In the late 1960s and early 1970s, the literature indicated that medical school educators realized physicians needed to know more about human sexuality (1–3). Reviews for textbooks (4) began to contain curricula for medical educators to use in teaching human sexuality (5, 6), and some researchers started to examine the successes and failures of medical school sexuality courses (7).

In the 1970s, articles from international medical and nursing schools described specific techniques for teaching human sexuality in multidisciplinary settings, such as role plays (8), video, and films (9).

In the 1990s, articles addressed teaching about homosexuality in medical schools (10, 11), reducing “homophobia” during medical training (12), exploring gay and lesbian issues among residents (13), assessing sexual health of residents (14), and exploring women’s sexuality as part of women’s health courses (15).

In the 1990s and 2000s, a few articles focused on teaching human sexuality to psychiatric residents. Psychiatry educators wrote about teaching sexual issues as part of broader cultural issue courses (16), teaching psychiatric residents about sexual feelings and boundaries (17), and developing human sexuality curricula for psychiatric residents (18).

Studies show that patients often rely on physicians to broach the subject of sexual health (19), yet only 58% of physicians ask even the most general sexual health questions (20). Furthermore, only 12%–34% of physicians ask about aspects of patients’ sexual histories that are deemed crucial for clinical care (21).

The paucity of sexual history-taking instruction and the passive nature of lecture-oriented curricula in medical schools failed to adequately train many physicians to take a comprehensive sexual history (22). In 1970, medical schools such as Bowman Gray required 40 to 50 hours of human sexuality education for medical students and offered a 3-month elective course for both medical students and residents (23), but a 2002 survey of 101 North American medical schools found that 61%–67% of schools taught fewer than 10 total hours of human sexuality. Most schools indicated that passive learning formats such as group lectures were the primary mode of teaching (24). Only a few schools used alternative methods such as scripted role play and group discussions to teach sexual history-taking skills (25, 26). A 2000 survey of residency programs (27) showed that although most programs had expert faculty in sexual dysfunctions and sex therapy, programs rarely offered rotations specifically on sexuality issues.

In response to a perceived lack of well-developed methods for gathering and classifying information related to sexual thoughts and behaviors, we developed the Sexual Events Classification System, a comprehensive and systematic method of sexual history-taking.

The Sexual Events Classification System contains multiple dimensions that reflect different aspects of patients’ sexual thoughts and behaviors, which are the focus of clinical attention. This, in turn, provides a means for clinicians to conceptualize patients’ sexuality more holistically. The format guides clinicians to focus on specific characteristics of sexual thoughts and behaviors that are often overlooked, including emotions, meanings, and motivations. The Sexual Events Classification System also encourages clinicians to use objective terms to describe sexual thoughts and behaviors, rather than judgmental or confusing jargon.

Sexual events are classified on six basic dimensions with specific subcategories: I. General Sexual Assessment/Demographics; II. Descriptive Summary of Sexual Thoughts and Behaviors of Clinical Focus; III. Motivations and Emotions Related to a Sexual Event(s) which is a Clinical Focus; IV. Factors which Impact Subject’s Sexual Health; V: Summary and Assessment; and VI. Post-Interview Presentation/Assessment.

A comprehensive interview takes about an hour to complete and is intended for use with patients who have sexual concerns. We also developed a brief Sexual Events Classification System Screening Interview as a screening tool for general psychiatry patients (all Sexual Events Classification System course materials are available at http://www.hsc.wvu.edu/som/bmed/Educational-Materials/PDFs/SECS-Book-09-04-27.pdf).

We postulated that combining the Sexual Events Classification System interview with other validated educational methods, such as standardized patient interviews and competency-based scoring assessments, would improve residents’ abilities to take nonjudgmental and comprehensive sexual histories. A review of the literature indicates that standardized patient interviews are an effective method of teaching sexual history-taking skills (28). Furthermore, the Accreditation Council for Graduate Medical Education encourages integrating competency-based teaching methods (26).

Although we previously taught courses for sexual history-taking skills in various settings that subjectively appeared successful, this is the first time we surveyed participants.

Seven general psychiatric residents in the second year of postgraduate study at West Virginia University were enrolled in a brief sexual history-taking course.

