Students' sexual knowledge, attitudes toward sex, and willingness to treat sexual concerns.

PIP: In the research reported here, the authors examine the relation of 82 medical students' feelings about sex to their level of sexual knowledge, willingness to treat patients with sexual concerns, and participation in an elective sex education course. 82 of the 100 2nd-year students at an Ontario medical school in 1986 participated in the initial phase of this survey research. This sample contains 37 men. 37 of the students (19 of them men) completed the follow-up measures. The results show that the erotophobic students (those with negative feelings about sexuality) had significantly lower levels of sexual knowledge and were significantly less likely to participate in an elective human sexuality course than the erotophilic students (those with positive feelings about sexuality). Moreover, the erotophobic students who took part in the sexuality course benefited from it less than did the erotophilic students as measured by their willingness to treat patients with sexual concerns. Finally, although the students overall were relatively knowledgeable about sex and were relatively willing to treat patients with sexual concerns, trouble in gaps in specific sexual knowledge and in willingness to treat patients with certain sexual concerns (such as acquired immunodeficiency syndrome) were identified. Medical schools need to structure sex education in ways that take account of students' ambivalent feelings about sex and need to provide sex education that increases both sexual knowledge and willingness to treat patients with sexual concerns.^ieng

Students' sexual knowledge, attitudes toward sex, and willingness to treat sexual concerns.

In the research reported here, the authors examined the relation of 82 medical students' feelings about sex to their level of sexual knowledge, willingness to treat patients with sexual concerns, and participation in an elective sex education course. The results showed that the erotophobic students (those with negative feelings about sexuality) had significantly lower levels of sexual knowledge and were significantly less likely to participate in an elective human sexuality course than the erotophilic students (those with positive feelings about sexuality). Moreover, the erotophobic students who took part in the sexuality course benefited from it less than did the erotophilic students as measured by their willingness to treat patients with sexual concerns. Finally, although the students overall were relatively knowledgeable about sex and were relatively willing to treat patients with sexual concerns, troubling gaps in specific sexual knowledge and in willingness to treat patients with certain sexual concerns (such as acquired immune deficiency syndrome) were identified. Medical schools need to structure sex education in ways that take account of students' ambivalent feelings about sex and need to provide sex education that increases both sexual knowledge and willingness to treat patients with sexual concerns.

Supra-biological factors in the assessment of males seeking penile prostheses.

The technique of installing penile prostheses for treatment of erectile dysfunction in the male is becoming increasingly popular, particularly, but by no means exclusively in the cases of impotence in which biological factors are clearly implicated. The literature to date fails to take into account suprabiological factors such as the nature of the couple's sexual relationship and more particularly the sexual myths that shape their sexual behaviour. The author evaluated eight couples in which the male was seeking a penile prostheses and in all eight couples a variety of sexual myths had contributed to major sexual problems for the couple, even before the onset of the erectile dysfunction. A plea is made for discarding the false dichotomy or "organic" versus "functional", in favour of a list of etiological factors including the biological ones as well as suprabiological ones. Also, the installation of penile implants should only be considered after a full investigation of the couple's sexuality by a competent sex therapist and only when other forms of couple/sex therapy have failed.

An assessment approach to couples with sexual problems.

We have described the assessment approach to couples with sexual complaints used in the McMaster Human Sexuality Clinic. Our approach takes into account a number of individual factors including intrapersonal and biological ones as well as issues of sexual socialization, gender role socialization and sexual orientation. Couple factors include relationship factors as well as factors dealing with sexual behaviours, attitudes and responses. In our view, the issues of sexual socialization and gender role socialization needs special emphasis in assessing such couples. We stress as well that the dichotomy between organic and functional is a misleading one and that for each individual and couple, any biological factors and the many supra-biological factors listed above, must be prioritized in terms of their role in symptom production. Such a priority list can then be used to map out treatment strategies.

Teaching individual psychotherapy: learning objectives in communication.

Communication is the essence of the process of psychotherapy. Understanding the parameters of communication can form the foundations for the development of psychotherapeutic skills in the student therapist. Using learning objectives within the context of teaching psychotherapy, the process of communication in individual psychotherapy is explored in this paper. With the aim of offering a practical framework to assist in the analysis of the communication process involved in individual psychotherapy, the following concepts are first examined. 1) channels of communication; 2) modes of functioning; 3) interaction between channels of communication and modes of functioning. Following this exploration, the learning objectives in communication are discussed. Using clinical examples, the relationship between the communication process and other concepts of individual psychotherapy are illustrated. Finally, some pedagogic reasons for teaching students the analysis of the communication process early in their psychotherapy training are presented.

Education for Sexuality: The Physician's Role.

We have plenty of education for sexuality in society, most of it based on an outmoded pronatalist code of sexual behavior that is destructive to human beings and to human relationships. Only when we are aware of the full ramifications of that code can we make the social and institutional changes required to educate for sexuality in a manner relevant to the true human needs of the 20th century. This article outlines the requisites for such a humanist code.

Teaching psychotherapy. Learning objectives in individual psychotherapy.

This paper constitutes an initial attempt to establish specific end-point objectives for the teaching (and learning) of individual psychotherapy skills. A working framework for teaching psychotherapy, which includes intrapsychic as well as interactional phenomena, is articulated. The framework also tries to achieve an integration of basic concepts of psychotherapy and specific skills for clinical practice. It draws on concepts derived from communication theory, psychoanalytic theory, adaptational theory (ego theory), learning theory, and transactional theory. In presenting these objectives three classes of skills are articulated: perceptual, conceptual, and executive. The end-point objectives are discribed for the following categories: 1) therapeutic stance, 2) history and mental status, 3) models and concepts, 4) communication channels, 5) patient's affect, 6) therapist's affect, 7) acceptance of affect, 8) interpretation, 9) transactions and 10) reinforcement and adaptation. This framework is truly eclectic in nature and effects a healthy compromise between the technique oriented "ABC's of psychotherapy" school and proponents of the view that psychotherapy is an art that cannot be taught. By drawing from more than one model it encourages the student to recognize early the distinction between theoretical formulation and ideological commitment in psychotherapy. It presents these objectives in the form of an instrument that can, with continuous refinement and testing, be used to evaluate student's progress in a psychotherapy training program.

Letter: The Canadian abortion law.

PIP: Results of a survey conducted by Doctors for the Repeal of Abortion Law in 1975, to determine how well the Canadian abortion law was meeting the needs of the unwillingly pregnant woman, are presented. There are 258 hospitals with abortion committees, and of these, 157 responded to the questionnaire. While an estimated 68 out of 258 hospitals performed more than 100 abortions each in 1974, an estimated 21 hospitals had zero abortion procedures and an estimated 34 had 5 or fewer. Many hospitals placed unofficial quotas on the numbers of abortions performed. Physicians on the staffs had little input into the hospital abortion policy. Large numbers of Canadian women were unable to obtain abortions in their own communities. The law clearly discriminates against women who are poor. The present Canadian abortion law must be removed from the Criminal Code.^ieng