Education Columns

Suzanne Minor, MD, Florida International University Herbert Wertheim College of Medicine, Miami, FL; Sarah Stumbar, MD, MPH, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; Yolangel Hernandez Suarez, MD, Florida International University Herbert Wertheim College of Medicine, Miami, Florida

Acknowledgments: The authors wish to thank Ms. Marquita Samuels for her support in the curriculum review.

Funding/Support: This project was not funded.

Other disclosures: None.

Ethical approval: No IRB approval required.

Background

Human trafficking is the “recruitment, transportation, transfer, harbouring or receipt of people through force, fraud or deception, with the aim of exploiting them for profit. Men, women and children of all ages and from all backgrounds can become victims of this crime, which occurs in every region of the world. The traffickers often use violence or fraudulent employment agencies and fake promises of education and job opportunities to trick and coerce their victims.”¹

Florida is the third highest trafficking destination in the United States.² Approximately half of the graduates of the Florida International University Herbert Wertheim College of Medicine (FIU HWCOM), our Miami-based medical school, train in Florida residencies.³ We recognized a need to assess how we are teaching medical students about human trafficking and to recommend curriculum and objectives to guide student learning.

Methods

We audited the curriculum for where and how human trafficking is taught, including the accompanying learning objectives and assessment. The following words were searched in FIU HWCOM’s electronic curriculum map: human trafficking, domestic violence, intimate partner violence, vulnerable, trafficking, slave, marginal, forced labor, labor, exploitation, prostitution, kidnapping, sex work, and smuggling. No session objectives or assignments contained any of these terms. Additionally, the course directors for all courses and clerkships were emailed. One course identified that students for the last several years had chosen human trafficking as the topic for an assigned community research paper. Additionally, an affiliate hospital system collaborated with a faculty member and several students to develop and deliver a CME session for faculty. Our curriculum currently has no specific coverage of human trafficking.

Next, we performed a literature review to determine best practices regarding learning objectives on this topic.  We then identified the gap between practiced and recommended education. 

Recommended Learning Objectives

Based on our literature review, we developed a list of recommended curricular learning objectives on human trafficking.^4-11

By the end of medical school, students should be able to:

1. Define human trafficking.
2. Screen for violence and trauma (with the goal of preventing future trafficking victimization).
3. Screen for red flag history and signs with the goal of identifying human trafficking.
4. Use trauma-informed, patient-empowering communication in patient interactions, documentation, and presentation
5. Recommend initial steps in care for patients experiencing human trafficking utilizing a trauma-informed approach

Recommendations for Next Steps

Our findings were presented to the FIU HWCOM Strand Leaders Committee, which oversees horizontal and vertical integration of curricular content at our institution. A recommendation was made to develop an introductory session on human trafficking in the first year Community Engaged Physician course, and to create a case-based learning activity during the Obstetrics and Gynecology Clerkship. The clerkship session is finalized and the first year session is in development. Both sessions will be added to the curriculum during the upcoming academic year. We also plan to work with the Office of Student Affairs to encourage co-curricular sessions with interest groups such as the American Women’s Medical Association. Through a needs assessment and development of curricular objectives, we were able to make specific, evidence-based recommendations for the integration of new curricular content. It is our hope that this process can serve as a framework for other medical educators.

References

1. United Nations Webpage. [Internet]. [cited 2023 April 11]. https://www.unodc.org/unodc/en/human-trafficking/human-trafficking.html
2. Florida Department of Health, Office of Communications. Human Trafficking Awareness January 11, 2018. [Internet]. [cited 2023 April 11]. https://www.floridahealth.gov/newsroom/2018/01/011118-human-trafficking-awareness.html
3. Florida International University Herbert Wertheim College of Medicine Office of Student Affairs Statistics, 2022.
4. Stoklosa H, Grace AM, Littenberg N. Medical Education on Human Trafficking. AMA J Ethics. 2015;17(10):914-921. doi: 10.1001/journalofethics.2015.17.10.medu1-1510.
5. Song AY, Poythress EL, Bocchini CE, Kass JS. Reorienting Orientation: Introducing the Social Determinants of Health to First-Year Medical Students. MedEdPORTAL. 2018;14:10752. https://doi.org/10.15766/mep_2374-8265.10752
6. Chambers R, Ravi A, Paulus S. Human Trafficking: How Family Physicians Can Recognize and Assist Victims. American Family Physician. 2019;100(4):202-204.
7. Garg A, Panda P, Malay S, Rose JA. A Human Trafficking Educational Program and Point-of-Care Reference Tool for Pediatric Residents. MedEdPORTAL. 2021;17:11179. https://doi.org/10.15766/mep_2374-8265.11179
8. Matson CC, Beck L, Rajasekaran SK. Using Language That Reflects Who Is the Center of Our Care. Academic Medicine. 2019;94(9);1400. doi: 10.1097/ACM.0000000000002799
9. National Child Traumatic Stress Network Schools Committee. Child Trauma Toolkit for Educators. Los Angeles, CA & Durham, NC: National Center for Child Traumatic Stress. October 2008. [Internet]. [cited 2023 April 11]. https://www.nctsn.org/sites/default/files/resources//child_trauma_toolkit_educators.pdf
10. Ravi A, Little V. Providing Trauma-Informed Care. Am Fam Physician. 2017;95(10):655-657.
11. Hodas GR. Responding To Childhood Trauma: The Promise And Practice Of Trauma Informed Care. Pennsylvania Office of Mental Health and Substance Abuse Services. February 2006. http://childrescuebill.org/VictimsOfAbuse/RespondingHodas.pdf