1. 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 Milone JM, Burg MA, Duerson MC, Hagen MG, Pauly RR Survey #1 (n=94) 1.Examine medical student acceptance of rape myths 2.Gauge student support for the routine screening of patients for a history of sexual assault 3.Identify potential barriers to routine screening 4.Explore trends in student beliefs and attitudes about rape myths and routine screening after a lecture and a standardized patient intervention Methods Discussion Introduction University of Florida second-year medical students in the Essentials of Patient Care course were asked to complete a survey before and after a lecture about sexual assault. The lecture addressed common physical and psychological sequelae, epidemiology, rape myths, and students were given instruction on how to screen, counsel and treat rape victims. Students completed the survey a third time following a standardized patient encounter with a recently raped female. Survey #3 (n=102) Intervention #1 Lecture Intervention #2 Patient Encounter Survey #2 (n=90) Data Analysis Results Percentage of Students Who Agreed with Survey Items Survey Administration#1 n=94 #2 n=90 #3 n=102 Rape Myth Acceptance Scale (Cronbach’s α = 0.63) Any healthy woman can successfully resist a rapist if she really wants to.5%2%0% In most cases, a woman should have done something to prevent her rape.5%8%5% During a rape, a woman should do everything she can to resist.49%23%20% If a woman has no physical signs of a struggle, it is unlikely that she was really raped. 2% 1% In the majority of rapes, the victim is promiscuous or has a bad reputation.4%0%1% Often women say “no” when they mean “yes”.1% 0% Most rape victims will be hysterical, shaky and distraught.16%6% It is very unlikely that I will ever be a victim of rape.54%47%46% Attitudes Towards Screening Scale (Cronbach’s α = 0.63) New primary care patients should be screened for a history of sexual victimization. 77%83%90% A complete medical history form should include questions about sexual assault.78%83%84% There is not enough time in an office visit to ask questions about sexual assault.16%1%5% I would avoid asking patients if they have been sexually assaulted because it could make them emotionally upset. 6%1%2% Most women who have been raped don’t want to discuss it with their physician.15% 8% I would feel uncomfortable asking a patient if she has been sexually assaulted.31%17%9% A rape victim should be encouraged to try to put her assault experience in the past. 18%13%14% A physician who treats a woman after a rape should urge her to press charges.31%9% I would feel uncomfortable if my doctor asked me if I have been sexually assaulted. 10%7%8% I would not know what to do if a patient told me she had been raped.41%7%5% Students tended to indicate greater agreement with screening and increased comfort screening following educational interventions. Overall, students showed low levels of agreement with rape myth endorsing statements. Rape myth acceptance was correlated with screening hesitancy (r = 0.43). Female medical students were less accepting of rape myths (t=5.61, p<0.0001, d=1.2) and expressed more positive attitudes about screening (t=3.56, p=0.0006, d = 0.75). To date the Liaison Committee on Medical Education (LCME) has no educational standards that address sexual assault. In 2003, medical schools reported an average of 9 hours required for instruction about domestic violence. It is unknown if any of that time was devoted to a discussion of sexual assault. 7 The results of this and other studies suggest that adding rape education to medical student curriculum may decrease rape myth acceptance and promote routine screening. References: 1.Tjaden PG, Thoennes N. Full report of prevalence, incidence and consequences of violence against women: findings from the National Violence Against Women Survey. 2000. 2.Dickinson LM, et al. Health-related quality of life and symptom profiles of female survivors of sexual abuse. Arch Fam Med. 1999;8:35-43. 3.Council on Scientific Affairs, American Medical Association. Violence against women: relevance for medical practitioners. JAMA. 1992;267:3184-3189. 4.Rodriguez MA, et al. Screening and intervention for intimate partner abuse practices and attitudes of primary care physicians. JAMA. 1999;281:468-474. 5.Parsons LH, et al. Methods of and attitudes toward screening obstetrics and gynecology patients for domestic violence. Am J Obstet Gynecol. 1995;173:381-387. 6.Burt MR. Cultural myths and supports for rape. J Pers Soc Psychol. 1980;38:217-230. 7.Barzansky B, Etzel SI. Educational programs in US medical schools, 2003-2003. JAMA. 2003;290:1190-1196. Study Objectives An estimated 1 in 6 women and 1 in 33 men has experienced an attempted or completed rape. 1 Patients with a history of sexual abuse have more physical and psychiatric symptoms and report lower health-related quality of life. 2 Although the AMA recommends that health care providers routinely screen patients for a history of sexual violence 3 evidence indicates that screening occurs infrequently in routine primary care visits. 4 Lack of education has been cited as the most common barrier to screening. 5 Physicians who receive training in abuse are more likely to screen. 5 In addition, health care providers’ belief in rape myths (stereotyped or false beliefs about rape victims) may negatively influence the care rape victims receive. 6 Statistical analysis was performed using SAS version 9. An 8-item “Rape Myth Acceptance” subscale and a 10-item “Attitudes Toward Screening” subscale were derived from the data. Cronbach’s α was computed to assess scale internal consistency reliability. Percentages were used to examine responses to the survey items. Pearson’s correlation coefficients were used to examine associations among scale items. Gender differences were calculated using t-tests. Then mean differences were divided by the pooled standard deviation to calculate the effect size (d). Future Directions Future research in this area could include: Study of attitudes toward male sexual assault victims Longitudinal study to determine if increasing sexual assault education influences physicians’ future screening practices Comparing students’ scores on the rape myth acceptance scale with their performance on a standardized patient encounter with a rape victim