Best Practices in North American Pre-Clinical Medical Education in
Sexual History Taking: Consensus From the Summits in Medical
Education in Sexual Health
Elizabeth S. Rubin, MD,
Jordan Rullo, PhD,
Perry Tsai, PhD,
Shannon Criniti, PhD, MPH,
Joycelyn Elders, MD,
Jacqueline M. Thielen, MD,
and Sharon J. Parish, MD
Introduction: This article discusses a blueprint for a sexual health communication curriculum to facilitate
undergraduate medical student acquisition of sexual history taking skills and includes recommendations for
important elements of a thorough sexual history script for undergraduate medical students.
Aim: To outline the fundamentals, objectives, content, timing, and teaching methods of a gold standard
curriculum in sexual health communication.
Methods: Consensus expert opinion was documented at the 2012, 2014, and 2016 Summits in Medical
Education in Sexual Health. Additionally, the existing literature was reviewed regarding undergraduate medical
education in sexual health.
Main Outcome Measures: This article reports expert opinion and a review of the literature on the development
of a sexual history taking curriculum.
Results: First-year curricula should be focused on acquiring satisfactory basic sexual history taking
skills, including both assessment of sexual risk via the 5 Ps (partners, practices, protection from sexually
transmitted infections, past history of sexually transmitted infections, and prevention of pregnancy) as well
as assessment of sexual wellness—described here as a sixth P (plus), which encompasses the assessment of
trauma, violence, sexual satisfaction, sexual health concerns/problems, and support for gender identity and
sexual orientation. Second-year curricula should be focused on incorporating improved clinical reasoning,
emphasizing sexual history taking for diverse populations and practices, and including the impact of
illness on sexual health. Teaching methods must include varied formats. Evaluation may be best as a
formative objective structured clinical examination in the ﬁrst year and summative in the second year.
Barriers for curriculum development may be reduced by identifying faculty champions of sexual health/
Clinical Implications: Medical students will improve their skills in sexual history taking, which will ultimately
impact patient satisfaction and clinical outcomes. Future research is needed to validate this proposed curriculum
and assess the impact on clinical skills.
Strengths & Limitations: This article assimilates expert consensus and existing clinical guidelines to
provide a novel structured approach to curriculum development in sexual health interviewing in the
Conclusion: The blueprint for developing sexual history taking skills includes a spiral curriculum with varied
teaching formats, incorporation of a sexual history script that incorporates inquiry about sexual wellness, and
longitudinal assessment across the pre-clinical years. Ideally, sexual health communication content should be
Received March 9, 2018. Accepted August 20, 2018.
Department of Obstetrics and Gynecology, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, PA, USA;
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN,
Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA;
University of North Carolina at Chapel Hill School of Medicine, Chapel Hill,
AccessMatters, Philadelphia, PA, Drexel University, Philadelphia, PA, USA;
Fay W. Boozman College of Public Health, University of Arkansas for
Medical Sciences, Little Rock, AR, USA;
Department of Medicine, Department of Psychiatry, Weill Cornell Medical
College, New York, NY, USA
Copyright ª2018, International Society for Sexual Medicine. Published by
Elsevier Inc. All rights reserved.
1414 J Sex Med 2018;15:1414e1425
incorporated into existing clinical interviewing and physical examination courses. Rubin ES, Rullo J, Tsai P,
et al. Best Practices in North American Pre-Clinical Medical Education in Sexual History Taking:
Consensus From the Summits in Medical Education in Sexual Health. J Sex Med 2018;15:1414e1425.
Copyright 2018, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
Key Words: Objective Structured Clinical Exam; Sex Education; Medical Education; Pre-Clinical Education;
Sexual Health; Sexual History
Sexual problems and sexually transmitted infections (STI) are
widely prevalent, and a comprehensive sexual history is an
essential component in the identiﬁcation and treatment of these
Thus, conducting a sexual history is a well-
established fundamental element of the clinical interview that
is strongly recommended by the World Health Organization.
Given that most patients do not speak with their physicians
about sexual health concerns,
routine sexual history screening
improves detection without placing the responsibility on the
patient to bring up potentially uncomfortable topics.
Unfortunately, the majority of health care providers, ranging
from 60e100%, do not routinely ask patients about their sexual
This oversight may leave patients feeling dismissed,
ignoring treatable sexual problems, or at risk of contracting/
As such, acquisition of comprehensive and ﬂuid sexual history
taking skills is essential for undergraduate medical students. The
NIH stated that health care providers should have courses in
effective sexual history taking; and the International Society for
Sexual Medicine curriculum in international undergraduate
sexual health education recommended sexual history taking,
comfort with sexual language, and general communication skills
as speciﬁc skills that should be acquired during undergraduate
Sexual history taking education, how-
ever, remains inconsistent, limited, or non-existent in the ma-
jority of North American medical schools,
training remains a prevalent barrier to adequate sexual history
In all, 44% of U.S. medical schools may have no
formal curriculum in sexual health.
Though the majority of medical students believe sexual history
taking is an important skill for future practice, over half of them
do not report adequate training in this area.
uation, many resident physicians remain uncomfortable
addressing topics of sexual health and sexuality with
Sexual health education is effective in increasing
students’, residents’, and health care providers’comfort and
conﬁdence in taking a sexual history.
perceive they have received adequate sexuality education, they are
more likely to be comfortable addressing patients’sexual
Undergraduate medical school curricula for the education and
evaluation of students’sexual history skills are widely vari-
in part due to lack of consensus among schools
regarding standardized goals, objectives, and curricula.
Though 128 medical colleges in North America report teach-
ing students to ask patients, "Do you have sex with men, women,
or both," curricula typically remain largely focused on risk
stratiﬁcation for STI and pregnancy prevention.
jority of programs do not include clinical training on sexual
problems and dysfunction, and sexual history scripts provided to
students rarely include discussion of sexual problems.
Though efforts have been made to improve standardization in
medical education in sexual health and sexuality,
vast majority (92%) of U.S. schools with a sexual health cur-
riculum have developed their own curriculum rather than basing
the curriculum on established standards.
programs may have found site-speciﬁc success in teaching sexual
history taking, there has not yet been described a prescriptive
model detailing best practices for teaching and evaluating student
acquisition of sexual history taking skills.
The First Summit on Medical Education in Sexual Health,
organized in 2012 and hosted by the Program in Human
Sexuality, Department of Family Medicine and Community
Health, University of Minnesota Medical School, Minneapolis,
MN, called for national standards for sexual health education.
