P2.D074: Preparing Emergency Medicine Residents and Pediatric Emergency Medicine Fellows to Care for Patients Who Present to the Emergency Department After a Sexual Assault

Background: Caring for patients who have experienced a sexual assault (SA) is an integral job function performed by emergency physicians, yet upon graduation from emergency medicine (EM) residency or pediatric emergency medicine (PEM) fellowship, many trainees do not feel adequately prepared to assess or treat patients who have experienced SA. This study explores whether a novel curriculum consisting of a didactic experience, medical simulation, and structured debriefing can improve EM residents' and PEM fellows’ competence and confidence in caring for patients who have experienced SA as well as retention six months after the intervention. As a secondary aim, data were also collected regarding trainees’ prior experience caring for patients who presented after experiencing a SA.

Methods: Trainees first underwent a pretest, simulation, and debrief; and second, they were given access to a novel care pathway that offers step-by-step instructions regarding how to care for patients who present to the ED after a SA. After the session, trainees completed a ten-question multiple choice competency assessment and a survey that examines their prior experience, perceived confidence in caring for patients who have experienced SA (including history, exam, forensic evidence collection, pharmacologic treatment, legal implications), and feedback about the training. The survey and posttest were again distributed six months later to examine trainees’ ongoing confidence and competence. The unmatched samples were then analyzed using a Wilcoxon signed rank test.

Results: EM (n = 30) and PEM (n = 5) trainees reported having undergone an average of 1.57 hours of prior training regarding SA. On the competency assessment, trainees performed better on the posttest when compared to the pretest (p = 0.005) as well as on the follow-up test (p > 0.10) (see attached table). Regarding trainee confidence, before the intervention, 74.28% of trainees disagreed that they felt confident whereas immediately after the training 2.78% disagreed, and 6 months later 23.53% disagreed. Regarding feedback, a common theme that emerged was that the simulation session was particularly helpful. Trainees also noted that the didactics regarding recommendations for pediatric versus adult patients as well as the legal implications of the forensic process were topics that had been absent from their prior medical education.

Conclusion: EM and PEM trainees receive minimal training in caring for patients who present after a SA. Both trainee competence and confidence improved after completing the training. However, during the six-month follow-up period, there was a slight decline in retention.