Chapter 26 From the outset of your career, you need to be aware of the needs of victims of domestic abuse and sexual assault. During your career you will see many victims of domestic abuse, even if they are not immediately apparent. It will be a good core skill to have a solid understanding of the issues. These are included in the new foundation programme for qualifying doctors, which emphasises the competences needed in the ‘good clinical care’ section (see Box 26.1). Demonstrates the ability to identify, refer to and participate in both medical assessment and care planning in cases where the interests of a child or vulnerable adult, including those with learning difficulties or who are a potential victim of abuse, need safeguarding. Demonstrates an awareness of the potential for physical, psychological and sexual abuse of patients, and manages such cases in a similar way to the safeguarding of children and vulnerable adults. If it was not well covered during undergraduate training, it is a good idea to consider a domestic abuse course early on. These are not run by many hospital trusts but they may be available from your local domestic abuse forum. There are various e-learning packages on the subject, including the Royal College of General Practitioners course, which is free to other health practitioners and is a good first step. The National Institute for Health and Care and Excellence has recently developed public health guidelines, published in 2014. The Department of Health Taskforce on tackling Violence against Women and Children has recommended that domestic abuse features in both undergraduate and postgraduate syllabuses and be part of routine continuing professional development. Many royal colleges are considering how to implement this. An intercollegiate document sets out the safeguarding competences (i.e. the knowledge, skills, attitudes and values required) for safe and effective practice by health workers (Royal College of Paediatrics and Child Health, 2010). All doctors need to have level 2 training (see Box 26.2) and doctors who see children as a significant part of their work (i.e. most doctors) must be trained to level 3. Some additional competences are required for certain specialities, such as forensic physicians, paediatricians and child and adolescent psychiatrists. Levels 4–6 are set for specialists and experts in safeguarding. Most hospital trusts run frequent level 1 and 2 child protection courses or have easily accessible e-learning packages. The care of victims of sexual assault is less well covered in medical training, yet poor care increases the workload of the NHS. It has been estimated that 50% of patients in the mental health services have been a victim of sexual assault, and the percentage in acute psychiatric hospitals is even higher. The Home Office, together with The Havens, has developed a useful e-learning package comprising two modules: ‘care of a victim’ and ‘evidence’ (www.careandevidence.org). It also has guidance on such aspects of care as who should be considered for HIV post-exposure prophylaxis following sexual exposure (PEPSE). If you want to develop your care of victims of sexual assault further, there is now a fairly clear series of steps. The Diploma in Forensic and Clinical Aspects of Sexual Assault (DFCASA) has been developed with help from the Department of Health and is set at the basic level of competence required to examine a victim. It is designed to be suitable for both doctors and nurses. The Faculty of Forensic and Legal Medicine (FFLM), part of the Royal College of Physicians, has a membership exam specifically for sexual offence examiners: the MFFLM (SOM). This is more advanced than the DFCASA and is only open to doctors. The FFLM is also developing modular credentialing, which if successful will allow a route on to the specialist register. The Royal College of Obstetrics and Gynaecology has developed an Advanced Specialist Training module on Leadership in Domestic Violence and Sexual Assault Services. These building blocks are now in place to allow you to become better trained in the issues of domestic and sexual abuse, to improve the general care of victims and to consider sexual offences medicine as a possible career route (see Figure 26.1). Figure 26.1 Career pathway and considerations. DFCASA, Diploma in Forensic and Clinical Aspects of Sexual Assault; MFFLM, Member of the Faculty of Forensic and Legal Medicine; SOE, sexual offences examiner; SARC, sexual assault referral centre. At all stages of your career, you can proactively develop knowledge, skills and attitudes in line with General Medical Council requirements and so further contribute to the care of your patients who have experienced domestic and sexual violence (see Boxes 26.3, 26.4 and 26.5).
Moving Forward: Pursuing a Career and Implementing Better Services
OVERVIEW
Domestic abuse
Box 26.1 Foundation years competency
Child safeguarding
Box 26.2 Child safeguarding training
Sexual assault
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