Preclassroom experiences consisted of residents performing sexual history interviews with simulated patients scripted to have complex sexual concerns. These sessions were video recorded and reviewed individually with each resident by a course instructor who offered feedback.

The classroom experiences began with instructors briefly describing human sexuality and showing residents how to perform a structured interview using the Sexual Events Classification System. The residents were given general tips for conducting successful sexual history interviews, such as the following:

During class, residents reflected on what they learned about their video-recorded interviews. They also observed brief videos of actors simulating bad sexual history-taking techniques, such as ignoring cues of patient’s sexual concerns, making religious judgments, making judgments about sexual norms, interviewing in cookbook style, and becoming overly anxious. The residents and instructors discussed how to avoid making such errors.

Residents interviewed simulated patients in front of the class with frequent pauses to explore how to phrase questions and comments in neutral, nonjudgmental terms. Residents also practiced using the Sexual Events Classification System to develop formulations for example cases.

Outside of class, residents independently watched the video A Good Sexual History-Taking Interview and assessed it with a Sexual Events Classification System competency score sheet, which precisely follows the System criteria.

Finally, each resident received an anonymous survey to assess perceptions of the usefulness of the course for improving sexual history-taking skills. This was declared exempt by the West Virginia University Institutional Review Board Committee.

Of the seven residents originally enrolled in the sexual history-taking course who were selected for the survey, six completed surveys.

The survey results indicate that 50% of participating second postgraduate year (PGY-2) residents had never previously performed a sexual history. Another 50% stated they had performed fewer than six sexual-history interviews. All described their precourse sexual history-taking skills as “fair” or “poor.”

Five residents described their postcourse improvement in sexual history-taking as “good” or “excellent.” Four stated they made “good” or “excellent” improvement in their abilities to be comprehensive when taking sexual histories.

Only three residents indicated that they made “good” improvement in their abilities to be nonjudgmental while taking a sexual history. Five residents indicated that they achieved “good” improvement in their comfort levels of taking sexual histories.

Five of the six residents preferred the Sexual Events Classification System approach to taking a sexual history to their previous methods of taking sexual histories. Four residents described the “practicality” of the System interview as “good” or “excellent,” and four indicated that interviewing a simulated patient is an “excellent” method to learn sexual-history taking. All six residents described the System as a “good” or excellent” reference for professionals to take a sexual history. Finally, three of the residents stated that they would “definitely recommend” that other health professionals learn the System method for taking sexual histories, while the other three stated they would “possibly recommend” the method.

As expected, the survey showed that the residents had little or no experience taking sexual histories before the course. Most residents found the course helpful in improving their ability to take a comprehensive sexual history. Also, they indicated that the course had increased their comfort level with this topic.

During class discussions, residents recognized that they initially used judgmental language in their preclass video-recorded interviews. They later reported that they were improving in their abilities to be less judgmental through interviewing simulated patients in class. Their fondness for simulated patient interviews is consistent with previous articles that support this technique as an effective teaching method (27).

Although the small sample size of the resident survey limits the strength of conclusions or inferences that can be drawn from this pilot project, we have had extensive experience teaching with this method before surveying these residents. Overall, residents seemed to enjoy having an opportunity to improve their sexual history-taking skills, although a few expressed reservations about the practicality of taking such an extensive sexual history with most general psychiatry patients. This concern appeared to resolve once the residents were introduced to the brief Sexual Events Classification System screening interview, which is intended to indicate which patients may benefit from a full sexual history evaluation.

In the future, it will be useful to expand to a multisite study and include residents and fellows from other disciplines, such as obstetrics and gynecology, urology, internal medicine, and family medicine. It may also be useful to ask participants to clarify reasons for their responses with brief comments on the survey form. Despite subjective successes with this course content and method, the Sexual Events Classification System interview should be validated against current sexual history-taking methodologies.

The results of this small pilot study indicate that the Sexual Events Classification System may offer a useful method for teaching residents to take in-depth and nonjudgmental sexual histories. We hold that this will ultimately lead to more effective clinician-patient communication and improved clinical outcomes.

Dr. Fidler is a board member for SymptomMedia, a corporation using actors to create simulations of medical symptoms and disorders for use in classroom and online health professional student education. At the time of submission, Dr. Petri and Mr. Chapman reported no competing interests.