The Second and Third Summit on Medical Education in Sexual
Health, 2014 and 2016, were held to create recommendations
for improvement in speciﬁc areas of sexual health curricula,
including sexual history taking. “Arguably, sexual history taking
is one of the most essential skills to addressing sexual health with
patients,”according to experts of the summit.
Bayer et al
2017 identiﬁed consensus from the ﬁrst and second summits on
proper content for sexuality in medical curricula and outlined 20
sexual health competencies for undergraduate medical education
in North America. Education in effective sexual history taking is
essential to attaining the competencies outlined in the accredi-
tation domains of patient care, interpersonal and communication
skills, and professionalism.
In this report we identify the current deﬁcits in sexual history
taking education and describe a model pre-clinical curriculum for
teaching sexual health communication skills that can be incor-
porated into existing clinical interviewing and physical exami-
nation courses. We address methods for educating students on
sexual history taking, explaining diagnosis and treatment, and
counseling patients on sexual health problems. We articulate how
a spiral curriculum, one that circles back to these topics
throughout the pre-clinical years, can provide this training.
J Sex Med 2018;15:1414e1425
Medical Education in Sexual History Taking 1415
Further, in accordance with the consensus from these summits,
and unlike most previous sexual history tool kits that emphasize
sexual risk assessment and stratiﬁcation,
also focuses on sexual problem screening.
While this is an ideal
framework and select elements will be more critical than others,
our hope is that programs can ﬁnd site-speciﬁc ways to include
elements of the curriculum described.
The Subcommittee on Sexual History Taking Education at
the Summit on Medical Education in Sexual Health consisted of
members with substantial research and clinical experience in
teaching and assessing sexual health communication skills. This
multidisciplinary group included multiple academic faculty and
resident physicians with speciﬁc expertise in medical education
and in sexual medicine spanning internal medicine, psychiatry,
and gynecology. This group also included representation from a
sex therapist, sex educator, and a nationally recognized leader in
public health. Participants extensively discussed both ideal and
critical elements of a comprehensive education in sexual history
taking at the second and third summits until consensus was
reached. Subsequently, a narrative literature review was per-
formed. The literature review involved a comprehensive English-
language search of several databases from 2006 to 2017, which
included MEDLINE In-Process and Other Non-Indexed Cita-
tions and Ovid MEDLINE, Ovid PsycINFO, and Ovid
Cochrane Database of Systematic Reviews. Key words included
“sexual health history taking,”“sexual history taking,”“sexuality
history,”“sex history,”“sexual risk assessment,”“sexual problem
assessment,”and “medical history taking”combined with
“reproductive health”or “sexual behavior.”Articles were selected
for inclusion based on authors’collective expertise and were
organized and consolidated by the ﬁrst, second, and senior au-
thors. Co-authors reviewed and revised this document for
consensus. The curriculum detailed below is developed from
those discussions and literature review.
OVERVIEW OF CURRICULUM FUNDAMENTALS
Undergraduate medical schools should strive to provide stu-
dents with a longitudinal education in sexual history taking and
sexual health communication skills within a broader curriculum
in communication skills.
A spiral curriculum, one that revisits
the same topics repeatedly with increasing level-appropriate
complexity, can be utilized to this end.
At each stage of
learning, students should meet speciﬁc objectives and be evalu-
ated by standards consistent with their level of development.
Though here we have delineated these recommendations as a
traditional ﬁrst and second year of pre-clinical education, some
programs have modiﬁed their curricula such that there is no
longer a distinction between ﬁrst and second academic years or
such that there are no longer distinct pre-clinical or clinical
years. Non-traditional curricula wishing to incorporate these
recommendations may beneﬁt from identifying when students
are ﬁrst taught communication skills and when these skills are
Core communication skills that students should learn in the
pre-clinical years are to take a patient-centered sexual history,
build rapport with patients, express empathy, and utilize coun-
seling techniques for a sexual problem.
sexual history taking during pre-clinical years are outlined in
The teaching methods that should be implemented
include a combination of didactics, role play, and skills practice
with simulated patients (SPs) as a variety of learning modalities is
recommended to maximize adult learning.
nication skills, sexual history taking skills, and these teaching
methods are all widely accepted educational principals.
This article does not address where and how to teach sexual
health content such as anatomy and physiology of sexual
response cycle, human reproduction, STI, contraceptive
methods, or speciﬁc treatment of sexual problems. Recom-
mended objectives for an entire sexual medicine curriculum can
be found in another summit consensus article by Bayer et al
2017. Additionally, given that the summits focused on North
American medical schools, these recommendations are written
for a North American curriculum. However, many of the prin-
ciples outlined here can be utilized for medical schools interna-
tionally. International recommendations are outlined in the 2
consensus reports on education from the International Consul-
tation in Sexual Medicine by Shindel et al
in 2016 and
Eardley et al
Fundamental to sexual health communication skills is the
patient-centered sexual history. Students should learn sexual
history taking skills in the context of a comprehensive sexual
health curriculum that addresses attitudes, knowledge, and
Basic Sexual History Interview
A primary education in sexual history taking must include
appropriate questions and how to phrase these questions so as to
be direct but also sensitive. This is best achieved by providing
students with a sexual history script that includes questions about
sexual problems or concerns.Students report that having a
Table 1. Pre-clinical objectives
1. Understand importance of discussing sexual health with patients
2. Demonstrate basic skills of sexual health communication
3. Explain key questions/topics for a sexual history
4. Practice taking a sexual history with peers
5. Include elements of counseling and education into patient encounters
6. Identify follow-up questions to speciﬁc sexual health concerns
7. Conduct personal reﬂection on sexual history taking and comfort with
discussing sexual health topics with patients
J Sex Med 2018;15:1414e1425
1416 Rubin et al
written script improves ease of learning sexual history taking
Therefore, early during their ﬁrst year, students should
be given a sexual history script on which to model their in-
terviews. Currently, most sexual history scripts focus entirely on
sexual risk taking. Arguably the most common sexual history
script is the Centers for Disease Control and Prevention (CDC)
5 Ps (partners, practices, protection from STIs, past history of
STIs, and prevention of pregnancy).
This is a helpful
mnemonic that outlines the important elements of a sexual risk
assessment and can incorporate an inclusive sexual orientation
and gender identity history within this framework. A thorough
sexual history, however, also needs to include an assessment of
sexual wellness: a sixth P (plus) (Figure 1). The Summit on
Medical Education in Sexual Health recommends that the “plus”
should encompass an assessment of trauma, violence, sexual
satisfaction, sexual health concerns/problems, and support for
gender identity and sexual orientation (Table 2). Many of these
topics are overlooked in sexual history taking education, perhaps
because they may be considered more challenging to address.
