Learning Overview: After attending this presentation, attendees will have learned about Italian medical students’ knowledge and training on child abuse and neglect. Impact Statement: This presentation will impact the forensic science community by analyzing the degree of medical students’ preparation on child abuse and by evaluating the medical school contributions on this topic. Child abuse and neglect are widespread social and medical issues that often go unreported, despite being associated with significant morbidity and mortality.1 They represent heterogeneous phenomena that widely vary in type, severity, and chronicity and, as a result, are challenging to identify: misdiagnosis may result in the development of psychiatric and other medical disorders.2,3 In the scientific literature, a limited number of studies have been conducted about health workers’ abilities to recognize suspected child abuse, although some researchers also reported physicians’ lack of knowledge on this topic.4 It is not clear if the reasons for this problem rely on insufficient preparation of students during medical school and/or a deficiency in continuing medical education during/after fellowships. For these reasons, a questionnaire was administered last year to medical students in order to evaluate the degree of knowledge on this theme. The study population included 179 Italian students, divided into two groups: Group A (79.8%)—students who attended pediatric traineeship and/or pediatric exam, and Group B (20.2%)—students who did not attend pediatric traineeship and/or pediatric exam. There were 12 questions focused on child sexual abuse, physical maltreatment, and neglect. Students’ knowledge was considered as sufficient if the final score was ≥6/12. Quantitative and statistical analysis were carried out by Excel® formulas. Results pointed out an overall negative outcome for the most part of the 179 students (77.7% scored <6/12). In this population, medical students’ awareness of child anogenital anatomy/pathophysiology appeared particularly deficient; 55.9% incorrectly answered that rectal prolapse is a manifest sign of chronic anal penetration. Indeed, a marginal percentage (7.3%) of students was aware of the physiological aspect of adult and preadolescent hymens. Similar considerations were highlighted considering the knowledge of suspected trauma sentinel lesions (abusive or accidental).5,6 For all questions, results of chi-square tests yielded no statistical differences between the two groups: the deficiencies were not related to students’ different levels of progression in medical school training and/or preparation. Therefore, this research clearly objectivated the need of a systematic implementation of basics in pediatrics, allowing specialists to acquire notions on child abuse and neglect. The most significant limitation of this study relies on the difficulty of extending the abovementioned considerations to medical students from other geographical regions and/or countries. However, comparison of different medical school systems suggests common issues in students’ education on child abuse and neglect.7 Thus, all these systems are at risk of generating students and future medical doctors who are unable to attend to the responsibility of protecting children from abuse and neglect.8 Study results and literature data suggested a widespread need to implement child abuse and neglect knowledge in medical schools. The present study highlighted the necessity for specific corrective interventions by governments and/or supranational organizations, as well as a proper pediatrics training. Reference(s): 1. Schilling, S.; Christian, C.W. Child physical abuse and neglect. Child Adolesc Psychiatr Clin N Am. 2014;23(2):309-319, ix. 2. Nemeroff, C.B. Paradise lost: The neurobiological and clinical consequences of child abuse and neglect. Neuron. 2016;89(5):892-909. 3. Adams, J.A.; Farst, K.J.; Kellogg, N.D. Interpretation of medical findings in suspected child sexual abuse: an update for 2018. J Pediatr Adolesc Gynecol. 2018;31(3):225-231. 4. Sheets, L.K.; Leach, M.E.; Koszewski, I.J.; Lessmeier, A.M.; Nugent, M.; Simpson, P. Sentinel injuries in infants evaluated for child physical abuse. Pediatrics. 2013;131(4):701-707. 5. Levin, A.V. Retinal hemorrhage in abusive head trauma. Pediatrics. 2010;126(5):961-970. 6. Bechtel, K.; Stoessel, K.; Leventhal, J.M., et al. Characteristics that distinguish accidental from abusive injury in hospitalized young children with head trauma. Pediatrics. 2004;114(1):165-168. 7. World health organization et al. Accreditation of medical education institutions: Report of a technical meeting. Schaeffergården, Copenhagen, Denmark, 4-6 October 2004. 2005. 8. Christian, C.W. Professional education in child abuse and neglect. Pediatrics. 2008;122 Suppl 1: S13-17.

