Table 3 Resident, nurse, and medical assistant reports during semistructured interviews regarding skill proficiency, relevance of gender, sexual health discussions, and potential for SPIs in Japan

Examination proficiency

 Have performed pelvic exams many times

3

1

–

 Unsure if able to find abnormalities/diagnose in pelvic exams

4

1

–

 Does not get to perform breast exams often

5

2

–

 Does not get to perform male genital exams often

6

3

–

 Patient(s) seemed uncomfortable during male genital exam

2

1

–

 Can properly feel the prostate during digital rectal exam

4

3

–

Gender concordance/discordance

 No issues with gender concordance

4

2

7

 No issues with gender discordance

1

1

2

 Prefers gender match

2

1

3

 Female patients tend to request female physicians

1

1

5

 Difficult to talk about sexual health when gender discordant

4

1

3

 Able to ask appropriate questions regardless of concordance

1

–

3

Women’s and men’s health

 Discusses sexual health and vaccinations with female patients

3

1

3

 Recommends contraception for female patients

3

–

2

 Recommends pap smears for female patients

3

2

–

 Recommends smoking cessation outpatient services for male patients

–

2

3

 Cannot think of any issues specific to men’s health

1

–

3

 Should improve on screening male patients for erectile dysfunction

2

2

–

SPI training

 It was a great experience

3

2

–

 Allows for learning that would not otherwise be possible in Japan

2

2

–

 Would prefer more practice either at University of Michigan or in Japan

4

1

–

 Would be difficult to have in Japan

2

–

4

 Would be difficult to find people willing to become SPIs

2

1

1

 Would like to have an SPI program in Japan

5

3

3