Recently, the National Coalition for Sexual Health (NCSH)
developed a guide for primary care providers to address the sexual
health of their patients.
This guide is an excellent tool for
undergraduate medical education. It includes the 5 Ps, a list of
essential sexual health questions to ask at least once annually, and
questions relevant to adults vs adolescents. Essential questions to
ask regarding the sixth P (plus), listed in Table 2, are an
important extension of this NCSH guide.
First-year medical students rarely have experience discussing
sensitive issues, and thus time should be spent outlining the
setting for patient discussions about sex or sexuality. Students
should be explicitly taught verbal and non-verbal elements of
creating a positive sexual health discussion setting, outlined in
Additionally, time should be devoted to discussing
the use of open-ended vs closed-ended questions.
Transition and Timing
Students should be supplied with techniques for transitioning
to the discussion of sexual health, including ideal transition
statements that utilize asking patient permission to discuss sexual
health, normalizing sexual health questions, and validation of
patient concerns. The NCSH guide suggests the following
transition statement, “I’m going to ask you a few questions about
your sexual health. Since sexual health is very important to
overall health, I ask all my patients these questions. Before I
begin, do you have any questions or sexual concerns you’d like to
Students should learn that the sexual history needs to
ﬁt logically into the ﬂow of questions, following medical history,
social history, or urologic/gynecologic review of systems.
applicable to the patient, students may want to link sexual his-
tory questions to questions about menstrual cycles, birth control,
menopausal status, or urinary concerns. In learning about tran-
sition and timing, students will also begin to discover which
elements of a sexual history are most important for different
FIRST-YEAR TEACHING METHODS
Varied teaching methods/formats will more effectively reach
students with different learning styles.
learning strategies for an entire sexual medicine curriculum are
outlined in Shindel et al
in 2016. The core elements and
teaching methods/formats of a ﬁrst-year curriculum in sexual
health communication skills are outlined in Table 4.
Directly prior to the initiation of the sexual health interview
curriculum, students should be referred to appropriate educa-
tional materials. Self-preparation is critical to student founda-
tional learning of not only the questions to ask, but the elements
of the setting as described in Table 2. In addition to receiving a
sexual history script, students should be assigned homework of
key articles introducing students to the fundamentals of taking a
sexual history. “Standard Operating Procedure for Taking a
Sexual History,”“The Proactive Sexual History,”and the CDC
“A Guide to Taking a Sexual History”are easily accessible in-
troductions, the last of which reviews the 5 Ps.
should also review a video demonstrating a sexual history role
play. Medical schools may wish to purchase a video for use or
create their own school-speciﬁc video. The Association of
American Medical Colleges (AAMC) and others have developed
Figure 1. US Centers for Disease Control and Prevention (CDC) 5 Ps and the sixth P (plus). Infographic showing the categories of sexual
history topics clinicians should cover during a sexual health interview. SOGI ¼sexual orientation/gender identity; STI ¼sexually transmitted
infections. Adapted with permission from the CDC.
J Sex Med 2018;15:1414e1425
Medical Education in Sexual History Taking 1417
a series of free online videos on sexual history taking
Although not as effective at teaching skills and promoting self-
reﬂection as interactive modalities,
large group lectures remain
the dominant paradigm in medical school education.
sexual health communication curriculum, lectures can be used to
introduce sexual health questions and effective communication
skills and to demonstrate an example of an effective, standardized
This should be made possible via
video or a live role-play demonstration, as observing an interview
has been found to improve interviewing skills.
who has signiﬁcant experience in sexual health communication,
ideally within the ﬁeld of sexual medicine, should be identiﬁed
for this demonstration.
Although this demonstration should
utilize the standardized script, students may also beneﬁt from an
additional, more advanced demonstration. AAMC has developed
a free modiﬁable sexual history taking lecture located online at
Role play, that is, taking on scripted "parts" and practicing a
physician-patient encounter, has been found to be an effective
teaching modality for teaching sexual health communica-
This is the ﬁrst-year students’opportunity to
practice their recitation of sexual history questions as well as the
body language critical to a comfortable encounter. Multiple
opportunities should be presented to ﬁrst-year students to
practice their sexual history taking skills. Initially students should
practice with peers, with peer and faculty feedback. Programs
should ensure that they provide adequately developed role-play
characters such that the students do not have to draw from
their own personal experience.
It may be beneﬁcial for students to have at least 1 encounter
with a SP designed speciﬁcally for the purpose of practicing
sexual history with immediate SP or faculty feedback.
education has been found to be effective in reducing student
anxiety and improving interview performance.
beneﬁts of utilizing a SP appear to be comparable to those of peer
Ultimately, the educational beneﬁtmaybe
determined more by the quality of feedback received, rather than
the individual giving that feedback.
Yet, unlike peer role play,
SP cases have the advantage of including a variety of ages, sexual
orientations, and gender identities, which enhances student
Table 3. Approach to creating a positive sexual health interview
setting for students
1. Reassure patient of privacy, and explain conﬁdentiality (including who
has access to personal information via electronic medical records)
2. Make efforts to ensure patient trust, comfort, and openness
3. Utilize empathy and build rapport
4. Use open body language and appropriate eye contact
5. Be aware of patient’s cultural background
6. Avoid assumptions about sexual orientation, gender identity,
monogamy, sexual activities, or age-related practices
7. Use simple, direct language within your comfort zone
8. Avoid unnecessary interruptions while utilizing gentle redirection
9. Disengage from electronic medical record, turn away from computer,
Table 2. "Plus"—assessment of sexual wellness
Do you have a history of unwanted sexual experiences? [If patient is confused] Have you ever been forced or coerced to have sex/sexual activity against
your will, either as a child or as an adult?
o If yes, is there anything about that experience that impacts your current sexuality?
o If yes, is there anything about that experience that makes seeing a health care provider or having a physical examination (if applicable) difﬁcult?
If so, I’d like to hear about this so we can work together more easily.
Support for sexual orientation/gender identity
Do you feel you are getting support and acceptance of your sexual orientation/gender identity from your family and friends?
Are you experiencing any harassment or violence—at home, at work, or in your community—due to your sexual orientation or gender identity?
Are you having any concerns with your sexual functioning or your interest in sexual activity?
Do you have decreased or increased interest in sex?
Do you have difﬁculty becoming sexually aroused? Becoming lubricated/developing an erection?
What about maintaining lubrication or arousal/maintaining an erection?
Do you have difﬁculty having an orgasm, orgasming too soon, or not soon enough?
