Addressing a Global Public Health Crisis: Human Trafficking Education in Medical Training

OBJECTIVESFew medical schools incorporate formal education on human trafficking (HT) and sex trafficking (ST) into their curriculum. Our objective was to develop, implement, and evaluate education on HT and ST in the first-year medical student curriculum.METHODSThe curriculum included a standardized patient (SP) experience and lecture. As part of their mandatory sexual health course, students interviewed an SP who presented with red flags for ST and then participated in a discussion led by a physician-facilitator in an observed small group setting. A multiple-choice survey to assess knowledge about HT and ST was developed and administered to students before and after the SP interview.RESULTSOf the 50 first-year medical students, 29 (58%) participated in the survey. Compared with the students’ baseline scores (according to the percentage of correct responses), scores after the educational intervention showed a significant increase in percentage correct on questions related to trafficking definition and scope (elder care, P = .01; landscaping, P = .03); victim identification (P < .001); referral to services (P < .001); legal issues (P = .01); and security (P < .001). On the basis of the feedback, a 2-hour lecture, which was adapted from the American Medical Women's Association–Physicians Against the Trafficking of Humans “Learn to Identify and Fight Trafficking” training, was presented the next year to all first-year medical students as part of their longitudinal clinical skills course and before the SP case. Curriculum objectives included learning trafficking definitions, victim/survivor identification, intersections with health care, the local impact of HT, and available resources.CONCLUSIONThis curriculum fulfills course objectives and could be replicated at other institutions. Further evaluation of this pilot curriculum is necessary to evaluate its effectiveness.

The Tragedy and Horror of Human Trafficking of Children and Youth

Standardized patients (SPs), now a mainstay of the undergraduate medical education experience, are beginning to play larger roles in helping students build competencies to better serve patients who have disabilities, in educating students about the lived experiences of persons with disabilities, and in testing students' understanding of disability-related issues. In this article, the authors discuss several U.S. training programs that involve SPs who have disabilities or SPs who do not have disabilities but who portray patients who do. The authors review the goals of each program (e.g., to provide students with opportunities to gain experience with patients with disabilities), describe their commonalities (enhancing students' interview skills) and differences (some programs are educational; some are evaluative), and summarize the evaluative data of each. The authors also explore the benefits and challenges of working with SPs with disabilities and of working with SPs without disabilities. Finally, they consider the practical issues (e.g., recruiting SPs) of developing and implementing such programs.

Health care professionals' self-efficacy in identifying and treating human trafficking victims

BackgroundHuman trafficking is an egregious human rights violation with profound physical and mental health sequelae. Healthcare encounters present critical opportunities to identify and support individuals experiencing trafficking. To maximize these opportunities, healthcare professionals must be equipped to recognize the signs of trafficking and respond effectively with trauma-informed, survivor-centered care. High quality training is essential to ensure that healthcare providers have the knowledge and skills to fulfill this role. To address the need for standardized, evidence-based evaluation of trafficking training, the Human Trafficking Curriculum Assessment Tool (HT-CAT) was developed as a structured quality assessment tool. This study evaluates HT-CAT’s reliability.MethodsThe Human Trafficking Curriculum Assessment Tool (HT-CAT) was used to evaluate the quality of a compendium of introductory human trafficking educational resources for health care professionals. Twenty-four trainings were systematically reviewed using the HT-CAT by a minimum of three reviewers. Statistical analyses were conducted to examine interrater reliability and to describe variation across trainings and assessment tool items.ResultsThere was high interrater agreement based on summed HT-CAT domain scores (ICC = 0.88, 95% CI 0.84–0.93). Individual item scores had variable agreement (K = 0.30, 95% CI 0.22–0.38) with high between training variability, as well as variable agreement on how specific items should be scored (alpha = 0.27, 95% CI 0.23–0.31). This variation in scoring was consistent between items, suggesting that there were no items that systematically produced more or less agreement than others.ConclusionsThe HT-CAT is a reliable tool for assessing the overall quality of human trafficking education of health professionals. HT-CAT has important applications for health policy makers and health professions educators. Rigorous assessment of key components of human trafficking trainings for healthcare professionals can help ensure that high quality, relevant education is offered to this group of direct service providers that play an important role in supporting survivors of human trafficking. High-quality training equips providers, a vital lifeline for survivors of human trafficking, with the knowledge and tools to offer compassionate, informed care.

East Tennessee State University James H. Quillen College of Medicine.

Pharmacist Licensure: Time to Step It Up?

