The Men in Australia Telephone Survey (MATeS) was conducted in 2003 and is still the only whole-of-nation, population-based study focusing on the reproductive health and other issues of middle-aged and older Australian men [
A study by White and Holmes again showed that men die earlier than women and they revealed this to be true in all 44 countries that they used in their sample [
The goal of this study was to explore the various issues that program directors of family medicine training programs and practicing family physicians express as important and therefore should be included in a men’s health curriculum for family medicine residency training programs.
A mixed-methodology approach, using both qualitative and quantitative methods, was used, specifically a sequential transformative design [
In this study, a quantitative survey was sent electronically to all program directors and site directors of the seventeen family medicine residency training programs in Canada. This was followed by a qualitative phase where interviews were arranged with some of the program directors and site directors. A matrix was created to purposefully select participants that have a men’s health curriculum as well as some that did not. However none of the participants stated that they had a men’s health rotation or curriculum. Participants were therefore selected based on availability and the quality of information received on the surveys. Saturation of information was felt to have occurred after only three interviews as no new information was obtained. Two focus groups were also conducted. One group consisted of four urban family physicians and the other of four rural family physicians, one resident, and one medical student. It was not the plan of the researcher to have a resident and medical student in the focus group, but they were working with the physicians at the time of the interview and felt that it would have been a good experience for them. It turned out that it was also a valuable source of information for the researcher, and therefore their comments were included in the analysis.
A certificate of approval was received from the University of Saskatchewan’s Behavioural Research Ethics Board prior to starting this research endeavour.
Many elements of the questionnaire focussed on different topics that might be considered relevant to men’s health and whether the participants believed that it was important to be included in a men’s health curriculum. The topics were chosen based on an extensive literature review. The participants were asked to select from each group all the topics they considered important to have in a men’s health curriculum.
The topics were grouped as follows: male sexual and reproductive health (e.g., prostate cancer, erectile dysfunction, etc.), general health relevant to men (e.g., cardiovascular disease in men, alcoholism, etc.), procedures specific to men’s health (e.g., vasectomies, circumcisions, etc.),
Participants were then asked to rank their top ten choices in the first group and their top five choices in the other two groups. The difference in ranking items is due to the difference in the number of items in each of the lists. Points were allocated to their ranked lists, for example if a topic was ranked first, it was scored 10 points in a rank list of ten, second was scored 9, and so on. Means, medians, and modes were calculated for all the responses. The topics were initially sorted in order of importance by using the means and secondly by the median. At the end of the survey, participants were invited to add any topic(s) that they believed should be included in a men’s health curriculum for family medicine residency training programs.
A case-based approach was used for the qualitative portion of the research. Cases can come in a variety of forms. In this study individual cases (interviews with program directors) as well as group cases (Focus groups) were used [
The discussions within the focus groups were recorded with both audio and video recording equipment and later transcribed. (Videotaping was used only to identify different speakers during transcription.) Interviews with program directors were only voice recorded.
These interviews and focus groups were transcribed by the researcher and imported into the NVivo (Version 9) software [
Through deductive reasoning, certain themes were identified from the questionnaire data. This implies that general statements were synthesised into more specific statements. Some of the specific statements were also grouped in “themes” that belong together. These predetermined themes were registered as “nodes” in the NVivo software and were used while analysing the qualitative data. Further themes (or nodes) evolved as the transcriptions were analysed.
Although both the qualitative and quantitative aspects of the study had questions about past and current training in men’s health, this paper will focus on what participants think that the content of a men’s health curriculum for family medicine residency training should contain.
The author was involved in all aspects of this project, including conducting the interviews and focus groups as well as transcribing the interviews and analyzing the data.
A total of eleven questionnaires, which represented 10 (59%) of the 17 family medicine residency training programs in Canada, were completed and returned. In one case, two different sites in the same program returned a survey. Even though the number of responses might appear low, it is still considered above expected when taken into consideration the overwhelming number of surveys that ends up on program directors’ desks. The rank list of problems identified from group one (sexual and reproductive health) is represented in Table
List of male sexual and reproductive health topics identified by program directors in order of importance.