Is sexual activity painful?
o If yes, what type of sexual activity is painful? Where is the pain
Are you having any sexual relationship difﬁculties? Such as discrepancy between your and your partner’s interest in sex, or your partner is having sex
On a scale from 1e10, with 10 being the greatest impact, how much impact has this problem had on your life? How distressing are these symptoms to
On a scale from 1e10, with 10 being the greatest satisfaction, how satisﬁed are you with your sexual health? Sexual relationship?
J Sex Med 2018;15:1414e1425
1418 Rubin et al
comfort in discussing sexual health with diverse patients.
to the logistical and ﬁnancial expense of securing SPs, some
programs may need to include sexual history taking SP en-
counters within other pre-existing SP experiences. All programs
should strive to provide at least 1 opportunity for students to
practice incorporating a sexual history into a complete patient
history with a SP.
Discussion Group and Self-Reﬂection
Many students have discomfort when discussing sexual health
or taking sexual histories,
and it is important to normalize
This discomfort is multifactorial and in-
cludes embarrassment, cultural differences, inadequate knowl-
edge base, anxiety around personal sexual experience, and
concerns about perception or development of sexual feelings
toward a patient.
While some programs might choose to
isolate this topic for discussion, others may choose to incorporate
it as part of a larger discussion group on a potpourri of sensitive
issues. Small group settings have been found to be effective in
improving communication skills in medical students.
can provide each other with peer-to-peer strategies while high-
lighting the importance of working through the discomfort to
optimize patient care. Ideally this discussion group should be
facilitated by trained and experienced leaders.
This may also be
an avenue to explicitly discuss the hidden curriculum: while
students may not see their preceptors taking sexual histories, this
should not imply that they themselves should not.
FIRST-YEAR EVALUATION METHODS
First-year student evaluations should be formative rather than
summative based on faculty-observed SP encounters or video
Given the wide prevalence of smartphones, tablets,
and laptop computers with video capabilities, video review is
now a logistically and ﬁnancially viable evaluation method.
Students should have an opportunity to ﬁlm themselves taking a
sexual history with a peer or SP, either in isolation or in
conjunction with a complete patient history, for self- or faculty
review. Review can take the form of a written self-reﬂection,
written feedback from a faculty member, or in-person self-
reﬂection, and feedback with a faculty member.
Many existing clinical interview courses include a year-end
objective structured clinical examination (OSCE) on history
taking. Sexual history should be a part of this clinical inter-
viewing OSCE. Failure to include sexual history implies that the
sexual history is not as important as other elements of the clinical
interview and misses a valuable opportunity for evaluation.
Recommended student evaluation methods are outlined in
Second-year students should review and expand upon the
basics of sexual health communication by learning to incorporate
advanced interviewing skills and clinical decision making. In a
traditional curriculum with distinct ﬁrst and second years, edu-
cation on sexual health communication may be separated by over
12 months. In that setting, programs should review the basics of
sexual history taking in year 2. This should be rapidly paced and
include student self-review of the sexual history example video
and a provided sexual history script. Core elements and teaching
methods for a second-year curriculum are outlined in Table 5.
The sections that follow more speciﬁcally discuss the advanced
sexual health communication skills that should be addressed in
pre-clinical education. These skills represent the consensus of the
authors and are based on expert opinion.
interviewing skills include clinical reasoning and purpose-driven
questioning, questions for speciﬁc populations/diversity of
practices, sexual problem-based history, sexual health counseling,
and illness-related sexual health interviewing.
Table 5. Core elements and teaching methods for a second-year
Self-preparation: Review of ﬁrst-year material (video and script)
Self-preparation: Video demonstrations of advanced sexual history role
Didactics: Advanced sexual communication skills
Didactics: Advanced sexual history with counseling role play
Didactics: Inclusion of sexual history items in existing didactics
Role play: Advanced sexual history taking with feedback from faculty; a
scenario with a LGBTQ patient with a sexual problem or illness-related
Role play: Sexual history taking during focused history in general
simulated patient scenarios
Role play: Sexual history taking during complete history in general
simulated patient scenarios
Summative evaluation: Inclusion of sexual history in midterm and year
end objective structured clinical exam or group objective structured
LGBTQ ¼lesbian, gay, bisexual, transgender, and queer.
Table 4. Core elements and teaching methods for a ﬁrst-year
Self-preparation: Video demonstration of sexual history role play
Self-preparation: Recommended reading on the sexual history
Self-preparation: Sexual history script
Didactic: Principles of sexual history taking (see “First-Year Content”)
Didactic: Sexual history role-play demonstration with simulated patient
Role play: Sexual history taking with peers with feedback
Role play: Sexual history taking in simulated patient scenario
Role play: Sexual history taking in context of larger patient encounter
(eg, complete history) in simulated patient scenario
Discussion group: Sexual health communication strategies and comfort
Formative evaluation: Video self-review of 1 of the above role plays
Formative evaluation: Objective structured clinical exam or group
objective structured clinical exam
J Sex Med 2018;15:1414e1425
Medical Education in Sexual History Taking 1419
Clinical Reasoning/Purpose-Driven Questions
Second-year students should be encouraged to ask questions
more speciﬁcally related to a chief symptom. They may, for
example, ask questions about pain during vaginal penetration for
a suspected diagnosis of endometriosis or questions about history
of chronic infections and allergic reactions for a suspected diag-
nosis of inﬂammatory vestibulodynia. The subtleties of identi-
fying the truly critical elements for evaluation in a particular
patient encounter compared with what should be deferred should
also be addressed, along with directing the conversation and
working within time constraints. Students at the second-year
level should be able to utilize their clinical knowledge to this end.
Questions for Speciﬁc Populations/Diversity of
Second-year students will beneﬁt from in-depth discussion
about diversity in sexual practices and higher-level case exam-
This includes exposing students to questions relevant to
the needs of speciﬁc populations.
Though the spectrum of
sexual orientation has become more widely embraced throughout
the United States, a recent study suggests medical students,
residents, and fellows remain uncomfortable obtaining sexual
history from lesbian, gay, bisexual, transgender, and queer
Medical students also lack knowledge of
the range of sexual practices engaged in by many same-sex
Students should have learned to include LGBTQ
patients in their questions during their ﬁrst year (outlined in
Table 2); however, many will need additional education for more
in-depth counseling. Additionally, students should learn perti-
nent questions for sex workers; victims of sexual trauma; sexual
enhancement device use; and those who engage in diverse sexual
activities including group sexual activity, bondage, dominance,
sadism, masochism, and paraphilias.
treatment, and management are outside the scope of this article,
students may need background knowledge lectures in order to
better direct patient interviews.
