Foundation Doctor training
Sexual and Domestic Violence
South Thames Foundation School
www.stfs.org.uk
Aim of this session
• To familiarise you with the materials
• So that we benefit from your feedback:
– Online materials
– Would you like similar resources for any other topics?
• To keep you awake after lunch
South Thames Foundation School
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Objectives
To provide materials to support relevant training for
foundation doctors eg a one hour interactive
session
At the end of the session foundation doctors
should:
• be aware of the associations and presentations
of violence and abuse*
• have an understanding of how to broach the
issue sensitively and confidently with patients
• be aware of local referral pathways and
documentation
*the session focuses on adults, as additional training on
safeguarding training should be provided separately
Contents of the pack
QUIZ
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Q1
What percentage of women in England and Wales say they
have been physically assaulted by a partner at some
point?
A) 5%
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B) 20%
C) 30%
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Q1 Answer
Correct answer is b - 20%
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Q2
What percentage of domestic violence occurs when children
are in the same or next room?
A)50%
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B) 70%
C) 90%
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Q2 Answer
Correct answer is c – 90%
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Q3
What is the cost to the NHS of dealing with physical injuries
alone caused by domestic violence?
a) £800 million
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b) £1.2 billion 3)
£3 billion
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Q3 Answer
Correct answer is B – £1.2 billion
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Q4
What is the biggest health difference between abused and
non-abused women?
a) more gynaecological problems
b) more broken bones
c) higher blood pressure
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Q4
Correct answer a – more gynaecological problems
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Q5
How many women are raped in the UK every week?
a) 500
b) 1000
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C) 2000
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Q5
Correct answer c - 2000
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Exploring abuse
• Privacy and sensitivity
• Setting the scene first, eg:
– ‘how are things at home?’
– ‘I am concerned that we have already seen you in A&E
three times this year . . and it is important that I ask
about your safety’
– ‘I am concerned that this injury seems to be more
severe than I would expect from tripping…’
– ‘it is good that you have asked for emergency
contraception . . can I just ask whether the sex that
happened was with your consent?’
– ‘are you safe to go home?’
Many different questions can be used to explore
The HARK questions are one model, developed for use in
general practice
• H
HUMILIATION
– In the last year, have you ever been humiliated or emotionally
abused in other ways by your partner or ex-partner
• A AFRAID
– In the last year, have you been afraid of your partner or ex-partner?
• R
RAPE
– In the last year have you been raped or forced to have sexual
activity of any kind
• K
KICK
– In the last year, have you been kicked, hit slapped or otherwise
physically hurt by your partner
Role plays with scenarios
• In your envelope you each have a sheet with 1
‘doctor’ and 1 ‘patient’ scenario, and possible
questions to ask
• Working in pairs, take it in turns to explore each role
for 5 minutes
• In your pairs, briefly feedback to each other:
– what went well?
– was anything difficult / made you feel awkward?
• Think about what next steps might help the patient in
each scenario?
Break for role plays and feedback in pairs
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Feedback after role plays – important
considerations for all scenarios
Always ask for advice eg senior doctor / safeguarding lead
(senior nurse will know who this is)
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Good documentation
– detailed, objective, legible, date
and time, signature and name in
capitals
– record words used verbatim eg ‘I
said no but he wouldn’t listen’
– record details of any assault eg
‘kicked twice in abdomen’ rather
than ‘assaulted’
– record injuries on body maps if
necessary (in case you are later
asked for a police statement)
Feedback after role plays –
Scenario - Amy
• Amy has presented to A&E asking for emergency
contraception. She is tearful and has brought a young child with
her
•
Last night her husband raped her while her 3 year old daughter
was in the same room asleep
• What next steps might be helpful?
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Interventions for Amy
• Is she safe to go home?
• Emergency contraception
• Discussion with senior colleagues / safeguarding staff as
regards child
• Does she want to report to police / local sexual assault referral
centre (SARC)?
• Sexual health referral / follow-up
• Discussion about local domestic violence services
• Good documentation
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Scenario - Paul
Paul is brought in by ambulance with the police following a
severe physical assault by a group of young men. Besides his
fractured ribs and pneumothorax, he was anally raped by three
of them. He is very upset, concerned about how he will tell his
girlfriend, and worried about whether he could have caught HIV
• Next steps?
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Interventions for Paul
• Post-exposure prophylaxis against HIV (as soon as possible/
within 72 hours)
• Sexual health follow-up
• Does he want to tell police / report to sexual assault referral
centre (SARC)?
• If not going to SARC, other sources of support for him (and
partner)
• Good documentation
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Scenario - Mrs Brown
• Mrs Brown was admitted following a fall, and is bruised on her
upper arms and backs of her legs, with a bite mark on her
shoulder
• She is a retired widowed headmistress living with her son and
daughter-in-law and their child, who has cerebral palsy. Since
breaking her wrist last month she has needed more help, and
her daughter-in-law has become frustrated and took it out on
her by hitting and biting her. Mrs Brown fell last night in an
attempt to get away from her
• Next steps?
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Interventions for Mrs Brown
• See Mrs Brown without any of her relatives present
• Management of injuries including human bite
• Safeguarding adults team (and safeguarding children team re
grandson)
• Ask her what action she would like to take eg police / not go
home
• If she does not want to go home, social services
• Good documentation
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Scenario - Fatima
• Fatima, aged 17, comes to see the GP with her 45 year old
husband. He does all the talking, although she can speak
English, and says she is pregnant. Fatima makes no eye
contact and looks thin and withdrawn
• Her marriage was arranged against her wishes. Her husband
does not let her out alone, and has sex with her against her
wishes several times a week, and hits her if she refuses. She
is only allowed food if she has done all the housework for her
mother-in-law, who lives with them
• Next steps?
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Interventions for Fatima
•
•
•
•
See Fatima without her husband or other relatives
Ask senior colleague
Confirm pregnancy and document any injuries
Find out what she would like to do as regards to pregnancy
and husband – but consider breaking confidentiality (following
advice) for her safety so that police are informed
• Provide information about domestic violence services
• Make TOP referral / involve antenatal team and safeguarding
midwife
• Involve safeguarding children team (as under 18 plus unborn
child)
Other resources
Local resources for patients (and staff)
Trainer - Research and identify local resources (useful contact names and
numbers for your area) and place in this slide for information:
•Use the list of resources/local services in the pack to identify your local
domestic and sexual violence services
•List your nearest SARC/Haven
•Contact your local DV or MARAC co-ordinator(s) as they are the best source
of information. Where not in place, Safer Neighbourhood teams and
Community Safety Teams should be knowledgeable, as are national DV
helpline staff
For further resources, please go to
http://www.stfs.org.uk/faculty/trainingabout-sexual-and-domesticviolence
South Thames Foundation School
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