Med students learn little about spotting, helping sex-trafficking victims

By Vishwadha Chander

By Vishwadha Chander

(Reuters Health) - Doctors are in a unique position to identify and help victims of sex trafficking, but little is taught in medical school about this issue, a review paper suggests.

About 400,000 people in the U.S. are estimated to be affected by human trafficking, and research indicates that up to 88% of them have seen a healthcare professional for treatment during their exploitation, the authors write in the American Journal of Preventive Medicine.

But there isn't enough discussion or education on the role doctors can play in helping these women, children and men, lead author Jennifer Talbott, a third-year medical student at the Mayo Clinic Alix School of Medicine in Scottsdale, Arizona, told Reuters Health.

"As future health care providers, it's important we learn about trafficking early, instead of five or ten years into our careers when maybe a dozen victims have slipped past us unnoticed," Talbott, who worked with her faculty to develop coursework on the topic, said in an email.

To assess what educational materials do exist for medical students, Talbott and colleagues searched medical journal databases, Google Scholar and other resources for terms including "human trafficking," "sex traffic," "sex violence," "sex work," "education," "medical" and "undergraduate."

They uncovered 64 scholarly articles. But after excluding papers that didn't talk about human or sex trafficking, didn't target medical students or were opinion pieces, they were left with just six. After adding in five papers discovered in other searches, they had a total of 11 educational resources on sex trafficking directed at medical students.

None of the resources was solely about sex trafficking, and less than half addressed legal considerations and how to prevent human trafficking. Eight resources discussed victims' treatment needs, provided screening tools and discussed health consequences of trafficking victimization, with five of these also discussing trauma and how doctors should speak to victims.

A comprehensive curriculum on human trafficking should ideally touch upon the definition of trafficking, identification, intervention, treatment, referral to services, safety considerations, legal issues and prevention, Talbott said.

The biggest challenge for medical students is the lack of awareness, she added. "So many of my peers had either never heard of trafficking or had no idea about the magnitude of the issue and how often victims interact with healthcare providers."

While awareness is growing, it's slow compared to growth in reported rates of trafficking, the authors point out.

"Human trafficking is perhaps coming to light more now because healthcare professionals and the public are talking about it more," said Dr. Asim Shah, professor and executive vice chair of psychiatry at the Baylor College of Medicine in Houston, who wasn't involved in the review.

The review authors call for a standardized curriculum on sex trafficking to help close the gap in medical education.

Creating such a curriculum can take time, however, said Kamila A. Alexander of the Johns Hopkins School of Nursing in Baltimore, who also wasn't involved in the review.

"Given the current structure of our health care system, having enough time to adequately assess and refer individuals experiencing trafficking is likely another big challenge," Alexander said in an email.

Even so, teaching young doctors what to look for and how to respond would not take long, Talbott and colleagues write. Citing a 2014 commentary in JAMA Pediatrics, they suggest all the information a medical student would need to know about trafficking could be delivered in a one-hour lecture.

Shah suggests that in that one hour, students should be taught to identify red flags like unexplained injuries, signs of depression and anxiety, suicide attempts and malnourishment.

"They also need to know traffickers abuse patients and control them, so if you have a patient accompanied by an older person who is not willing to leave the room, question it," Shah said in a phone interview.

In the U.S., the National Human Trafficking Hotline is 1-888-3737-888 (humantraffickinghotline.org).


SOURCE: https://bit.ly/2OdQTvH American Journal of Preventive Medicine, online January 27, 2020.