Sexual Problem-Based History
Second-year students should advance beyond screening for
sexual problems (Table 2) and should learn the basics of con-
ducting a sexual problem-based history. This begins by learning
to contextualize patient problems and establish intent to help.
Students should then learn to appropriately inquire about the
problem’s impact on relationships, partner response to the
patient’s problem, and patient motivation for improving
Second-year students should begin training in sexual health
counseling. This includes explaining a diagnosis, soliciting and
addressing questions, and utilizing motivational interviewing
techniques to address barriers to change. Some programs may
already have established coursework in motivational interviewing
and can explain how these skills can be generalized to sexual
health discussions. For example, students may beneﬁt learning to
elicit a medication side effect from a contraceptive method and
how to counsel toward a different method. As students complete
coursework in contraception, sexual problems, and STIs, they
will be better equipped to respond to patient concerns, questions,
Illness-Related Sexual Health Interview
Second-year students should be exposed to the impact of
illness on sexual function and the illness-related sexual health
interview. Programs can teach the BETTER model for assisting
students in bringing up sex and sexuality while caring for patients
with chronic illnesses, such as cancer.
The BETTER mne-
monic, developed speciﬁcally for cancer patients, stands for:
Bringing up the topic of sexuality; Explaining to the patient or
partner that sexuality is a part of quality of life; Telling the
patient about resources available to them (as well as gauging the
trainee’s ability and willingness to assist in addressing questions
and concerns); Timing the discussion to when the patient would
prefer, not only when it is convenient for the interviewer; and
Recording that the conversation took place and any follow-up
plans to further address patient concerns or questions.
illness-related sexual interview is beyond the scope of a pre-
clinical education, but students may beneﬁt from learning the
goals of an illness-related sexual health interview. Table 6 out-
lines a medical student-level illness-related sexual health
SECOND-YEAR TEACHING METHODS
Teaching modalities for second-year students are similar to
those of ﬁrst-year students: self-preparation, didactics, role play,
standardized patients/SPs, and discussion groups. Didactic ses-
sions and SP encounters should be speciﬁcally tailored to
acquisition of more advanced content.
Second-year clinical interviewing or physical examination
course didactics should emphasize the sexual history as a neces-
sary component of conducting a focused history. Students should
receive didactics speciﬁcally on taking a complex sexual history
and discussion of sexual problems, keeping in mind the content
areas described above, including a demonstration of a counseling
Table 6. Goals of illness-related sexual health interview for
Screening and identiﬁcation of sexual concerns or diagnosis of
Clinical assessment of sexual dysfunction, origin, and impact on pa-
Empathy and counseling utilizing normalization and support
Referrals for counseling, physical therapy, and/or a medical specialist as
J Sex Med 2018;15:1414e1425
1420 Rubin et al
visit. Programs may wish to incorporate this into didactics on
caring for speciﬁc populations. When possible, focused sexual
history items should be included in existing didactic descriptions
of clinical presentations. Instructors should include scenarios in
which patients have sexual health problems to normalize and
emphasize the importance of these clinical discussions. If dedi-
cated class time is not possible, programs should seek out videos
of advanced sexual history taking for students to view. AAMC
has developed a series of online videos that can be used for this
For teaching the advanced skills outlined above, programs may
need to reach outside their normal sphere of hired SPs. Some
programs may ﬁnd senior medical students or members of
community organizations such as LGBTQ community groups or
cancer survivorship groups willing to volunteer for these role
Role play is particularly important in teaching inter-
viewing skills pertinent to discussing sex and sexuality with
The AAMC has developed a series of
online videos speciﬁcally for sexual history taking with LGBTQ
Should programs wish to incorporate sexual history
taking for transgender patients into their role plays, it is
important to have transgender actors/volunteers playing such
patients as to avoid inadvertently offensive portrayals.
Comfort with increasingly complex SP encounters is an
important skill second-year students must master in advance of
their clinical rotations and for passing the Step 2 Clinical Skills
U.S. Medical Licensing Exam.
While peer-to-peer role play
with large group feedback may not be time-efﬁcient or high
stakes enough for second-year students, students should be given
time to practice their skills with a SP or faculty member with
Sexual history should regularly be included in SP
encounters designed to represent general or all-encompassing
clinical scenarios. Excluding this portion of the history re-
inforces it as unimportant. SP encounters may be important for
second-year students in the form of evaluation, described below.
SECOND-YEAR EVALUATION METHODS
Second-year evaluations should be summative as students
should have advanced beyond needing targeted sexual history-
speciﬁc evaluations. Instead, sexual history taking should be
incorporated into pre-existing OSCE or group OSCE that
evaluate overall communication or interviewing skills. Students
should be required to ask relevant sexual history questions in
order to pass mid-year clinical exams that evaluate complete
history taking, focused history taking, or time management.
Finally, sexual history should be included in the history taking
components of a summative year-end OSCE.
The ﬁrst-year curriculum we’ve described is focused on
acquiring satisfactory basic sexual history taking skills, including
both sexual risk (ie, the 5 Ps)
as well as the sixth P (plus),
which encompasses the assessment of trauma, violence, support
for gender identity and sexual orientation, sexual satisfaction, and
sexual health concerns/problems. The second-year curriculum is
focused on incorporating improved clinical reasoning, empha-
sizing sexual history taking of diverse populations and practices,
and including the impact of illness on sexual health. For more
effective learning, teaching methods must include varied formats
including student self-reﬂection, didactics, video demonstrations,
SP encounters with immediate feedback, and role play. Evalua-
tion may be best as a formative OSCE in the ﬁrst year and
summative OSCE in the second year.
Several barriers exist regarding the incorporation of a compre-
hensive education in sexual health communication into an existing
undergraduate medical school curriculum.
curricula are becoming increasingly condensed; and the majority
of lecture time is often devoted to only those topics tested on the
U.S. Medical Licensing Exam. In an effort to address monetary
and temporal constraints, lectures, role plays, and discussion
groups must be organized and efﬁcient. Whenever possible, sexual
history taking should be included into existing courses on clinical
interviewing or human reproduction. Students should be advised
that their skills must be practiced outside of class time.
Additionally, faculty endorsement can be difﬁcult to obtain, as
faculty themselves may be uncomfortable discussing sexual health,
may lack experience in sexual medicine, or may not take sexual
histories in their own practices. This in turn can shape the "hidden
curriculum," ie, the practices learned by observing faculty mem-
bers’attitudes or behavior. Utilizing faculty sexual health cham-
pions to rally for curriculum committee support can mitigate issues
surrounding faculty buy-in. Clinical faculty will need professional
development around discussing sexual health.
