January 2012 Education Column

Men’s Health: Development of a Niche Curriculum in Family Medicine

By Joel J. Heidelbaugh, MD, Departments of Family Medicine and Urology, University of Michigan Medical School, Ann Arbor, MI

A defined multi-disciplinary men’s health curriculum is paramount to ensure training future family physicians in providing optimal care for men across all socio-economic strata, ethnicities, ages, and sexual orientations. Dedicated required teaching of men’s health is lacking in most medical school and family medicine residency curricula. Current Liaison Committee on Medical Education (LCME) accreditation standards do not list specific provisions for how men’s health is incorporated into either preclinical or clinical programs in the educational objectives.¹ Current Accreditation Council for Graduated Medical Education (ACGME) guidelines do not mandate any provisions for teaching men’s health in family medicine residency programs.² During the standard 3-year family medicine residency training program, the ACGME stipulates that “Residents must have hands-on educational experiences in the following subspecialty areas: otorhinolaryngology, urology, and ophthalmology.” Thus, the majority of learning of men’s health is accomplished via “rotating through the VA hospital” or “just seeing male patients.”

Medical students and family medicine residents at the University of Michigan Medical School have expressed concern that they do not receive adequate exposure to comprehensive, multi-disciplinary men’s health during their training. Rigorous survey data is lacking to support or refute this notion on a national level or to adequately assess medical student and family medicine resident competencies in the evaluation of patients’ conditions inherent to men’s health. A needs assessment posed the following questions:

• Since there is no defined men’s health curriculum in medical school or family medicine residency, are our learners adequately prepared to address the urologic and multi-disciplinary concerns of men across various settings?
• How do we measure competency and confidence across students and residents in dealing with complex men’s health issues?
• Are we adequately training the “future of men’s health” in clinical care and multi-disciplinary research?

I developed a men’s health curriculum to address these concerns centered on a needs-based analysis of perceived areas of poor competency. The following are common topics emphasized throughout the curriculum in concert with direct patient care providing medical students and family medicine residents with an opportunity for diagnosis, evaluation, management, and potential for continuity:

• Evidence-based approach to prostate cancer screening
• Evaluation of the elevated PSA (prostate specific antigen) test
• Erectile and sexual dysfunction
• Premature ejaculation
• Benign prostatic hypertrophy
• Prostatitis and sexually transmitted diseases  
• Testicular and scrotal disorders, including acute and chronic pain  
• Testicular hypogonadism, with relationship to obesity and metabolic syndrome  
• Cardiovascular disease, with relationship to erectile dysfunction and hypogonadism  
• The role of men in family planning  
• Peyronie’s disease  
• Evaluation of microscopic hematuria  
• Renal and urethral stone disease  
• Chronic urinary tract infections  
• Overactive bladder syndrome  
• Stress and urge incontinence  
• Interstitial cystitis and painful bladder syndrome

Since 2008, the Department of Family Medicine at the University of Michigan has had a successful collaboration with the Department of Urology. Three family physicians have established dedicated clinics whereby we receive referrals from primary care clinicians to address the topics listed above. These clinics serve as educational opportunities for students to obtain skills in men’s health and as a mandatory rotation for our second-year family medicine residents.

In 2010, I developed the Scientific Spotlight section of the International Society of Men’s Health (ISMH) Web site (http://www.ismh.org/en/). The goal is to serve as a worldwide educational resource for men’s health specialists, as well as students and residents who have a interest in dedicating their future practices to providing multi-disciplinary men’s health (http://www.ismh.org/en/scientific-spotlight/mens-health-news/). In 2011, I founded the STFM Group on Men’s Health. It is my hope that fellow clinicians, researchers, residents, and students with an interest in men’s health will contribute to expanding this unique niche within family medicine.

References

1. Accreditation Council for Graduate Medical Education. ACGME Family Medicine Program Requirements 2007. http://www.acgme.org/acWebsite/downloads/RRC_progReq/120pr07012007.pdf. Accessed November 15, 2011.

2. Liaison Committee on Medical Education. LCME Accreditation Standards. http://www.lcme.org/functionslist.htm#educational%20objectives. Accessed November 15, 2011.