title: Low-fidelity hybrid sexual assault simulation training's effect on the comfort and competency of resident physicians.
abstract: BACKGROUND
  Alternative training methods are needed for resident physicians to ensure that care is not compromised should they practice in settings without well-established Sexual Assault Nurse Examiner (SANE) programs.
  
  
  OBJECTIVE
  The purpose of this study is to determine the effectiveness of a simulation-based sexual assault response course for resident physicians at an institution without an on-site SANE program.
  
  
  METHODS
  Educational intervention study of 12 emergency medicine residents using a low-fidelity hybrid simulation model. The study was comprised of eight male and four female physicians at a military medical center in San Diego, CA. Assessment occurred using three separate metrics. The first was a written knowledge test. The second was a simulated interview and evidentiary examination. These metrics were given 1 month before and 3 months after an 8-h training course. The final metric was Likert-scale questionnaires surveying pre- and post-course feelings of competency and comfort.
  
  
  RESULTS
  The emergency medicine residents showed a 13% improvement (95% confidence interval [CI] 7-20%) in written examination scores pre and post intervention. Post-course interview and examinations reflected a 44% improvement (95% CI 24-64%) in critical action completion. Pre-course comfort and competency questionnaires were a median of 2 (interquartile range [IQR] 1-3) on a Likert Scale. Post-course survey responses were a median of 4 (IQR 2-5).
  
  
  CONCLUSIONS
  Low-fidelity hybrid simulation is a useful tool to train inexperienced physicians to perform evidentiary examinations and interviews without sacrificing the privacy and direct care of sexual assault victims.
authors.affiliation: Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Auten
authors.affiliation: Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California.
authors.forename: Elliot M
authors.initials: EM
authors.lastname: Ross
authors.affiliation: Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: French
authors.affiliation: Department of Obstetrics and Gynecology, Naval Medical Center San Diego, San Diego, California.
authors.forename: Ivy Z
authors.initials: IZ
authors.lastname: Li
authors.affiliation: Deloitte Consulting, US Navy Bureau of Medicine and Surgery, Washington, District of Columbia.
authors.forename: Lovette
authors.initials: L
authors.lastname: Robinson
authors.affiliation: Office of Women's Health, US Navy Bureau of Medicine and Surgery, Washington, District of Columbia.
authors.forename: Nanette
authors.initials: N
authors.lastname: Brown
authors.affiliation: Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California.
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: King
authors.affiliation: Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California.
authors.forename: David A
authors.initials: DA
authors.lastname: Tanen
mesh_terms: D002983:Clinical Competence; D004521:Educational Measurement; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital; D005260:Female; D005554:Forensic Medicine / Q000193:education; D007722:Health Knowledge, Attitudes, Practice; D006772:Hospitals, Military; D006801:Humans; D007396:Internship and Residency; D008297:Male; D020377:Self Efficacy; D012742:Sex Offenses; D000066908:Simulation Training / Q000379:methods*; D011795:Surveys and Questionnaires; D014481:United States
keywords: domestic violence; emergency medicine; graduate medical education; rape; resident; sexual assault; simulation