Content for faculty
is similar to that for students and should include a script, current
standard operating procedures or best practices in sexual history
taking, and webinars or video modules. Materials are frequently
available fully formed and free of cost. For example, the National
LGBT Health Education Center, a program of the Fenway Insti-
tute, has developed a free, modiﬁable, all-staff sexual history
training presentation that is available online.
has a number of well-developed sexual history taking
curriculum materials that can be used for faculty development.
Due to the nature of expert consensus, our proposed curric-
ulum is limited in that it is not yet validated. Ideally, validation
would comprise student appraisal of the individual curricular
components, including an assessment of which elements students
perceive to be most useful. Optimal validation needs to
also incorporate faculty input regarding the quality of the
implementation of curricular components and ideally patient
feedback regarding evidence of acquisition of skills. Assessment is
J Sex Med 2018;15:1414e1425
Medical Education in Sexual History Taking 1421
needed regarding the effectiveness of this curriculum in teaching
sexual history taking across the spectrum of sexuality and illness
(eg, sexual orientation, gender identity, disability). To ensure the
appropriate skills are being acquired, validation may also occur
using assessments before and after curricular intervention via
OSCEs and/or observed patient encounters.
Our proposed curriculum represents expert consensus on the
ideal curriculum that will be attainable for some programs. This
curriculum is aspirational, and many programs will only be able to
incorporate those aspects that align with their current curriculum.
Programs may ﬁnd they need to incorporate some of this material
into the clinical years. Indeed, next steps in this ﬁeld would be
creating sexual health communication skills curricula in relevant
clerkships including obstetrics and gynecology, internal medicine,
family medicine, pediatrics, ambulatory care, psychiatry, and
urology. At present, it is of the utmost importance that medical
schools use the dedicated pre-clinical time to create the foundation
for excellent clinical sexual health communications skills.
This article is a summary of the consensus from 2012, 2014,
and 2016 Summits on Medical Education in Sexual Health on
best practices in medical education in sexual history taking and
serves as a blueprint for sexual health communication curricula in
pre-clinical undergraduate medical education in North America.
The ideal model for developing these skills includes a spiral
curriculum utilizing multiple educational modalities that weaves
the core concepts of sexual history taking into the advanced skills
required for medical students in the clinical setting.
The authors of this article would like to acknowledge the
Program in Human Sexuality in the Department of Family
Medicine and Community Health at University of Minnesota
Medical School as well as additional members of the Subcom-
mittee on Sexual History Taking Education: Alyson Kristensen
and Daniel E. Rohe, PhD.
Corresponding Author: Elizabeth S. Rubin, MD, Department
of Obstetrics and Gynecology, Hospital of the University of
Pennsylvania, 3400 Spruce Street, Fifth Floor Dulles Building,
Philadelphia, PA 19104, USA. Tel: 215-662-2459; Fax: 215-
349-5893; E-mail: firstname.lastname@example.org
Conﬂict of Interest: The authors report no conﬂicts of interest.
STATEMENT OF AUTHORSHIP
(a) Conception and Design
Elizabeth S. Rubin; Jordan Rullo; Joycelyn Elders; Sharon J.
(b) Acquisition of Data
Elizabeth S. Rubin; Jordan Rullo; Sharon J. Parish
(c) Analysis and Interpretation of Data
Elizabeth S. Rubin; Jordan Rullo; Sharon J. Parish
(a) Drafting the Article
Elizabeth S. Rubin; Jordan Rullo; Sharon J. Parish
(b) Revising It for Intellectual Content
Elizabeth S. Rubin; Jordan Rullo; Perry Tsai; Shannon Criniti;
Joycelyn Elders; Jacqueline M. Thielen; Sharon J. Parish
(a) Final Approval of the Completed Article
Elizabeth S. Rubin; Jordan Rullo; Perry Tsai; Shannon Criniti;
Joycelyn Elders; Jacqueline M. Thielen; Sharon J. Parish
1. Boekeloo BO, Marx ES, Kral AH, et al. Frequency and
thoroughness of STD/HIV risk assessment by physicians in a
high-risk metropolitan area. Am J Public Health 1991;
2. Laumann EO, Nicolosi A, Glasser DB, et al. Sexual problems
among women and men aged 40e80 y: prevalence and
correlates identiﬁed in the Global Study of Sexual Attitudes
and Behaviors. Int J Impot Res 2005;17:39-57.
3. Shifren JL, Monz BU, Russo PA, et al. Sexual problems and
distress in United States women: prevalence and correlates.
Obstet Gynecol 2008;112:970-978.
4. Lewis RW, Fugl-Meyer KS, Corona G, et al. Deﬁnitions/epide-
miology/risk factors for sexual dysfunction. J Sex Med 2010;
5. McCabe M, Sharlip ID, Atalla E, et al. Deﬁnitions of sexual
dysfunctions in women and men: a consensus statement from
the fourth international consultation on sexual medicine 2015.
J Sex Med 2016;13:9.
6. Althof SE, Rosen RC, Perelman MA, et al. Standard operating
procedures for taking a sexual history. JSexMed2013;10:26-35.
7. Shindel AW, Baazeem A, Eardley I, et al. Sexual health in un-
dergraduate medical education: existing and future needs and
platforms. J Sex Med 2016;13:1013-1026.
8. World Health Organization. Brief sexuality-related communi-
cation: recommendations for a public health approach. Available
health/sexuality-related-communication/en; Accessed February
9. Smith S, Hanson JL, Tewksbury LR, et al. Teaching patient
communication skills to medical students: a review of ran-
domized controlled trials. Eval Health Prof 2007;30:3-21.
10. Laumann EO, Glasser DB, Neves RC, et al. A population-based
survey of sexual activity, sexual problems and associated help-
seeking behavior patterns in mature adults in the United
States of America. Int J Impot Res 2009;21:171-178.
11. Jayasuriya AN, Dennick R. Sexual history-taking: using
educational interventions to overcome barriers to learning. Sex
J Sex Med 2018;15:1414e1425
1422 Rubin et al
12. Balami JS. Are geriatricians guilty of failure to take a sexual
history? J Clin Gerontol Geriatr 2011;2:17-20.
