GP training seeks to improve response to survivors of sexual violence

Anastasia Tsirtsakis

16/07/2021 4:19:41 PM

The pilot program is aimed at GPs working in rural and remote areas, and is accredited by the RACGP.

A woman hunched over in distress.
It is estimated GPs will see at least one female patient a week that has experienced sexual violence, Professor Kelsey Hegarty says.

In Australia, it is estimated that one in five women and one in 20 men have experienced sexual violence since the age of 15. And in the aftermath, GPs are often a vital source of support.
According to the 2016 Australian Bureau of Statistics’ Personal Safety Survey, four out 10 women who sought advice or support about sexual violence did so through their GP or other health professional.
Professor Kelsey Hegarty is the Chair of Family Violence Prevention at the University of Melbourne, Director of the Safer Families Centre and clinical editor of the RACGP’s White Book. She told newsGP that while research into sexual violence presentations to general practice in Australia is limited, that GPs may be seeing more patients who are affected than they realise.
‘About one in 10 women attending general practice will have experienced domestic violence of which some of it will be sexual violence. So, really, a GP is probably seeing a woman who may have experienced sexual violence every week,’ she said. 

But despite the high prevalence, Professor Hegarty said responding to sexual violence is not often covered during medical training.
‘Sexual violence is an area that perhaps has not had enough attention in training of doctors and nurses,’ she said.
‘It’s still very hidden; the disclosure rate is not very high. And yet, GPs are the highest professional group disclosed to about sexual violence. So it’s really important that GPs and primary care nurses get training in this.’
That is precisely what a new three-unit pilot training program, Recognising and Responding to Sexual Violence, developed by Monash University in partnership with the Victorian Institute of Forensic Medicine, is hoping to achieve.
Funded by the Commonwealth Department of Social Services under the Fourth Action Plan of the National Plan to Reduce Violence Against Women and their Children 2010–2022, GPs will learn how to identify risk factors for sexual violence, as well as how to respond in culturally sensitive and appropriate ways.
Each unit is six-hours long and will be delivered online over the course of six-weeks, featuring live sessions with clinicians who have expertise in responding to sexual violence:

  • Unit 1: Sexual Violence: Drivers and Impacts – an evidence-based overview of sexual violence prevalence, drivers, short- and long-term impacts on individuals and the community and an overview of justice responses
  • Unit 2: Responding to Sexual Violence – this will focus on the patient consultation and care
  • Unit 3: Responding to sexual violence in at-risk cohorts – this will cover care for individuals who are known to be at a higher risk of experiencing sexual violence.
While the training curriculum has been designed to be patient-centred, it also recognises and addresses the risk of vicarious trauma for health practitioners in caring for survivors of sexual violence.
To take part in the training, consideration will be given to rural and remote GPs and nurses, as well as those whose practice catchment includes patient cohorts deemed to be at higher risk of experiencing sexual violence.
Professor Hegarty said GPs in rural and remote areas often have an even greater role to play in responding to sexual violence.
‘Sometimes there are fewer specialist services in those areas and therefore, the referral that we might do to a specialised sexual violence service in Victoria to a centre against sexual assault is less available in some country areas,’ she said.
‘So the GPs and the nurses may have to do more of the work.’

Curriculum lead, Associate Professor David Wells, who has spent a significant portion of his career assisting survivors of sexual violence, said there is limited awareness among frontline responders of how to recognise and respond to disclosures of sexual violence in ways that support recovery.
‘This program is a key element in early intervention and improving frontline workers’ ability to provide trauma-informed care and planning to support long term recovery,’ he said.
Professor Hegarty said it is important for GPs to remember that while a patient may not necessarily disclose their experience, to be mindful of associated presentations.
‘They will be seeing her with the mental health consequences of that sexual violence, including obviously depression, anxiety, post-traumatic stress disorder,’ she says. ‘They’ll also have a lot of chronic pain.
‘So in these sorts of circumstances, GPs should be thinking about asking about domestic family and sexual violence.’
While Professor Hegarty agrees that GPs need further training in sensitive inquiry and first line response, she says it is simply building on the existing skillset of GPs who are already providing good patient-centre care.
‘It’s giving them the scripts and language to ask about safety and to have the referral pathways for safety, and really utilising the principles of trauma-informed care,’ she said.
‘It’s important to not mystify it and say it’s really challenging and difficult because I don’t find that that’s necessarily true for experienced GPs – they really are keen to learn it.’
The first unit, Sexual Violence: Drivers and Impacts, will be delivered via Zoom on 16 August and has been accredited by the RACGP. It is free and worth 40 CPD points. Units two and three are expected to be delivered later this year.
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