Rank | Topic | Mean | Median |
---|---|---|---|
1 | Benign Prostatic Hypertrophy | 9.09 | 9 |
2 | Prostate cancer | 8.64 | 10 |
3 | Erectile dysfunction | 7.64 | 8 |
4 | Sexually Transmitted Infections | 5.55 | 6 |
5 | Prostatitis (acute) | 3.36 | 5 |
6 | Testicular cancer | 3.27 | 3 |
7 | Epididymitis | 2.36 | 2 |
8 | Andropause | 1.94 | 0 |
9 | Prostatitis (chronic) | 1.82 | 2 |
10 | Testicular torsion | 1.82 | 0 |
11 | Contraception for men | 1.82 | 0 |
12 | Urinary Tract Infections in men | 1.45 | 0 |
13 | Undescended testes | 1.36 | 0 |
14 | Hydrocele | 0.73 | 0 |
15 | Phimosis | 0.27 | 0 |
16 | Varicocele | 0.27 | 0 |
17 | Balanitis | 0.27 | 0 |
18 | Male infertility | 0.18 | 0 |
19 | Premature ejaculation | 0.09 | 0 |
20 | Gynecomastia | 0.09 | 0 |
21 | Peyronie's disease | 0 | 0 |
22 | Penile cancer | 0 | 0 |
23 | Paraphimosis | 0 | 0 |
24 | Other sexual dysfunction | 0 | 0 |
25 | Priapism | 0 | 0 |
26 | Genital trauma | 0 | 0 |
27 | Klinefelter disease | 0 | 0 |
List of topics related to general health identified by program directors in order of importance.
Rank | Topic | Mean | Median |
---|---|---|---|
1 | Alcoholism | 3.00 | 3 |
2 | Abuse | 3.00 | 2 |
3 | Psychiatry | 2.82 | 3 |
4 | Eyes and Ear Nose and Throat | 2.73 | 0 |
5 | Cardiovascular | 2.27 | 1 |
6 | Pharmacology | 2.09 | 0 |
7 | Respiratory | 1.82 | 0 |
8 | Musculoskeletal | 1.55 | 0 |
9 | Skin | 1.45 | 0 |
10 | Gastrointestinal | 1.00 | 0 |
11 | Neurological | 0.36 | 0 |
List of procedures identified by program directors in order of importance.
Rank | Topic | Mean | Median |
---|---|---|---|
1 | Newborn circumcision | 1.36 | 1 |
2 | Reduce paraphimosis | 1.36 | 0 |
3 | Vasectomy | 1.18 | 0 |
4 | Drain hydrocoele | 1.00 | 0 |
5 | Bladder catheterization | 0.91 | 1 |
6 | Intracavernosal injections | 0.82 | 0 |
7 | Adult circumcision | 0 | 0 |
8 | Prostate biopsy | 0 | 0 |
Mental health issues came up in several of the interviews and focus groups. Even though “Psychiatry” was one of the topics in the quantitative survey, the participants in the focus groups and interviews wanted suicide to be singled out as an important topic in men:
Some physical conditions were also mentioned.
Even though the Program Directors did not rank it very high, participants in the focus groups reported that they would have liked to be more competent in dealing with priapism and Peyronie’s disease.
When it came to procedures, no new procedures were mentioned that had not already been covered in the survey responses of the program directors. Two of the participants in the focus groups did however classify digital rectal exams as a “procedure” and would have liked more and better formal training in performing this correctly.
The majority of the top ten topics listed in Table
Even though some conditions in Table
With the rank list of topics listed in Table
The list of procedures that were ranked in Table
Topics that were identified and discussed in the interviews and focus groups reflect the variety of issues that family physicians deal with on a regular basis. It was also clear that the participants (mostly practicing physicians) did not feel comfortable dealing with issues related to men’s health. Many of the participants told stories about how they learned many of these skills after being in practice for a while. If family physicians can become competent in these skills before they start their practice, this could cut down on many unnecessary and costly referrals to specialists.
The topics that were identified as important to incorporate into a men’s health curriculum compare well to curricula developed in the UK, Australia, and the State of Hawaii [
This study was performed in a Canadian context and can therefore not neccesarily be extrapolated to other countries. The sample size in each of the different components is quite low due to the small number of possible participants. This has been addressed in the methodology section. Some of the surveys contained the minimum required answers and did not contain any further ideas. It would have been helpful if participants could have added information that was not part of the questionnaires. The fact that the principle author was the only person conducting the interviews and analyzing the data could be seen as a limitation. This was unfortunately an expectation as this study formed part of an Ph.D. research program.
Participants in both the quantitative and qualitative aspects of the study provided lists of men’s health issues that could and should be seen as competencies that family medicine residents attain during their training. It appears that there is no formal curriculum to address any of these issues in any of the current family medicine residency training programs in Canada. Based on the information gathered from participants in this study, a common theme emerged in that there is a great need for such a curriculum. This curriculum has to comply and mesh with the Triple C curriculum as proposed by the College of Family Physicians of Canada [