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Gender-based violence training is a healthcare necessity

In this piece, Caitlin Stuart-Delavaine - a fourth year medical student studying at the University of Glasgow addresses an oft underreported and under-addressed topic. In this she tackles the importance of acknowledging the responsibility of healthcare providers in the tackling of gender-based violence.



Abstract/summary:


In the fight against gender-based violence, we must reflect on what we, as healthcare professionals, can do to truly meet our patients’ needs. The answers lie in education.


Article:


Recent reporting of the Sarah Everard trial has been harrowing and deeply distressing, bringing into stark focus the pandemic that is gender-based violence (GBV). If the subsequent personal accounts detailing GBV, which have flooded social platforms, weren’t disturbing enough, the statistics on such incidences prove equally shocking. Pre-covid pandemic, in the UK, 1 in 4 women had experienced domestic abuse and 1 in 5 sexual assault.(1) To call this unacceptable is a grave understatement, it is therefore devastating to see such trends have continued to drastically rise throughout the pandemic.(2) Each attack is one too many. A blind eye can no longer be turned.


Each attack is one too many. A blind eye can no longer be turned

It is very easy to become numb to numbers; to separate statistics from the stark reality they represent. So, let’s make this very clear: if you have not personally experienced GBV, you will know someone who has. GBV is everyone’s problem.


The only question to ask now: what can be done to help these survivors?


Clearly, ending GVB is the ultimate aim. Here, increased education and awareness is key. However, social media posts, placards in parks and doorstep vigils do little with regards to creating real tangible change. Perhaps more importantly, it does little to help those currently affected.


Although specialist, trauma-informed services are available, they are severely oversubscribed and underfunded. Women’s Aid have waiting lists for long-term support exceeding 6 months.(3) Similarly, Rape Crisis centres have, at times, had to close their doors to survivors due to unprecedented demand.(4) This leaves many lacking a place to turn when most vulnerable.


So, what can be done to respond to such survivors during times of crisis?

Enter stage left, the NHS: caring from cradle to coffin.


Both healthcare students and workers are guaranteed to meet survivors of GBV. However, contrary to its high societal prevalence, knowledge of GBV and treatment for those it impacts remains relatively absent from the medical curriculum.(5)


It is important to recognise that the primary response to disclosures of trauma can set the tone for future conversations, shaping a survivor’s recovery. As future and current clinicians, this initial response may likely stem from us. Therefore, we must be both competent and comfortable recognising and responding to GBV. Despite this, healthcare workers often fail to identify presentations of GBV,(6) resulting in a breakdown in care received by the patient.

It is important to recognise that the primary response to disclosures of trauma can set the tone for future conversations, shaping a survivor's recovery.

As negative responses to GBV disclosures can result in lasting distrust and disenfranchisement of survivors,(7) we must not rely on an individual clinician’s intuition alone. A lack of training is not only unacceptable, it is harmful.


In a curriculum already information-saturated, where studying priorities are guided by learning outcomes and exam performance, we cannot rely on students to seek out information out with curriculum requirements. This important issue will not be solved through the addition of a token sentence at the end of an already filled lecture. Restructuring the medical curriculum on a wider scale is required.


Trauma-informed approaches cannot be learned overnight. As practice makes perfect, these tactics must be introduced from pre-clinical years, using a similar spiral-curriculum approach as adopted with other medical disciplines. This will dispel professional anxieties surrounding broaching GBV with patients and decrease the probability of vicarious trauma occurring amongst healthcare students and workers,(8) protecting both staff and patients.


Equally, as medicine is not purely academic, practical reinforcement of these skills is needed. Generic communication skills sessions are insufficient in refining specific trauma-informed approaches. Simulated patients presenting with GBV-related complaints must be included in teaching. If we do not encounter these patients from the beginning of our medical careers, how can we possibly optimally engage with them upon graduating?


In a mass movement to eradicate healthcare inequalities, reflection on current practice is essential. Our training must be updated to remain relevant, mirroring current societal demands. Only then can we meet our patient’s needs. Only then can we truly fulfil our role in fight against GBV.


******


Helpful resources for those seeking support related to this article’s contents. Please do reach out if you feel able, and know you are not alone.