Health Professional Role in Identifying and Assessing Victims of Human Labor Trafficking

Delivering human trafficking education to nursing students may improve graduates' ability to identify and assist persons victimized by trafficking. A paucity of research has examined human trafficking as a content area in academic nursing programs as well as nurse educators' understanding and teaching practices of human trafficking. This study sought to (a) describe nurse educators' perceived knowledge, actual knowledge, attitudes, instructional beliefs, and instructional practices of human trafficking; (b) determine if differences in actual knowledge, attitudes, and instructional beliefs of human trafficking exist among nurse educators who have experience teaching about human trafficking compared to nurse educators who have never taught about human trafficking; and (c) determine if differences in actual knowledge, attitudes, and instructional beliefs exist among nurse educators who have received human trafficking training compared to nurse educators who have not received human trafficking training. A descriptive, cross-sectional study was conducted using survey methodology. A nationwide sample of 332 academic nurse educators was analyzed. Findings among nurse educators included low perceived knowledge levels and strong actual knowledge levels about human trafficking. Participants held awareness they may encounter trafficked individuals in the workplace and expressed responsibility to respond to suspected cases. However, participants reported having received insufficient training on the topic and low confidence responding to trafficking situations. While nurse educators find relevance and value in teaching students about human trafficking, most do not have personal experience teaching about human trafficking or feel confident teaching on the topic. This study provides preliminary knowledge of nurse educators' understanding and teaching practices of human trafficking. Findings from this study offer implications for nurse educators and program administrators to improve human trafficking training among nursing faculty and integrate human trafficking education into curricula.

IntroductionThe ability to utilize the electronic health record (EHR) without compromising the doctor-patient relationship (DPR) is an essential skill of all physicians and trainees, yet little time is spent on educating or assessing learners on needed techniques. To address this gap, we developed a conventional OSCE station coupled with a simulated patient chart within the Epic program in order to assess our students' skills utilizing the EHR during a patient encounter.MethodsOf third-year medical students, 119 were given full access to the patient's simulated chart 24 hours in advance of their OSCE to review clinical data. During an in-person OSCE with a standardized patient (SP), students performed a focused history and physical, using the EHR to verify allergies and medications. Students completed an electronic patient note graded by faculty. SPs evaluated the students on communication and interpersonal skills with specific rubric elements. Faculty graded the students' notes to evaluate their expression of clinical reasoning in the assessment and plan.ResultsTraining SPs and faculty to assess students on EHR skills was feasible. After implementation of a comprehensive curriculum focused on EHR and DPR, there was a significant difference on EHR-related communication skills (M = 76.4, SD = 17.6) versus (M = 37, SD = 28.9) before curriculum enhancement t (117.9) = −12.4, p <.001.DiscussionThe EHR OSCE station provided a standardized method of assessing students' EHR skills during a patient encounter. Challenges still exist in the technological requirements to develop and deliver cases in today's EHR platform.

Nurses as healthcare professionals are in key positions to identify trafficked persons. Assessment of nurse knowledge shows the benefit of using asynchronous human trafficking education as a means for learning. Recommendations from this study for professional development educators include garnishing nurse executive support and use of case-study, evidence-based approaches. Support for state-mandated human trafficking education requirements for initial and ongoing licensure of nurses is necessary as human trafficking knowledge may decrease over time.

University of South Alabama College of Medicine.

The prevalence of human trafficking continues to increase worldwide, and the implementation of human trafficking education and victim identification within institutions is slow to catch up. The Oregon State Hospital is a psychiatric in-patient hospital that currently does not provide human trafficking education or a screening tool for staff and does not know how to provide treatment to trafficked victims. Interviews were conducted with employed social workers at the Oregon State Hospital to obtain a baseline understanding of their previous education, training, and knowledge of human trafficking to aid in the creation of a trafficking screening tool. Results indicate participants have a rudimentary knowledge about human trafficking and unknowingly identified risk factors for domestic violence and sexual assault that also overlap with human trafficking. Participant confidence in identifying and reporting signs of human trafficking is low compared to identifying and reporting signs of domestic violence and sexual assault; however, more referrals and resources were listed for human trafficking compared to domestic violence and sexual assault. The creation and implementation of human trafficking education, training, and screening tool at the Oregon State Hospital could increase social worker confidence and improve victim identification to then provide patients with the necessary person- centered, trauma-informed care for competency restoration. If the goal of treatment is competency restoration, social workers must have the necessary education, training, and tools to treat the entire patient--especially those that frequently go unseen, like human trafficking survivors.

University of Hawaii at Mãnoa John A. Burns School of Medicine

Human sex trafficking, often referred to as modern-day slavery, is a major global human rights problem with at least 4.5 million people trafficked for commercial sex annually. Many of these women interface with the medical system regularly, often in women’s health clinics and the emergency departments. Therefore, it is important for healthcare providers to be able to identify red flags for human trafficking, to be able to screen effectively, and to know how to connect patients with resources in the community. It is also important for healthcare providers to be aware of the many long-term health effects related to sexual trauma that victims of human trafficking may develop. OBGYNs are able to have long-lasting impacts on the many survivors of human sex trafficking by screening effectively and providing compassionate, trauma-informed care. This review contains 4 figures, and 3 tables, and 40 references. Keywords: Sexual assault, sexual violence, Intimate partner violence, Human trafficking, Rape, Trauma-informed care, Women, Primary Care, Obstetrics and Gynecology.