A forensic pathologist’s perspective of the Sexual Assault Nurse Examiners (SANE) course

Abstract

Forensic pathologists (FPs) frequently perform examinations of the lower genital tract in deceased sexual assault victims. The accuracy with which they report abnormal findings improves with training by knowledgeable practitioners [1]. Unfortunately other than during an autopsy, there may be very little formal instruction specifically designed to educate trainee FPs on how to perform such examinations competently. The Sexual Assault Nurse Examiners (SANE) course, which is based on a curriculum approved by the International Association of Forensic Nurses [2], is a program expressly designed to train nurses to perform sexual assault examinations. Trainee FPs may be either too busy trying to meet case quotas required for board examinations to participate in such courses, or may be biased against training intended for nurses, with the perception that they are of an inferior quality. Interestingly non medical personnel who lack the constraints of tradition and medical hierarchy, such as social workers, attorneys, and detectives who investigate sexual assaults, have flocked enthusiastically to the course. An FP trainee’s exposure to sexual assault injuries is, by default, limited to those cases in which the victim was deceased and probably suffered grossly obvious traumatic injuries. Subtle injuries that are more easily missed are likely to be seen in living patients. Consequently the best teachers would be professionals who have far greater experience in these matters. Indeed Willoughby et al. [1] observed enhanced detection skills for genital trauma in trained versus untrained observers. Their report emphasizes the need for proper training of the FP to perform sexual assault examinations competently. Other reasons participants gave to take the course were; to better understand how nurses are trained to deal with patients under such traumatic circumstances, to refresh my knowledge of female genital anatomy, to enhance my understanding of the various circumstances surrounding a sexual assault, how those injuries present and are examined, and to practice those newly acquired skills at the autopsy table, and to become more familiar with the various agencies and authorities involved in the management, investigation, and prosecution of sexual crimes.