First do no harm: The role of medical education in addressing sexual, intimate partner and family violence by Anna MP

*Content warning: sexual violence, intimate partner violence, family violence*

The role of medical education is to train future doctors to meet the healthcare needs of their population at the individual level. More than just didactic teaching, it is preparing the next generation of healthcare professionals for the challenges of tomorrow. With shifting population demographics and concurrent changes in disease burdens, and the ever-evolving nature of medications and technology, the sheer volume and dynamic nature of information can be difficult to distill into course content to be learnt over a few years. Despite this challenge, a medical school graduate should be able to identify, diagnose, and manage or refer most of the common presentations they would typically encounter within the general population of where they trained.

Statistics reveal sexual violence, intimate partner violence, and family violence are disturbingly common within the Australian population. Since the age of 15, 1 in 5 women and 1 in 20 men have experienced sexual violence, and 1 in 6 women and 1 in 16 men have been subjected to physical and/or sexual violence from a partner, and from 2014 to 2015, 8 women and 2 men were hospitalised per day as a result of violence from a partner (1,2,3). Sexual violence is any unwanted or unwelcome sexual contact, including words or actions, which can make a person feel humiliated or intimidated including rape, sexual assault and sexual threats (3,4,5). Intimate partner and family violence can be defined respectively as efforts by a partner or family member to exert power or control over an individual, and can incorporate sexual, physical, and verbal abuse (3).

The routine inclusion of sexual, intimate partner and family violence in medical school curricula is not a novel or unwarranted concept. Many sources argue that as these are such prevalent issues globally, cause harmful short- and long-term physical and mental health impacts, and are subject to public misconception, there is an imperative to educate medical students to improve care for victims and survivors (6,7). A 2017 study found that of the 15 Australian medical schools participating in the survey, 3 included no training on intimate partner violence, the median time dedicated to this subject was two hours and it was usually delivered in an ad-hoc basis, and that only 2 medical schools offered 10 or more hours of integrated teaching on this subject (7). No similar survey of Australian medical schools regarding teaching on sexual violence was apparent.

In conversations with my colleagues at various universities, we struggle to come to a consensus of the amount and type of content covered, and crucially if it is adequate, with regards to sexual violence, and intimate partner and family violence at Australian medical schools, amongst other sexual and reproductive health (SRH) issues.

AMSA Reproductive Rights is currently conducting a survey to assess the current teaching of SRH issues at Australian medical schools, including any content on sexual violence, and intimate partner and family violence, from the perspective of those undertaking or having recently undertaken medical education in Australia. Our aim is to identify any significant gaps in the SRH content provided at Australian medical schools that medical students feel should be addressed.

As future clinicians we are compelled to ‘first do no harm’. In order to do so, we must first learn no harm.

by Anna MP

AMSA Reproductive Rights Project Co-Coordinator

AMSA Global Health

AMSA Reproductive Rights Medical Curriculum Survey:
https://amsaorgau.wufoo.eu/forms/r17nzhhv0n8x9jf/

If you or someone you know is impacted by sexual violence, intimate partner or family violence, call 1800RESPECT on 1800 737 732 or visit 1800RESPECT.org.au.
In an emergency, call 000.

References:

  1. Australian Bureau of Statistics. Personal Safety Survey, Australia, 2016. Canberra ACT: Australian Bureau of Statistics; 2017. Available from: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4906.0
  2. Australian Institute of Health and Welfare 2017. Hospitalised assault injuries among women and girls fact sheet. Cat. no. INJCAT 184. Canberra: AIHW
  3. Australian Institute of Health and Welfare 2018. Family, domestic and sexual violence in Australia 2018. Cat. no. FDV 2. Canberra: AIHW.
  4. National Sexual Violence Resource Center. About Sexual Assault. Harrisburg, PA: National Sexual Violence Resource Center; 2018 [cited 2018 Apr] Available from: https://www.nsvrc.org/about-sexual-assault-friends-family
  5. Australian Human Rights Commission. Sexual Harassment. Sydney, NSW: Australian Human Rights Commission; 2008 [cited 2018 Apr]. Available from: https://www.humanrights.gov.au/our-work/sex-discrimination/guides/sexual-harassment#sh
  6. Kennedy K. The case in favour of educating medical students about sexual violence. Med Teach. 2014;36(3):267–8.
  7. Valpied J, Aprico K, Clewett J, Hegarty K. Are Future Doctors Taught to Respond to Intimate Partner Violence? A Study of Australian Medical Schools. J Interpers Violence. 2017;32(16):2419–32.

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