National Helplines

Refuge (for survivors of domestic abuse)

Telephone: 0808 2000 247 (open 24/7)

Online chat: https://www.nationaldahelpline.org.uk/en/Chat-to-us-online (open Monday-Friday; 3pm-10pm)

URL: https://www.refuge.org.uk


Women’s Aid (on website gives additional information for helplines for men and LGBTQ+ survivors)

Online chat: https://chat.womensaid.org.uk (open Monday-Friday 3pm-10pm and weekends 10am-6pm)

Email: [email protected]

URL: https://www.womensaid.org.uk


Domestic and sexual abuse helpline (open 24/7)

Telephone: 0808 802 1414 (open 24/7)

Email: [email protected]

Live chat/URL: https://www.dsahelpline.org


Scotland

Rape Crisis Scotland National Helpline (open 6pm-midnight, daily)

Telephone: 08088 01 03 02

Text: 07537 410 027

Email: [email protected]

URL: https://www.rapecrisisscotland.org.uk


Scottish Women’s Aid (open 24/7)

Telephone: 0800 027 1234

Online chat: https://womensaid.scot/contact-us/

Email: [email protected]

URL: https://womensaid.scot


England & Wales

Rape Crisis England & Wales National Helpline (open 12 noon – 2:30pm; 7pm-9:30pm, daily)

Telephone: 0808 802 9999

Live chat: https://rapecrisis.org.uk/get-help/live-chat-helpline/about-the-live-chat-helpline/ (open at variable times)

URL: https://rapecrisis.org.uk


Northern Ireland

Rape Crisis Northern Ireland National Helpline (open 6pm-8pm; Monday-Thursday)

Telephone: 0800 0246 991

Email: [email protected]

URL: https://rapecrisisni.org.uk



About the Author




Caitlin Stuart-Delavaine

Fourth year medical student, University of Glasgow

[email protected]















References


1. Home Office News Team. Violence against Women and Girls and Male Position Factsheets. GOV.UK; 2019 [accessed 6 Jul 2021]. Available from: https://homeofficemedia.blog.gov.uk/2019/03/07/violence-against-women-and-girls-and-male-position-factsheets/.

2. Mittal S, Singh T. Gender Based Violence During COVID-19 Pandemic: A Mini-Review. Front Glob Women’s Health. 2020; 1 [accessed 20 Apr 2021]. Available from: https://www.frontiersin.org/articles/10.3389/fgwh.2020.00004/full.


3. BBC. Domestic abuse victims ‘forced onto waiting lists for charity help’. BBC. 2020 Mar 8 [accessed 23 Apr 2021]. Available from: https://www.bbc.co.uk/news/uk-scotland-scotland-politics-51783289.

4. Paul Hutcheon. Twelve month waiting times for Scots rape crisis services blasted as ‘national disgrace’. The Daily Record. 2021 Mar 24 [accessed 23 Apr 2021]. Available from: https://www.dailyrecord.co.uk/news/politics/twelve-month-waiting-times-scots-23785575.

5. Potter L C, Feder G. Domestic violence teaching in UK medical schools: a cross-sectional study. Clin Teach. 2018; 15:382-386 [accessed 22 Apr 2021]. Available from: https://pubmed.ncbi.nlm.nih.gov/28984416/.


6. Blank K, Rösslhumer M. Trauma manual on gender based violence for health professionals. Austria. Austrian Women’s Shelter Network (AÖF); 2015 [accessed 3 Apr 2021]. Available from: https://eeca.unfpa.org/sites/default/files/pub-pdf/implement_train_EN_201606_hires.pdf


7. Ullman S E, Peter-Hagene L. Social Reactions to Sexual Assault Disclosure, Coping, Perceived Control and PTSD Symptoms in Sexual Assault Victims. J Community Psychol. 2014; 42:495-508 [accessed 22 Apr 2021]. Available from: https://pubmed.ncbi.nlm.nih.gov/24910478/.


8. Sweeney A, Filson B, Kennedy A, Collinson L, Gillard S. A paradigm shift: relationships in trauma-informed mental health services. BJPsych Adv. 2018; 24:319-333 [accessed 22 Apr 2021]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6088388/.

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