How teaching on the care of the victim of sexual violence alters undergraduate medical students' awareness of the key issues involved in patient care and their attitudes to such patients

Women attending the sexual assault treatment unit services in the Republic of Ireland: A 7-year review

OBJECTIVE

Sexual assault is pervasive in today's society, with the numbers of those reporting it increasing. In Ireland, 50% of women will experience some form of sexual violence in their lifetime. We sought to describe the incident details of females presenting to the Sexual Assault Treatment Unit (SATU) network in the Republic of Ireland and to determine associations between incident characteristics and: (1) victim age, (2) presence of injury, (3) victim-perpetrator relationship, and (4) number of assailants.

METHODS

This was a retrospective cross-sectional study of all females who attended between 2017 and 2023. Descriptive bivariate analysis was performed.

RESULTS

There were 5942 female attendances, with an average age of 26 years. The largest age group was women between 18 and 25 years (38.1%, n = 2263). Forensic examinations were performed in 76.6% (n = 4549). Assailants were male in 92% (n = 5469) of incidents, with multiple assailants disclosed in 7.3% (n = 435). Strangers or recent acquaintances were the assailant in 38.5% (n = 2290) of incidents, and close associates in 22.9% (n = 1359). Incidents occurred at the survivor's home in 22% (n = 1306) of incidents, and in the assailant's home in 22.6% (n = 1342). Drug use within 24 h was reported in 15.1% (n = 897) of cases, and alcohol use in 72% (n = 4276). Drug-facilitated assault was suspected by 16.1% (n = 955). Injuries (genital and extra-genital) occurred in 30.3% (n = 1800) of attendances and were more likely to be seen in those who disclosed ingesting alcohol (Relative risk [RR] 1.325, P < 0.001) or drugs (RR 1.111, P = 0.04) in the 24 h preceding the incident, in those who presented within 24 h (RR 1.646, P < 0.001), those aged 18 years or older (RR 1.07, P = 0.003), and those where the incident occurred outdoors (RR 1.24, P < 0.001).

CONCLUSION

This study, one of the largest on female attendances to a national SATU network, offers detailed insights into demographics, incident details, and circumstances. Most were young women, mainly 18 years and older, many of whom were full-time students. Forensic examinations were the primary reason for attendance, underscoring the network's key role in evidence collection. The study also identified factors linked to a higher risk of injury detection, such as immediate post-incident attendance, being over 18, outdoor incidents, perpetration by a stranger, and prior alcohol or drug use.

General practice trainees' understanding of post-sexual assault care: the impact of a specialist educational intervention

BACKGROUND

Sexual assault (SA) is a highly prevalent issue, with significant adverse health sequelae. Given that general practitioners (GPs) may serve as the first point of contact for many SA victims, their awareness of post-SA care and appropriate understanding of referral pathways to a sexual assault treatment unit (SATU) are critically important. This study evaluated GP trainees' knowledge of and comfort with post-SA care.

METHODS

Educational intervention study using a didactic teaching session was delivered by a specialist forensic examiner on post-SA care. A pre and post-study questionnaire was implemented to assess participants' knowledge and comfort levels with subject material. Significance was set at p-value below 0.05.

RESULTS

Seventy-five GP-trainees attended the teaching session. Fifty-three completed the pre-teaching questionnaire and 50 completed the post-teaching questionnaire. Only a minority of trainees had received prior teaching in post-SA care as a medical student (13.2% n = 7) or as a postgraduate (28.3% n = 15). After the teaching session, there was a significant improvement trainees' comfort levels in explaining a forensic examination (p < 0.0001), referral pathways to a SATU (p < 0.0001) and offering advice in relation to emergency contraception (p < 0.0001). There was also a significant improvement in understanding HIV post-exposure prophylaxis (PEP) (p < 0.001) and forensic examination (FE) time-lines (p < 0.001).

CONCLUSION

This study reveals that GP-trainees have had limited exposure to teaching on post-SA care. Additionally, significant improvements were observed following a 1-h didactic teaching session on post-SA care. Trainees demonstrated increased understanding of SATU referral pathways, understanding of immediate medical care after SA, including PEP and FE timelines.

Diagnosing and Discussing Sexual Abuse: A Scoping Review on Training Methods for Health Care Professionals

Purpose

Sexual abuse is a health issue with many consequences. Recognizing and discussing past sexual abuse has proven to be challenging for health care professionals. To improve overall quality of health care for sexual abuse victims, health care professionals need to be properly trained. The aim of this paper is to provide an overview of training methods for health care professionals and to report on their effectiveness.

Methods

A scoping review was conducted. A broad search was executed in six databases in December 2022. Study selection was performed by two independent reviewers, followed by quality assessment and data extraction.

