Physicians, medical students in need of sex trafficking education: survey

Last Updated: 2015-06-19

By Larry Hand

NEW YORK (Reuters Health) - A need exists for standardized human sex trafficking education for physicians, residents, and medical students, according to a new report.

While physicians and medical trainees may believe that knowing about human sex trafficking is important to them, many lack knowledge about how big the problem is and where to turn if they encounter a trafficking victim in their practices, according to a survey completed by 1,648 medical students, residents, and practicing physicians in the United States.

"Medical personnel are constantly under time constraints, so training needs to be brief and to the point," Dr. Kanani E. Titchen, of the Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware, told Reuters Health by email. "I'm dedicated to this cause, so I have no problem devoting a free weekend to training, but most practitioners have perhaps an hour -- often less -- to devote to learning about a new topic."

Dr. Titchen and colleagues conducted the anonymous electronic survey between June and October 2013.

They found that 80.6% of practicing physicians agreed or strongly agreed that knowledge about trafficking was important to their practice, compared to 71.1% of residents and 69.2% of medical students (p=0.0008), the researchers report in the Journal of Pediatric and Adolescent Gynecology, online May 20.

On the other hand, they found that only 16.1% of practicing physicians correctly estimated the number of trafficked U.S. youth according to data from the U.S. Department of Justice. For residents and students, the number was 11.7% and 7.9%, respectively (p=0.0011).

About 100,000 U.S. minors are at risk for trafficking every year, the researchers wrote.

They also found that 40.4% of practicing physicians said they knew whom to call if they encountered a potential trafficking victim, compared to 20.4% of residents and 8.9% of medical students (p=0.0001).

The researchers emailed the 11-question survey to physicians and students based on data from the electronic mailing lists of the Association of Pediatric Program Directors, the American Medical Women's Association, and the Nemours Children's Health System, as well as five chapters of the American Academy of Pediatrics.

Of 1,708 respondents, 1,694 completed the survey, and the researchers included 1,648 of those in the final analysis: 386 practicing physicians, 92 fellows, 744 residents, and 426 medical students. They received 46 "other" responses from individuals including nurses and physician assistants.

"Of the physician respondents, 13.7% of attending physicians and 6.9% of residents had ever 'suspected that a patient of mine was a victim of human trafficking,'" the researchers wrote.

Residents and physicians with 13-20 years of experience were more likely than others to estimate correctly the percentage of children living on the streets and exchanging sex for drugs or money.

As to what type of education is needed, Dr. Titchen said, "In general, medical personnel are accustomed to receiving information in a no-nonsense manner without a lot of hype, so any training program should avoid hyperbole while still conveying the severe health consequences of human sex trafficking."

"I think a training program tastefully blending the victim-survivor's narrative about health care experiences with evidence from research literature would best engage and appeal to medical staff. Imperative to any training program would be to address the delicate nature of mandated reporting and the importance of disclosing to the patient the limits of confidentiality," she continued.

"In terms of training about the sex trafficking of minors, I think the leadership needs to come from the American Academy of Pediatrics in partnership with the Society of Adolescent Health and Medicine, the American College of Obstetrician Gynecologists, the American Psychological Association, and the American College of Emergency Physicians," she added.

"When sex-trafficked children, teens, and young adults present to nonpediatric specialties, they most frequently present to adult emergency departments and to obstetric gynecologists. And they present with very complicated psychological issues, in addition to physical trauma, unplanned pregnancy, sexually transmitted diseases, and a host of other health problems," Dr. Titchen said.

SOURCE: http://bit.ly/1So8fQG

Am J Gastroenterol 2015.