, etc. ), taking a sexual history from LGBTQIA + patients, discussing safe sexual practices with LGBTQIA + patients, familiarity with the 2014 CDC recommendations for HIV testing, and familiarity with the most recent CDC guidelines for pre-exposure prophylaxis (PrEP) for HIV. Results are given in greater detail in Table 2.
Table 2
Average responses for each group on the 10 comfort questions
Variable | Volunteered (N = 44) | Never Volunteered (N = 225) | p value | |
Topic (mean response out of 5) (95% CI) | | | | |
1 | 3.79 (3.53–4.04) | 3.39 (3.26–3.51) | 0.05 | |
2 | 3.63 (3.30–3.96) | 3.14 (3.01–3.29) | 0.002 | |
3 | 3.79 (3.46–4.11) | 2.91 (2.75–3.07) | < 0.001 | |
4 | 3.81 (3.45–4.16) | 3.05 (2.9–3.20) | < 0.001 | |
5 | 3.93 (3.6–4.26) | 2.51 (2.34–2.67) | < 0.001 | |
6 | 3.57 (3.22–3.92) | 2.35 (2.19–2.5) | < 0.001 | |
7 | 3.72 (3.41–4.04) | 2.81 (2.67–2.96) | < 0.001 | |
8 | 3.61 (3.27–3.95) | 2.67 (2.52–2.81) | < 0.001 | |
9 | 2.59 (2.23–2.95) | 1.96 (1.82–2.1) | 0.002 | |
10 | 2.82 (2.47–3.17) | 1.87 (1.73-2.0) | < 0.001 | |
Abbreviations: SD = standard deviation, 95% CI = 95% confidence interval. Topic 1: taking a sexual health history from patients. Topic 2: discussing safe sexual practices with patients. Topic 3: evaluating patients for HIV risk factors. Topic 4: providing counseling to patients on methods to reduce transmission of STIs or HIV. Topic 5: discussing pre-exposure prophylaxis (PrEP) with patients. Topic 6: using sexual slang when taking a sexual history (i.e. bottom, top, vers, etc.). Topic 7: taking a sexual history from LGBTQIA + patients. Topic 8: discussing safe sexual practices with LGBTQIA + patients. Topic: How familiar, if at all, are you with the 2014 CDC recommendations for HIV testing? Topic 10: How familiar, if at all, are you with the 2017 CDC recommendations for pre-exposure prophylaxis (PrEP) for HIV? |
Additionally, the relative proportion of students reporting comfort levels of “extremely” or “very” comfortable with various sexual health topics when delivering patient care was higher in the group of students that volunteered. For example, 25% or greater of students who had volunteered reported being “extremely comfortable” on 8 of the 10 self-reported comfort topics. Furthermore, only 10% or more of the students who had volunteered reported feeling “not at all” comfortable on only 2 of the 10 topics. In contrast, only 12% or greater of students who had not volunteered reported feeling “extremely” comfortable on only 2 of the 10 self-reported comfort topics. Those that had not volunteered reported feeling “not at all” comfortable greater than 15% of the time in 5 of the 10 topics (Table 3). Even when adjusting for gender, age, racial/ethnic identity, marital status and year in medical school by logistic regression analysis, those who volunteered in PrEP clinic had an increased comfort level on all sexual health topics. This distribution is represented in Table 3.
Table 3
Comfort level by group broken down by individual self-report
Variable | Volunteered (N = 44) | Never Volunteered (N = 225) | Chi square statistic or *TTEST | P value |
Topic n (%) | | | | |
taking a sexual health history from patients | | | 13.567 | 0.0088 |
0 | 7 (3%) | | |
1 (2%) | 25 (11%) | | |
17 (39%) | 98 (44%) | | |
15 (34%) | 66.8 (30%) | | |
11 (25%) | 28 (13%) | | |
discussing safe sexual practices with patients. | | | 20.069 | 0.022 |
1 (2%) | 12 (5%) | | |
6 (14%) | 46 (20%) | | |
12 (27%) | 88 (40% | | |
14 (32%) | 53 (24%) | | |
11 (25%) | 24 (11%) | | |
evaluating patients for HIV risk factors | | | | |
0 | 24 (11%) | 24.727 | < 0.001 |
6 (14%) | 67 (30%) | | |
11 (26%) | 59 (27%) | | |
12 (28%) | 49 (22%) | | |
14 (33%) | 24 (11%) | | |
providing counseling to patients on methods to reduce transmission of STIs or HIV | | | | |
1 (2%) | 22 (10%) | 15.798 | 0.003 |
5 (11%) | 50 (23%) | | |
11 (25%) | 71 (32%) | | |
11 (25%) | 52 (23%) | | |
16 (37%) | 27 (12%) | | |
discussing pre-exposure prophylaxis (PrEP) with patients. | | | | |
0 | 59 (26%) | 54.483 | < 0.001 |
6 (14%) | 63 (28%) | | |
8 (19%) | 48 (21%) | | |
12 (28%) | 37 (16%) | | |
17 (39%) | 17 (8%) | | |
using sexual slang when taking a sexual history (i.e. bottom, top, vers, etc.). | | | | |
3 (7%) | 61 (27%) | 48.46 | < 0.001 |
4 (9%) | 78 (35%) | | |
12 (27%) | 45 (20%) | | |
15 (34%) | 24 (11%) | | |
10 (23%) | 16 (7%) | | |
taking a sexual history from LGBTQIA + patients | | | | |
1 (2%) | 23 (10%) | 27.979 | < 0.001 |
4 (9%) | 62 (28%) | | |
15 (34%) | 81 (36%) | | |
11 (25%) | 38 (17%) | | |
13 (30%) | 19 (9%) | | |
