International Journal of Healthcare Simulation

Background:

Sexual assault is a worldwide epidemic. According to the World Health Organization (WHO), 35% of women worldwide have experienced sexual violence ^[1]. Additionally, the Director of Crimes Against Children Center states, ‘one in five girls and one in 20 boys is a victim of sexual abuse’ ^[2]. In the USA, SANEs (Sexual Assault Nurse Examiners) and SAFEs (Sexual Assault Forensic Examiners) respond to victims of sexual assault as part of a SART (Sexual Assault Response Team). This victim-centred approach is comprised of three members: Victim’s Advocate, Law Enforcement and a SANE/SAFE. Prior to 2014, SANEs and SAFEs obtained certification by practicing on live victims. Once initial studies proved the efficacy of simulation in SANE training, it was recommended that certification be obtained with Gynecologic Teaching Associates (GTAs). Most countries do not have a standard of trauma response for sexual assault victims, and in the USA, there is a misunderstanding of best practices and many SANEs/SAFEs still obtain certification through clinical practice on victims.

Aim:

The aim of the work being conducted in the field was to develop an effective protocol for training sexual assault responders that supports goals of trauma-informed care and provides a standardized protocol to obtain certification through simulation.

Simulation activity outline:

SANE/SAFE training requires an initial 40-hour didactic with anatomy skills training specific to trauma care. Trainees subsequently practice the sexual assault forensic evidence collection kit on simulated patients. They practice communication skills designed to build rapport with trauma survivors, the specialized urogenital examination techniques involved in sexual assault care and have opportunities for speculum insertions to competency. Additionally, they practice documentation/chain of custody procedures critical to the admissibility of evidence in court. Stations are developed to provide practical experience with the kit and with providing specialized care to patients in a variety of demographics; age, gender (or transgender), socio-economic backgrounds, etc.

Method:

This work is based on findings of previous studies that highlight the efficacy of live patient simulation in SANE training to implement safe, effective methods of trauma response via collaboration between SANE/SAFE directors and GTA programming.

Results:

GTA methodology is proved to be an effective method for training the well-patient gynaecologic examination. One of the identified benefits is a reduction in learner anxiety. Because GTAs act as both instructor and patient, they can teach trauma examination skills and provide a unique opportunity for feedback from a simulated sexual assault victim’s perspective. Developing protocol in the field is crucial as more programmes utilize simulation to train new SANEs. It is critical to meet standards of best practices and to maintain safety and reduce risk.

Implications for practice:

This protocol has influenced the way SANEs and SAFEs learn trauma-informed care. The benefits to trauma patients are numerous. The methodology, utilized across the USA, was recently brought to Brazil to train new SANEs. More work must be done internationally to bring this method to areas of the world where no standardized method of sexual assault response exists. Additionally, safety measures and better collaboration are paramount to the continued success of this method.