Results

After screening of titles and abstracts and later full-text assessment for quality appraisal, seven articles were selected, consisting mostly of non-randomized trials, performed among a total of 1299 health care professionals. All studies were assessed to be of moderate to poor quality. The participants attended training courses with a wide variety of durations, settings, formats and methods. The outcomes showed improvements in self-perceived or measured knowledge, skills and confidence to discuss sexual violence. Changes in clinical practice were scarcely investigated. Training courses were most effective when a mix of didactic passive methods, such as lectures and videos, and active participatory strategies, such as discussions and roleplay, were applied. Timely iteration to reinforce retention of gained knowledge and skills also contributed to effectiveness. Participants most enjoyed incorporating opportunities for receiving feedback in small settings and sharing personal experiences.

Conclusion

This scoping review summarizes on how to effectively train health care professionals. Flaws and difficulties in measuring the effectiveness of training courses were discussed. Recognition and discussion of past sexual abuse by health care providers can be effectively trained using an alternating mix of multiple active and passive training methods with room for feedback and personal experiences.

Gaps in sexual health content of healthcare professional curriculum: a systematic review of educational interventions

BACKGROUND

Sexual health care, including assessment and patient teaching, is part of comprehensive patient care. Health professional (medical and nursing) students' education in sexual health lacks uniformity in content and assessment skills.

OBJECTIVES

The current systematic review aimed to assess sexual health educational curriculum for health professional students regarding the educational content, duration, and evaluation of these educational interventions.

METHODS

This systematic review followed the preferred reporting guidelines for systematic reviews. A comprehensive search was conducted between May-August, 2023 across four databases (PubMed, Scopus, CINAHL, EMBASE), outlining 614 sources. Following the screening process, 36 educational intervention studies were deemed eligible for inclusion. The quality assessment of these studies was conducted using The Effective Public Health Project tool, which was found appropriate for evaluating this type of research.

RESULTS

The studies had a global representation, with most studies conducted in the US. Limited nursing educational interventions were found. Three main categories emerged from the analysis of the educational interventions: one-time interventions, workshops, and semester courses. These categories differed in terms of their duration. Upon evaluating the educational intervention programs, it was found that the majority relied on participant self-reporting, while only a few included objective evaluations.

CONCLUSIONS

This review revealed inconsistencies in educational content for healthcare professional students and may impact their clinical skills, particularly in sexual health. The variation in content, duration, and evaluation methods created challenges in assessing the interventions. The lack of standardized sexual health education highlighted a significant gap, raising concerns about students' ultimate proficiency in this area. Bridging this divide is essential by integrating comprehensive sexual health content and assessment skills into the health professional curriculum.

Analysis in the ethical decision-making of dental, nurse and physiotherapist students, through case-based learning

INTRODUCTION

Training in ethical competencies is perceived with special interest among the objectives of health education. The dimensions of the person such as integrity, autonomy and dignity influence the choice of interventions, but the different specialties of the health sciences conceive these dimensions with different perspectives depending on the clinical setting. These divergences can be detected during the first years of undergraduate studies, and it is important to know the professional bias and its possible causes.

MATERIALS AND METHODS

A procedure was developed through case-based learning (CBL) to assess various characteristics of decision-making during the early stages of student training. A semi-quantitative method was designed based on the narrative responses of a case with ethical implications in the field of gender violence. The method was applied to 294 undergraduate students in nursing (95), physiotherapy (109) and dentistry (90) from the Faculty of Health Sciences of a Spanish university. A frequency analysis of the narrative responses of the students to the proposed case was carried out, using the chi-square test to determine any association between the variables studied: gender, specialty and ethical knowledge.

RESULTS

Four types of response categories were detected, as a result of combining the personal conversation, report to legal authority or require assistance of other teams. The most common option in dentists is conversation only, while physical therapists include the assistance of other teams. In nursing, a balance is observed between both possibilities. The results show that student responses differ significantly among specialties and also differ significantly according to test scores on ethical knowledge. However, no significant differences were found between the responses provided by men and women.

CONCLUSION

Most of the health sciences students highly valued their own capacity for dialogue and reflection to approach situations with complex ethical dimensions. We consider that case-based learning (CBL), in combination with narrative analysis is a valid means of evaluating the professional ethical competencies of students in health sciences careers applied to a common goal.

