APGO

Shannon L. Bell, M
Boston Medical Center, Boston, MA Jessica T. Ristau, Olivera Vragovic,

Study Objectives: Most patients reporting sexual assault are identified and treated in emergency departments by sexual assault nurse examiners (SANEs). However, SANE programs across the US often do not have the budget or manpower to extend services to patients identified after they are admitted to the hospital. Local hospital policies state that obstetrics and gynecology teams are responsible for evaluating non-ICU inpatients who disclose an assault. OB-GYN residents and attendings have not traditionally received training around care of these patients or evidence collection. Objectives of this pilot study were: 1) To meet a minimum standard of education for health care personnel who are asked to conduct the sexual assault exam; and 2) To assess the impact of a novel resident curriculum covering an ACGME competency area for OB-GYN.

Methods: Investigators organized a four hour training program initiated in fall, 2012 focusing on psychological aftercare and the SANE evaluation (taught by representatives from the local rape crisis center and SANE nurses, respectively). Investigators administered identical pre and post-tests to the eleven OB-GYN residents who participated in the full training program. The test included a combination of multiple choice and fill-in questions assessing knowledge of important material. Participants also answered questions regarding prior exposure to the topic and confidence in key skills before and after the training. A delayed six-month post-test was then administered in June, 2013 to reassess resident confidence and knowledge with a test identical to the immediate post-test.

Results: Four of the 11 (36%) residents had prior personal experience with sexual assault (SA), and 9 of 11 (82%) had a friend or family member who experienced SA. Three of 11 (27%) had administered a rape kit, but only 1 participant had been previously trained. Residents’ self-reported confidence in eight elements of providing effective care to sexual assault survivors showed a statistically significant increase, or shift towards “agree” or “strongly agree” on a Likert scale (p≤0.05) following the training. There was no difference when the same questions were asked at six months post-training (p=0.86), with approximately two-thirds (63%) of the group with this high level of confidence at both time points. Residents showed improved scores on knowledge-based questions with average scores of 54% (range 40-76%) on the pretest versus 72% (range 48-96%) on the post-test. This difference was statistically significant (p=0.006). The six-month post-test indicated that the residents retained the knowledge, although at the lower average score of 65% (range 52-80%). The difference was still statistically significant (p=0.04).

Conclusions: Results support continued training of new OB-GYN residents and sustained efforts to foster a culture within the department that sexual assault survivor care falls under the purview of obstetrician-gynecologists.

Key Word: sexual assault education