Beyond the Protocols: A Team-Based Learning Intervention Improving Student Knowledge and Confidence on Caring for Survivors of Sexual Assault : Academic Medicine

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Beyond the Protocols: A Team-Based Learning Intervention Improving Student Knowledge and Confidence on Caring for Survivors of Sexual Assault

Daily, Kylene P.1; Loftus, Tiffany MD1; Waickman, Colleen PhD1; Start, Amanda R. PhD1; Fernandes, Ashley K. MD, PhD1

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doi: 10.1097/ACM.0000000000004294
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Sexual assault (SA) rates among women approach 20%, with devastating acute and long-term sequelae for survivors. 1 A humanistic response from health care providers that employs trauma-informed care (TIC) empowers SA survivors and promotes better outcomes. 2 Historically, medical school teaching on SA focused on epidemiology and treatment protocols rather than a bio-psycho-social-spiritual model of care. 3,4

To address this gap, we developed a student-led, team-based learning (TBL) activity focused on SA. TBL is effective in a variety of educational settings, assesses knowledge, promotes engaged collaboration, and requires fewer educational resources. 5 Our objective was to create and assess a TBL exercise better preparing medical students for the evidenced-based, whole-person care of SA survivors.


Using best practices from the literature, 5 we integrated SA education into an existing TBL within a fourth-year medical student clerkship. The SA component included: learning outcomes, prework (readings and a written reflection on 2 actual cases of physician–SA survivor interaction), knowledge assessment (2 multiple-choice questions for the Individual and Group Readiness Assurance Tests and final exam), an application exercise (with role play, facilitated by SA-trained medical student peers), and large-group discussion (self-care and the role of TIC in one’s specialty). Medical students received a pre- and postsession evaluation of relevance to specialty, confidence in treatment, and satisfaction.

Over 2 years, 336 fourth-year medical students participated (48% female, 41% male). A future frontline specialty (future-FLS: a specialty in which a first disclosure of SA is more likely: psychiatry, emergency medicine, pediatrics, family medicine, and obstetrics) was reported by 40% of students, compared with 60% reporting a future non–frontline specialty (future-NFLS).


We assessed the need for SA education, the impact of the TBL on knowledge, attitudes, and confidence, and differences between gender and specialty choice (future-FLS versus future-NFLS).

Nearly a quarter of fourth-year students felt the medical school curriculum did not prepare them to care for SA survivors, and only 31% agreed that it did. Analysis of variance revealed no differences in perceived preparation by gender or specialty.

Medical students performed poorly on 1 of 2 knowledge-based multiple-choice questions, with only 43.8% of students answering a question related to emotive interviewing correctly. Students pursuing a future-FLS were 2 times more likely to answer correctly than future-NFLS students (P = .05).

Future-FLS students reported greater perceived relevance both pre- and post-TBL than future-NFLS students, but future-NFLS students did show an increased perception of relevance after the TBL (P < .001).

Post-TBL, students were confident in their ability to care for patients (62.2%) and friends (70.5%) who had survived SA. Relative to males, females reported higher confidence in caring for a patient (P = .043) and a friend (P = .007).


Student knowledge and confidence in SA care increased. Future-FLS students were more knowledgeable about SA, reporting higher levels of perceived relevance than their future-NFS counterparts. Future-NFS students did report an increase in relevance following the intervention, significant since perceived relevance correlates with learning and motivation. Females reported greater confidence in caring for survivors of SA, a “gender gap” whose cause needs further exploration.


The integration of TIC into a TBL exercise on SA is an approach not previously found in the literature. The problem of limited curricular space was ameliorated by “piggybacking” onto an extant TBL. We expanded traditional TBL by introducing a presession reflection written assignment, deepening content exploration. SA-trained medical student facilitators had a profound impact on engagement and satisfaction. Future interventions could target gender biases to reduce the confidence gap between genders. TBL can be employed effectively in SA education to show that the bio-psycho-social-spiritual care for persons must transcend protocols.


The authors acknowledge the efforts of Jill Davis from the Sexual Assault Response Network of Central Ohio and Amy Zoller and Jennifer Bright from the Central Ohio FNE/SANE program in creating the prework brochure and training the student/trainee authors to be sexual assault advocates. They would also like to acknowledge additional faculty support and mentorship in medical education from G. Patrick Ecklar, MD, and Kristen Rundell, MD, of the Ohio State University College of Medicine.


1. Black MC, Basile KC, Breiding MJ. The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2011. Accessed July 6, 2021
2. Goldstein E, Murray-García J, Sciolla AF, Topitzes J. Medical students’ perspectives on trauma-informed care training. Perm J. 2018; 22:17–126
3. Milone JM, Burg MA, Duerson MC, Hagen MG, Pauly RR. The effect of lecture and a standardized patient encounter on medical student rape myth acceptance and attitudes toward screening patients for a history of sexual assault. Teach Learn Med. 2010; 22:37–44
4. Kennedy KM, Vellinga A, Bonner N, Stewart B, McGrath D. How teaching on the care of the victim of sexual violence alters undergraduate medical students’ awareness of the key issues involved in patient care and their attitudes to such patients. J Forensic Leg Med. 2013; 20:582–587
5. Fernandes AK, Wilson S, Kasick R, Humphrey L, Mahan J, Spencer S. Team-based learning in bioethics education: Creating a successful curriculum for residents in an era of “curricular squeeze”. Med Sci Educ. 2020; 30:649–658
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