By Scott W. George
The application of simulated learning and standardized patient methodology has been proven to be effective in the instruction and assessment of sexual assault responders by employing Standardized Patients (SP) and Gynecological Teaching Associates (GTA) in their training and assessment. Most SP Programs are not participating in SANE (Sexual Assault Nurse Examiner) and SAFE (Sexual Assault Forensic Examiner) trainings and assessments despite the presence of these programs within 50 miles of nearly every ASPE member institution. My project assignment as a Member Liaison on the ASPE Board of Directors for the past two years has been to research the viability of expanding this application to interested SP Programs, and establishing a recommended protocol and resource for assisting ASPE members in establishing such partnerships with their own local SANE and SAFE programs.
My Atlanta-based organization, Clinical Skills USA, Inc., presently supports 19 medical and nursing schools in the U.S. with the instruction of the female pelvic and breast, and male urogenital exams, by referring a staff of 20 trained Gynecological Teaching Associates (GTAs) and Male Urogenital Teaching Associates (MUTAs). On a smaller scale, we also provide SPs for other clinical skills simulation assignments for nursing, physician assistant and physical therapy schools. As with most other SP programs, I am always seeking other opportunities to apply the talents of these remarkable people.
Several years ago I initially began considering what appeared to be a natural application of SP methodology for the training and assessment of sexual assault responders, including SANES, victim advocates and law enforcement. I first became aware of the utilization of SPs and GTAs for teaching the well-woman exam to SANEs and SAFEs in February 2009, when discussing the work that Isle Polonko from Rutgers (formerly UMDNJ) was performing with her GTAs in assisting SANEs and SAFEs in New York and New Jersey involving domestic violence training and vaginal speculum use. In exploring how our own SPs and GTAs could provide similar support to local Georgia SANE agencies, I met with Ann Burdges at the local Gwinnett Sexual Assault Center (GSAC) and Kim Day with the International Association of Forensic Nurses (IAFN) in August 2010. Both were very encouraging about the possibilities for utilizing our SPs and GTAs in Georgia, and further establishing a prototype for other such agencies to pattern their own programs after, outside of Georgia. In addition to training new forensic nurse examiners they were particularly interested in utilizing SPs and GTAs in meeting a critical need to offer newly-trained SANEs with the necessary observed clinical experiences required to become certified. They felt that simulated encounters might be the answer to the shortage of observable clinical experiences and they strongly encouraged me to pursue this project.
My initial research revealed that a few institutions were already involved in these activities to varying degrees, including the SP Programs at Johns Hopkins University, Eastern Virginia Medical School, SUNY Upstate University, Tulane University, University of Pittsburgh, University of Louisville, University of Arkansas, University of Manitoba, University of Medicine and Dentistry of NJ and University of Vermont. Upon surveying these programs, all confirmed that employing SPs and/or GTAs had been effective in meeting the goals of clients by providing their learners with a beneficial simulated learning experience .
In March 2012, CSUSA partnered with Denise Atkinson, SANE trainer, and executive director of the Georgia Network to End Sexual Assault (GNESA) Jennifer Bivins, in preparing 11 of our SPs and GTAs to work with their agency in employing simulation for SANE training and competency assessment. GNESA provided our staff with a 6-hour training session covering the definition of sexual assault and its impact, the associated law enforcement and judicial response system, and the forensic evidence collection process. We also addressed their role in portraying an assault victim during the forensic evidence collection process, including the fact-finding interview and physical evidence collection. Since that preparatory instruction, our GTAs have participated in 10 actual SANE training sessions and 2 competency assessments at both GSAC and GNESA. Feedback from instructors and students about the simulated interaction with the SPs and GTAs has been highly favorable in every case.
Concurrent with the activities of CSUSA in supporting our SANE agencies in Georgia, we also collaborated with Isle Polonko in an ASPE grant project to study the application of SP methodology with the utilization of SPs and GTAs in orienting medical residents to the process of forensic evidence collection. The study was conducted with Ob/Gyn and Family Medicine residents at the University of New Jersey Medical School (now Rutgers), Eastern Virginia Medical School, and the University of Mississippi Medical Center. Once again, the quality of learning was proven to be enhanced with the involvement of simulation and the hands-on utilization of SPs and GTAs in the role of the assault victim. This research study will be published in the near future, however a preliminary copy of the study results are available upon request.
Most recently, Isle Polonko and I were asked to assist in the training of SPs and GTAs at the University of Texas, Medical Branch, in preparation for their participation in sexual assault responder training with both their medical residents and SANE agencies throughout the State of Texas. We worked with Dr. Karen Szauter, Professor of Internal Medicine, and Dr. Patricia Crane, Associate Professor of Nursing and a Forensic Nurse Consultant. The training conducted for their staff was closely modeled after the similar instruction that we had conducted for our own SPs and GTAs in New Jersey and Georgia. The successful implementation there has helped to further solidify a simple format for preparing SPs and GTAs for these assignments.
My current objective is to facilitate the widespread application of SP simulated methodology for training and competency assessment of SANEs and other sexual assault responders, by sharing our experiences at CSUSA, and the experiences of the other Programs that have already participated in these endeavors. This can be achieved by encouraging our member institutions to explore the possibility of establishing partnerships with their own local sexual assault responder agencies, especially SANE and SAFE programs, and coordinating appropriate networking. ASPE has agreed to support such partnerships by providing resources for matching the interested member institution with local community sexual assault responder agencies, and providing a basic template and ancillary materials for preparing their SPs, GTAs and MUTAs for these assignments. The GTA/MUTA Special Interest Group has agreed to serve as the primary contact and resource for this purpose. I strongly encourage anyone with an interest in establishing a similar program to contact me, or the GTA/MUTA Special Interest Group.
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