Improved student care of sexual assault survivors through team-based learning intervention

About one in five women in the United States will be the victim of sexual assault in their lifetime; the number is even higher in marginalized communities. The traumatic experience is often followed by acute and long-term health consequences, and survivors are nearly four times more likely to suffer psychiatric disorders.

Even more disturbing, about 57% of sexual assault cases go unreported by the victim, and only about one-third of victims receive medical care. Survivors can seek the care of counselors and psychiatrists who are specially trained to address emotional and mental needs, but many sexual assault victims have trouble acquiring these resources. For a patient, the road to psychological recovery from sexual assault can begin through disclosing the assault during any clinician-patient interaction. Therefore, to mitigate the physiological and psychological ramifications of sexual assault, it’s essential for health care providers to provide supportive, nonjudgmental responses that empower survivors to provide an accurate medical history as well as seek out resources and holistic recovery.

While medical education has attempted to address this problem, some programs have focused too little on the mental health needs of survivors or have offered limited meaningful opportunities for discussion and interaction. To address these limitations and improve sexual assault education in the medical curricula, Ashley Fernandes, MD, PhD, associate professor of Pediatrics and associate director of the Center for Bioethics at The Ohio State University College of Medicine, and Amanda Start, PhD, director of the Office of Curriculum and Scholarship at the Ohio State College of Medicine, teamed up with medical students Kylene Daily, Tiffany Loftus and Colleen Waickman. Together, they developed a student-led, team-based learning activity on how to provide effective care and support to sexual assault survivors.

“We integrated 45 minutes of sexual assault education content into a two-hour, pre-existing mandatory training on family violence for all fourth-year medical students,” says Loftus. “The sexual assault component included five core elements: the development of sexual assault learning outcomes, pre-work, knowledge assessment, an application exercise and a discussion centered around how the holistic care of survivors impacts their specialty of choice, and their own personal self-care.”

The training includes learning outcomes designed to strengthen medical students’ abilities to effectively respond to sexual assault disclosures. This means providing holistic sexual assault care through humanistic communication and comprehensive patient advocacy. In designing the pre-work portion of the module, the team worked with a variety of sexual assault content experts to develop a brochure featuring information about sexual assault and society, empathetic interviewing, emergency department protocol, forensic nursing exam basics, surveyor resources, sexual assault in marginalized communities and the psychological consequences of sexual assault.

Students then complete an assessment that’s integrated into an existing team-based learning exercise on family violence. The assessment identifies common myths and stereotypes of sexual assault, and demonstrates effective emotional interviewing strategies. Students then demonstrate takeaways in the application portion through role-play scenarios, and conclude the learning module with a 10-minute open discussion on future implications. To account for possible gender bias, the curriculum uses real-life cases of female physicians who made missteps in sexual assault care, and questions that include male sexual assault survivors.

“Our curricular exercise teaches students, using an evidence-based educational method integrating trauma-informed care, to facilitate physical and mental healing for patients,” says Daily. “This is an approach not previously found in the literature.”

A review of the learning activity found it improved overall knowledge, skill and perception of relevance to medical students when responding to sexual assault cases.

“The curriculum improved student understanding of emotive interviewing,” says Waickman. “Future frontline-specialty students were more knowledgeable about sexual assault compared to future non-frontline-specialty students. We speculate that the students who are most likely to encounter sexual assault survivors in the future felt that the curriculum was more relevant, and that they were more motivated to utilize the information. They may have also pursued learning on this topic outside of required curriculum.”

Further, the learning intervention provides real-time instruction that allows for meaningful discussion about self-care, clinical relevance and societal advocacy, all while using fewer resources.

“In medicine it is imperative that future physicians be armed not simply with the rigorous knowledge that it takes to be a modern physician, but that students learn and practice the skills necessary to deliver humanistic care to the person who suffers,” says Dr. Fernandes. “For me, the significance of this curricular intervention is twofold. First, it is student-led, student-driven and student-taught, underscoring the immense talent and passion of the medical students at our college and the privilege it is to teach them. Second, we utilize evidence-based, team-based learning, and open, free, interactive discussions to tackle the deeply troubling, personal and important medical, ethical and social issues of sexual assault with the presumption that our success will ultimately lead to kinder, more humanistic care for survivors.”

A study outlining the curriculum and its effects has been published in the 2021 Academic Psychiatry journal, and will be presented to a national audience at the Association of American Medical Colleges national conference later this year.

This team-based approach to improving medical student knowledge and confidence in handling sexual assault survival cases can be used at the Ohio State College of Medicine and other medical schools to cultivate physicians who are more adept at helping sexual assault survivors heal.