13. Holman KM, Carr JA, Baddley JW, et al. Sexual history taking
and sexually transmitted infection screening in patients initi-
ating erectile dysfunction medication therapy. Sex Transm Dis
14. McCool ME, Apfelbacher C, Brandstetter S, et al. Diagnosing
and treating female sexual dysfunction: a survey of the per-
spectives of obstetricians and gynecologists. Sex Health
15. Ribeiro S, Alarcao V, Simoes R, et al. General practitioners’
procedures for sexual history taking and treating sexual
dysfunction in primary care. J Sex Med 2014;11:386-393.
16. Sargant NN, Smallwood N, Finlay F. Sexual history taking: a
dying skill? J Palliat Med 2014;17:829-831.
17. Sobecki JN, Curlin FA, Rasinski KA, et al. What we don’t talk
about when we don’t talk about sex: results of a national
survey of U.S. obstetrician/gynecologists. J Sex Med 2012;
18. Loeb DF, Lee RS, Binswanger IA, et al. Patient, resident
physician, and visit factors associated with documentation of
sexual history in the outpatient setting. J Gen Intern Med
19. Barber B, Hellard M, Jenkinson R, et al. Sexual history taking
and sexually transmissible infection screening practices among
men who have sex with men: a survey of Victorian general
practitioners. Sex Health 2011;8:349-354.
20. Cornelisse VJ, Fairley C, Roth NJ. Optimizing healthcare for
men who have sex with men: a role for general practitioners.
Aust Fam Physician 2016;45:182-185.
21. Forsyth S, Rogstad K. Sexual health issues in adolescents and
young adults [erratum appears in Clin Med (Lond) 2015;15:
565]. Clin Med (Lond) 2015;15:447-451.
22. Briedite I, Ancane G, Ancans A, et al. Insufﬁcient assessment
of sexual dysfunction: a problem in gynecological practice.
Medicina (Kaunas) 2013;49:315-320.
23. Heath GE, Fairchild P, Berger M, et al. Sexual health inquiry
preferences among gynecologic cancer patients after radiation
therapy. J Clin Oncol 2016;34(Suppl 3).
24. Levey HR, Gilbert B, Burnett A, et al. Let’s talk about sex:
implementation of a healthcare provider-based educational
training module to improve sexual health communication.
J Sex Med 2012;9:38.
25. NIH Consensus Conference. Impotence. NIH Consensus
Development Panel on Impotence. JAMA 1993;270:83-90.
26. Parish SJ, Rubio-Aurioles E. Education in sexual medicine:
proceedings from the international consultation in sexual
medicine, 2009. J Sex Med 2010;7:3305-3314.
27. Criniti S, Andelloux M, Woodland MB, et al. The state of sexual
health education in US medicine. Am J Sex Educ 2014;9:65-80.
28. Malhotra S, Khurshid A, Hendricks KA, et al. Medical school
sexual health curriculum and training in the United States.
J Natl Med Assoc 2008;100:1097-1106.
29. Nusbaum MR, Hamilton CD. The proactive sexual health his-
tory. Am Fam Physician 2002;66:1705-1712.
30. Parish SJ, Clayton AH. Sexual medicine education: review and
commentary. J Sex Med 2007;4:259-267; quiz 68.
31. Shindel AW, Ando KA, Nelson CJ, et al. Medical student
sexuality: how sexual experience and sexuality training impact
US and Canadian medical students’comfort in dealing with
patients’sexuality in clinical practice. Acad Med 2010;
32. Coverdale JH, Balon R, Roberts LW. Teaching sexual history-
taking: a systematic review of educational programs. Acad
33. Abdessamad HM, Yudin MH, Tarasoff LA, et al. Attitudes and
knowledge among obstetrician-gynecologists regarding
lesbian patients and their health. J Womens Health (Larchmt)
34. Merrill JM, Laux LF, Thornby JI. Why doctors have difﬁculty
with sex histories. South Med J 1990;83:613-617.
35. Wittenberg A, Gerber J. Recommendations for improving
sexual health curricula in medical schools: results from a two-
arm study collecting data from patients and medical students.
J Sex Med 2009;6:362-368.
36. Rosen R, Kountz D, Post-Zwicker T, et al. Sexual communi-
cation skills in residency training: the Robert Wood Johnson
model. J Sex Med 2006;3:37-46.
37. Vieira TC, de Souza E, da Silva I, et al. Dealing with female
sexuality: training, attitude, and practice of obstetrics and
gynecology residents from a developing country. J Sex Med
38. Muin D, Sheikh Rezaei S, Dadak C, et al. Residents’attitudes
towards sexual medicine in obstetrics and gynecology—a
national survey. J Sex Med 2016:S171.
39. Pancholy AB, Goldenhar L, Fellner AN, et al. Resident educa-
tion and training in female sexuality: results of a national
survey. J Sex Med 2011;8:361-366.
40. Abraham A, Hawkins K, Chen R. An educational intervention
to improve physician interviewing skills of adolescent patients
during the pediatric clerkship. J Adolesc Health 2011:S34-
41. Baraitser P, Elliott L, Bigrigg A. How to talk about sex and do it
well: a course for medical students. Med Teacher 1998;
42. Horn K, Fitzgerald J, Tometzki B. “Find your mate”! an inter-
active game to support the teaching of sexual history taking to
medical students. Sex Transm Infect 2015;91:A78-A79.
43. Milone JM, Burg MA, Duerson MC, et al. The effect of lecture
and a standardized patient encounter on medical student rape
myth acceptance and attitudes toward screening patients for a
history of sexual assault. Teach Learn Med 2010;22:37-44.
44. Galletly C, Lechuga J, Layde JB, et al. Sexual health curricula in
US medical schools: current educational objectives. Acad
45. Roth Bayer C, Satcher D. Moving medical education and
sexuality education forward. Curr Sex Health Rep 2015.
46. Shindel A, Parish SJ. Sexuality education in North American
medical schools: current status and future directions (CME).
J Sex Med 2013;10:16.
J Sex Med 2018;15:1414e1425
Medical Education in Sexual History Taking 1423
47. Obedin-Maliver J, Goldsmith ES, Stewart L, et al. Lesbian, gay,
bisexual, and transgender-related content in undergraduate
medical education. JAMA 2011;306:971-977.
48. A clinician’s guide to sexual history taking. In: California
Department of Public Health STD Control Branch and Cali-
fornia STD/HIV Prevention Training Center, editor. Sacra-
mento, CA; 2011. Available at: https://www.cdph.ca.gov/
Programs/CID/DCDC/CDPH Document Library/CA-STD-
49. Creegan L, Gelt M. Sexual history-taking toolkit: focus on
Chlamydia, gonorrhea, and HIV in the family planning clinic.