Which Violence Against Women Educational Strategies Are Effective for Prequalifying Health-Care Students?: A Systematic Review

Gender-based violence (GBV) is a global public health issue which disproportionately affects women. Health-care providers have an important role in recognizing and addressing GBV in practice, yet research suggests that the issue remains underrecognized, with many qualified professionals reporting lack of confidence and a sense of unpreparedness. Prequalifying GBV educational strategies are inconsistent in both quantity and quality worldwide, and to date, there has been no comprehensive review of those programs' effectiveness. This internationally focused literature review aimed to identify best educational practices in GBV for prequalifying health-care students. A systematic search of six databases yielded 17 studies meeting the inclusion criteria, with all studies examining one or more educational intervention. Quality appraisal was undertaken and data were tabulated to capture relevant information. Thematic findings suggest that interactive educational strategies yield better results than didactic approaches. Similarly, interventions with a focus on practical application of learning are generally preferred over strictly theoretical approaches. Courses of longer duration seem to be more effective in instilling attitudinal changes. Lastly, gendered differences were noted in a number of studies, with female students consistently outperforming males. However, more research is needed before conclusions can be drawn about the effectiveness of single- versus mixed-gender audiences. This review makes a useful contribution to the literature of health education, supporting many findings from previous studies and identifying knowledge gaps to be explored in future research. There are implications for both educators and practitioners in creating discernible change for women in their care.

A Pilot Project Exploring Medical Students' Barriers to Screening for Intimate Partner Violence and Reproductive Coercion

BACKGROUND

Multiple studies have shown that the majority of health care practitioners do not routinely screen for intimate partner violence (IPV); lack of provider preparedness and education is an often-cited barrier to screening. Our third-year family medicine clerkship includes a pregnancy options counseling objective structured clinical examination (OSCE) that requires students to review a preencounter online educational module that highlights screening guidelines for IPV and reproductive coercion. The goal of this study was to explore students' internal barriers to screening patients for IPV and reproductive coercion, and whether our curricular interventions adequately addressed these barriers.

METHODS

We administered an immediate postencounter, anonymous, online survey with open-ended and Likert-type questions to 118 medical students during the 2016 academic year. We used an exploratory, iterative process to analyze qualitative responses and quantify recurrent and commonly identified themes.

RESULTS

After the OSCE, students reported they were more likely to screen for IPV (94%) and reproductive coercion (82%) in future encounters. Qualitative analysis revealed two major types of barriers to screening: internal barriers concerning the screening inquiry itself and concerns regarding handling of patients' responses.

CONCLUSIONS

The online preparatory module and subsequent OSCE provided a low-stakes environment in which to practice screening. However, student comments about their barriers to screening suggest that a first or early curricular intervention folding IPV and reproductive coercion into an educational module on pregnancy options counseling did not optimally promote this screening behavior.

Development and evaluation of sexual assault training for emergency department staff in Ontario, Canada

OBJECTIVE

The purpose of this evaluation was to assess the efficacy of a training in improving competence to address sexual assault among Emergency Department (ED) staff, as well as to compare in-person and online training modalities.

METHODS

A total of 1564 staff from 76 EDs in acute care hospitals across Ontario participated in either on-site (n = 828 staff) or online (n = 736 staff) training sessions, of whom 1366 (87%) completed both a pre- and post-training questionnaire. Mean pre- and post-training scores measuring perceived competence in responding to victims/survivors of sexual assault were compared using paired t-tests. The mean gain score for in-person and online training was then compared using the Mann-Whitney U test. Finally, in-person and online participants' ratings of the training content and delivery were compared using the Mann-Whitney U test.

RESULTS

There were significant improvements for all 16 self-reported measures of competence following training. The mean gain in knowledge and skills was higher for in-person training participants. Participants in the in-person modality more strongly agreed that the information they learned would help in providing care for sexual assault victims/survivors, and were more satisfied with the training overall. However, these participants less strongly agreed that there was an appropriate amount of time allotted for the scope of material presented.

CONCLUSIONS

Overall, the training led to immediate improvements in ED staff perceived understanding and ability to address the needs of victims/survivors of sexual assault, with particular advantages to the in-person training.

A Student Selected Component (or Special Study Module) in Forensic and Legal Medicine: Design, delivery, assessment and evaluation of an optional module as an addition to the medical undergraduate core curriculum

The General Medical Council (United Kingdom) advocates development of non-core curriculum Student Selected Components and their inclusion in all undergraduate medical school curricula. This article describes a rationale for the design, delivery, assessment and evaluation of Student Selected Components in Forensic and Legal Medicine. Reference is made to the available evidence based literature pertinent to the delivery of undergraduate medical education in the subject area. A Student Selected Component represents an opportunity to highlight the importance of the legal aspects of medical practice, to raise the profile of the discipline of Forensic and Legal Medicine amongst undergraduate medical students and to introduce students to the possibility of a future career in the area. The authors refer to their experiences of design, delivery, assessment and evaluation of Student Selected Components in Forensic and Legal Medicine at their respective Universities in the Republic of Ireland (Galway) and in the United Kingdom (Oxford).