discussing safe sexual practices with LGBTQIA + patients. | | | 41.662 | < 0.001 |
1 (2%) | 35 (16%) | | |
7 (7%) | 63 (29%) | | |
12 (27%) | 76 (35%) | | |
12 (27%) | 32 (15%) | | |
12 (27%) | 13 (6%) | | |
How familiar, if at all, are you with the 2014 CDC recommendations for HIV testing? | | | | |
10 (23%) | 101 (45%) | 15.659 | 0.004 |
11 (25%) | 53 (24%) | | |
12 (27%) | 51 (23%) | | |
9 (20%) | 14 (6%) | | |
2 (4%) | 4 (2%) | | |
How familiar, if at all, are you with the 2017 CDC recommendations for pre-exposure prophylaxis (PrEP) for HIV? | | | | |
7 (16%) | 108 (48%) | 33.849 | < 0.001 |
9 (20%) | 57 (25%) | | |
16 (36%) | 43 (19%) | | |
9 (20%) | 13 (6%) | | |
3 (7%) | 23 (1%) | | |
For the six knowledge-based questions, there was no statistically significant difference in correct responses between students who had volunteered at the PrEP clinic and those who had not. The average correct responses for each of the knowledge questions are represented in Table 4.
Table 4
Mean correct responses to general sexual knowledge questions
Question n (%) | Volunteered (N = 44) | Never Volunteered (N = 225) | P value | |
Can a person with an STI pass it on if they do not have symptoms? | 44 (100%) | 217 (99.6%) | 0.329 | |
Are HIV and AIDS the same thing? | 43 (97.7%) | 221 (98.2%) | 0.414 | |
Will a person infected with HIV always show symptoms? | 42 (95.5%) | 204 (90.6%) | 0.148 | |
Will a pregnant woman with HIV/AIDS always pass it on to their unborn child? | 42 (95.5%) | 203 (90.5%) | 0.167 | |
Can a swab of the inside of the cheek be used to test for HIV? | 21 (47.7%) | 97 (42.9%) | 0.277 | |
Is pre-exposure prophylaxis (PrEP) covered by insurance? | 35 (79.5%) | 152 (67.4%) | 0.07 | |
Students were asked to provide narrative comments on their experiences regarding sexual health education during medical school. Of the students who volunteered, there were several affirming comments that volunteering advanced their sexual health knowledge.
—“I feel like almost everything functional that I learned about taking a sexual history came from 1. Being queer and 2. Going to PrEP clinic. I do not think the [University of Utah School of Medicine] curriculum has taught me much about this at all, and sexual history taking is not at all discussed at the other student-run clinics.”
—"All of my knowledge on these topics came from sessions I attended through the PrEP clinic, EPAC [Education in Pediatric Across the Continuum], or Layers of Medicine [course taught as part of the pre-clinical core curriculum]. I would not say that these topics get well covered in general core curriculum or in [clinical methods course]. I loved the orientation session done by the PrEP clinic and think that should be mandatory for all med students”.
—"The majority of what I've learned about taking a good sexual history and educating patients on risk reduction, etc. has been directly as a result of working at the PrEP clinic.”
Among the students that had not volunteered with the PrEP clinic, there were 13 comments noting a lack of sexual health curriculum, desire to know more or be better trained in sexual health topics and PrEP. Sample narratives:
—"Would love to see some time dedicated to LGBTQIA + Health, in addition to PrEP.”
—"My knowledge and comfort with discussing and understanding sexual health stem from my own personal experiences and learning I have done on my own. I did not learn these skills from the curriculum at the [University of Utah School of Medicine]. I feel the [University of Utah School of Medicine] has a huge deficit in teaching sexual health.”
—"I'm much more comfortable taking sexual histories since I'm gay. Many of my classmates do not know what top/bottom/vers is - these important details are never addressed in the classroom although they should be!”
—"My comfort with taking sexual histories has nothing to do with what I was taught at school. Our training is inadequate and does not teach us anything about LGBTQIA + health.”
—"During medical school, I attended one PrEP clinic lecture on taking a sexual history first year and it was my only exposure to the topic until my OB/gyn rotation. On OB/gyn, we were given a brief lecture and able to practice. I now feel capable of taking a sexual history but I would have LOVED more practice with this over the first 2 years and into clerkships as it is such an important skill to talk about sex with patients with a respectful and patient-oriented attitude.”
—"Need to brush up on STI treatment and prophylaxis for LGBTQIA + patients.”
—"Very important work, I realize I feel very ignorant in these things.”
—"This made me realize how little I know.”