Are Medical Students Prepared to Recognize Child Abuse and Neglect? The Evaluation of an Italian Sample

Lupariello, Francesco
;
Capello, Francesca;Bonci, Camilla;Di Vella, Giancarlo
2022

Abstract

Learning Overview: After attending this presentation, attendees will have learned about Italian medical students’ knowledge and training on child abuse and neglect. Impact Statement: This presentation will impact the forensic science community by analyzing the degree of medical students’ preparation on child abuse and by evaluating the medical school contributions on this topic. Child abuse and neglect are widespread social and medical issues that often go unreported, despite being associated with significant morbidity and mortality.1 They represent heterogeneous phenomena that widely vary in type, severity, and chronicity and, as a result, are challenging to identify: misdiagnosis may result in the development of psychiatric and other medical disorders.2,3 In the scientific literature, a limited number of studies have been conducted about health workers’ abilities to recognize suspected child abuse, although some researchers also reported physicians’ lack of knowledge on this topic.4 It is not clear if the reasons for this problem rely on insufficient preparation of students during medical school and/or a deficiency in continuing medical education during/after fellowships. For these reasons, a questionnaire was administered last year to medical students in order to evaluate the degree of knowledge on this theme. The study population included 179 Italian students, divided into two groups: Group A (79.8%)—students who attended pediatric traineeship and/or pediatric exam, and Group B (20.2%)—students who did not attend pediatric traineeship and/or pediatric exam. There were 12 questions focused on child sexual abuse, physical maltreatment, and neglect. Students’ knowledge was considered as sufficient if the final score was ≥6/12. Quantitative and statistical analysis were carried out by Excel® formulas. Results pointed out an overall negative outcome for the most part of the 179 students (77.7% scored <6/12). In this population, medical students’ awareness of child anogenital anatomy/pathophysiology appeared particularly deficient; 55.9% incorrectly answered that rectal prolapse is a manifest sign of chronic anal penetration. Indeed, a marginal percentage (7.3%) of students was aware of the physiological aspect of adult and preadolescent hymens. Similar considerations were highlighted considering the knowledge of suspected trauma sentinel lesions (abusive or accidental).5,6 For all questions, results of chi-square tests yielded no statistical differences between the two groups: the deficiencies were not related to students’ different levels of progression in medical school training and/or preparation. Therefore, this research clearly objectivated the need of a systematic implementation of basics in pediatrics, allowing specialists to acquire notions on child abuse and neglect. The most significant limitation of this study relies on the difficulty of extending the abovementioned considerations to medical students from other geographical regions and/or countries. However, comparison of different medical school systems suggests common issues in students’ education on child abuse and neglect.7 Thus, all these systems are at risk of generating students and future medical doctors who are unable to attend to the responsibility of protecting children from abuse and neglect.8 Study results and literature data suggested a widespread need to implement child abuse and neglect knowledge in medical schools. The present study highlighted the necessity for specific corrective interventions by governments and/or supranational organizations, as well as a proper pediatrics training. Reference(s): 1. Schilling, S.; Christian, C.W. Child physical abuse and neglect. Child Adolesc Psychiatr Clin N Am. 2014;23(2):309-319, ix. 2. Nemeroff, C.B. Paradise lost: The neurobiological and clinical consequences of child abuse and neglect. Neuron. 2016;89(5):892-909. 3. Adams, J.A.; Farst, K.J.; Kellogg, N.D. Interpretation of medical findings in suspected child sexual abuse: an update for 2018. J Pediatr Adolesc Gynecol. 2018;31(3):225-231. 4. Sheets, L.K.; Leach, M.E.; Koszewski, I.J.; Lessmeier, A.M.; Nugent, M.; Simpson, P. Sentinel injuries in infants evaluated for child physical abuse. Pediatrics. 2013;131(4):701-707. 5. Levin, A.V. Retinal hemorrhage in abusive head trauma. Pediatrics. 2010;126(5):961-970. 6. Bechtel, K.; Stoessel, K.; Leventhal, J.M., et al. Characteristics that distinguish accidental from abusive injury in hospitalized young children with head trauma. Pediatrics. 2004;114(1):165-168. 7. World health organization et al. Accreditation of medical education institutions: Report of a technical meeting. Schaeffergården, Copenhagen, Denmark, 4-6 October 2004. 2005. 8. Christian, C.W. Professional education in child abuse and neglect. Pediatrics. 2008;122 Suppl 1: S13-17.
A responsive Academy - meeting and surpassing the challenges of a modern forensic science world
Seattle - WH
21-25 february 2022
Proceedings
AAFS
XXVIII
646
646
Child Abuse, Neglect, Medical Students
Lupariello, Francesco; Capello, Francesca; Bonci, Camilla; Di Vella, Giancarlo;
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