Los Angeles, CA: California Family Health Council Inc, Center
for Health Training, California STD/HIV Prevention Training
50. Solursh DS, Ernst JL, Lewis RW, et al. The human sexuality
education of physicians in North American medical schools.
Int J Impot Res 2003;15(Suppl):S41-S45.
51. Haist SA, Lineberry MJ, Grifﬁth CH, et al. Sexual history in-
quiry and HIV counseling: improving clinical skills and medical
knowledge through an interactive workshop utilizing stan-
dardized patients. Adv Health Sci Educ 2008;13:427-434.
52. Coleman E, Elders J, Satcher D, et al. Summit on medical
school education in sexual health: report of an expert
consultation. J Sex Med 2013;10:924-938.
53. Bayer C, Eckstrand KL, Knudson G, et al. Sexual health
competencies for undergraduate medical education in North
America. J Sex Med 2017;14:6.
54. Wagner E, McCord G, Stockton L, et al. A sexual history-taking
curriculum for second year medical students. Med Teacher
55. Leeper H, Chang E, Cotter G, et al. A student-designed and
student-led sexual-history-taking module for second-year
medical students. Teach Learn Med 2007;19:293-301.
56. Harden RM. What is a spiral curriculum? Med Teacher 1999;
57. Bruner J. The process of education. Cambridge, MA: Harvard
University Press; 1960.
58. U.S. Department of Health and Human Services: Centers for
Disease Control and Prevention. Taking a sexual history: a
guide to taking a sexual history. CDC publication 99-8445.
Atlanta; Centers for Disease Control and Prevention; 2005.
Available at: https://www.cdc.gov/std/treatment/sexualhistory.
pdf; Accessed April 7, 2017.
59. National LGBT Health Education Center. A Program of the
Fenway Institute and National Association of Community
Health Centers. Taking routine histories of sexual health: a
system-wide approach for health centers. Available at: https://
60. Eardley I, Reisman Y, Goldstein S, et al. Existing and future
educational needs in graduate and postgraduate education.
J Sex Med 2017;14:475-485.
61. O’Keefe R, Tesar CM. Sex talk: what makes it hard to learn
sexual history taking? Fam Med 1999;31:315-316.
62. Sexual health and your patients: a provider’s guide. Washing-
ton, DC: Altarum Institute; 2016.
63. Sadovsky R, Nusbaum M. Sexual health inquiry and support is
a primary care priority. J Sex Med 2006;3:3-11.
64. Vollmer S, Wells K, Blacker KH, et al. Improving the prepara-
tion of preclinical students for taking sexual histories. Acad
65. Lee R, Loeb D, Butterﬁeld A. Sexual history taking curriculum:
lecture and standardized patient cases. MedEdPORTAL Pub-
66. Athanasiadis L, Papaharitou S, Salpiggidis G, et al. Educating
physicians to treat erectile dysfunction patients: development
and evaluation of a course on communication and manage-
ment strategies. J Sex Med 2006;3:47-55.
67. Anderson M, Grudzen M, LeBaron S. A workshop on taking a
sexual history and counseling on contraception. Acad Med
68. Levinson W, Lesser CS, Epstein RM. Developing physician
communication skills for patient-centered care. Health Aff
69. Jha V, Setna Z, Al-Hity A, et al. Patient involvement in
teaching and assessing intimate examination skills: a sys-
tematic review. Med Educ 2010;44:347-357.
70. Lane C, Rollnick S. The use of simulated patients and role-play
in communication skills training: a review of the literature to
August 2005. Patient Educ Couns 2007;67:13-20.
71. Bosse HM, Nickel M, Huwendiek S, et al. Cost-effectiveness of
peer role play and standardized patients in undergraduate
communication training. BMC Med Educ 2015;15:183.
72. Bosse HM, Schultz JH, Nickel M, et al. The effect of using
standardized patients or peer role play on ratings of under-
graduate communication training: a randomized controlled
trial. Patient Educ Couns 2012;87:300-306.
73. Arifﬁn F, Chin KL, Ng C, et al. Are medical students conﬁdent in
takinga sexual history?An assessment on attitude and skillsfrom
an upper middle income country. BMC Res Notes 2015;8:248.
74. Foy L. How do medical students feel about sex? Insight into
medical student attitudes towards sexual health. Contracep-
75. Wolf C. Exploring the sexual attitudes of physician assistant
students: implications for obtaining a sexual history.
J Physician Assist Educ 2012;23:30-34.
76. Nicol DJ, Macfarlane-Dick D. Formative assessment and self-
regulated learning: a model and seven principles of good
feedback practice. Stud Higher Educ 2006;31:199-218.
77. Black P, William D. The formative purpose: assessment must
ﬁrst promote learning. Yearb Natl Soc Stud Educ 2004;
78. Metcalfe H, Jonas-Dwyer D, Saunders R, et al. Using the
technology: introducing point of view video glasses into the
simulated clinical learning environment. Comput Inform Nurs
79. Volino LR, Pathak Das R. Video review in self-assessment of
pharmacy students’communication skills. J Educ Learn 2014;
80. Zahl DA, Schrader SM, Edwards PC. Student perspectives on
using egocentric video recorded by smart glasses to assess
J Sex Med 2018;15:1414e1425
1424 Rubin et al
communicative and clinical skills with standardized patients.
Eur J Dent Educ 2018;22:73-79.
81. Hayes V, Blondeau W, Bing-You RG. Assessment of medical
student and resident/fellow knowledge, comfort, and training
with sexual history taking in LGBTQ patients. Fam Med 2015;
82. Talley H, Cho J, Strassberg DS, et al. Analyzing medical stu-
dents’deﬁnitions of sex. Am J Sex Educ 2016;11:129-137.
83. Mick J, Hughes M, Cohen MZ. Using the BETTER model to
assess sexuality. Clin J Oncol Nurs 2004;8:1.
84. Althof SE, Parish SJ. Clinical interviewing techniques and
sexuality questionnaires for male and female cancer patients.
J Sex Med 2013;10(Suppl):35-42.
85. Eckstrand K, Lomis K, Rawn L. An LGBTI-inclusive sexual
history taking standardized patient case. MedEdPORTAL
86. Federation of State Medical Boards and National Board of
Medical Examiners. US Medical Licensing Exam. Step 2 CS.
1996e2018. Available at: http://www.usmle.org/step-2-cs/.
Accessed June 22, 2018.
87. Association of American Medical Colleges. MedEdPORTAL.
Available at: https://www.mededportal.org/. Accessed
February 7, 2017.
Supplementary data related to this article can be found at
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