Exeni McAmis Nicole E, Feinn Richard S, Saxena Monica R, Roszczynialski Kelly N
Los Robles Regional Medical Center, Department of Emergency Medicine, Thousand Oaks, CA.
UCLA West Valley Medical Center, Department of Emergency Medicine, Los Angeles, CA.
J Educ Teach Emerg Med. 2025 Oct 31;10(4):S1-S41. doi: 10.21980/J8.52150. eCollection 2025 Oct.
The aim of this simulation case is to educate medical students, interns, junior residents, senior residents, nurses, and faculty on how to identify victims of human trafficking in the healthcare setting. This scenario is adaptable for emergency medicine, outpatient clinic settings, and prehospital settings, including EMS personnel as learners.
Human trafficking is a profound violation of human rights and a pressing local, national, and global health problem. Victims are reduced to objects for commerce, fueling a $150 billion-dollar industry and representing the second largest source of income for organized crime.1,2,3,4 Globally, an estimated 40.3 million people are victims of modern slavery, with more than 70% being women and girls, and one in four victims being children under the age of 18.3,4 While once perceived as a mostly international problem, prevalence estimates now show 5.4 victims per 1,000 people across the world, with 1.3 victims per 1,000 in the United States for forced labor.4Healthcare providers are among the few professionals likely to encounter victims. Multiple studies show that 28-88% of victims sought medical care while being trafficked.6-9 These victims are most likely to seek medical care from emergency departments (63.3%), Planned Parenthood clinics (29.6%), private practices (22.5%), urgent care clinics (21.4%), women's health clinics (19.4%), and neighborhood clinics (19.4%).8 Despite this, only a small fraction of emergency physicians report receiving formal training on human trafficking. This highlights the critical need for enhanced education in emergency medicine, where providers are frequently the first point of contact for victims.
At the conclusion of this case, learners should be able to: 1) review red flags of identifying victims of human trafficking in healthcare settings, 2) identify common indicators and injuries associated with human trafficking, 3) demonstrate a trauma-informed care approach when interviewing potential victims, 4) list and provide patients with national resources for human trafficking,5) understand federal and state mandatory reporting laws and the role of the healthcare provider, 6) determine best treatment options in patients with limited healthcare access, including counseling on empiric treatment of sexually transmitted infection (STI), 7) review management options for an undesired pregnancy according to local institutional policies and state laws for the senior case.
This simulation was designed to assess and improve the level of knowledge on identifying victims of human trafficking in the healthcare setting. This session was conducted using standardized patients portraying both the patient and father/trafficker, a faculty member in the nursing role, and a second faculty member in the control booth. The control booth faculty adjusted the displayed vitals, facilitated case progression, and could call in as registration if needed to progress the case. Each case included approximately four to five learners. A pre-brief was provided to the residents prior to the start of the case, explaining the expectations for interacting with standardized patients (SPs) and emphasizing the importance of safety and professionalism. After each scenario concluded, a post-simulation debriefing was held focusing on the presentation, differential diagnosis, physical exam findings, and management of the targeted social and medical issues. This case scenario can also be adapted for use as an oral board examination case.
The authors performed a knowledge assessment of the case using both pre-simulation and post-simulation surveys designed specifically for this project. These surveys measured participants' knowledge of human trafficking prior to training and their knowledge after the session. Facilitators also provided informal feedback to the scenario developers after the case was piloted. These evaluations were reviewed after implementation. This case was trialed with emergency medicine residents across all training levels (PGY-1 through PGY-4).
Linear mixed models were used to compare pre-session to post-session knowledge of human trafficking, with means reported as descriptive statistics and Cohen's standardized difference (d) used as a measure of effect size. For ordinal questions, a chi-square test compared pre- and post-session responses. Residents' post-session perceptions of effectiveness were analyzed using frequency distributions. Statistical analyses were conducted using SPSS v29. Open-ended feedback responses were analyzed qualitatively using content analysis, with each author independently reviewing and categorizing key themes.Participants reported gaining a deeper understanding of the complexities of human trafficking and greater confidence in their ability to recognize and intervene. A total of 29 residents participated across all four years of training (PGY-1 = 9, PGY-2 = 4, PGY-3 = 11, PGY-4 = 5; 51% female). Only 24% reported prior training, while 94% believed they would benefit from training on human trafficking. Knowledge scores improved significantly (Pre: 59.2 → Post: 65.1; Cohen's d = 0.39, p < .05). Self-reported comfort recognizing victims increased from 35% to 64% (p < .05), and comfort managing victims increased from 28% to 69% (p < .05), with no differences by PGY level or gender. On the post-survey, 100% of participants agreed the simulation enhanced their knowledge.Qualitative comments were gathered digitally through a QR code linked to Smartsheet as part of the standard process for resident didactic feedback. Resident responses were provided to case authors without any identifying information, except for PGY year. Prompts for qualitative comments were open-ended response questions of feedback for presenters and their most valuable learning points. Qualitative feedback (n = 27) emphasized increased awareness, the Human Trafficking Hotline as a valuable resource, and strategies for investigating concerns and providing medical management. Many also suggested smaller groups, additional pre-simulation training, and clearer integration of social work. Overall, residents highlighted that this simulation not only improved their base of knowledge but also provided practical tools to support victims in real-world clinical settings.
Simulation-based training on human trafficking in emergency medicine is a vital tool for preparing providers to recognize and respond to these complex cases. By engaging in highly interactive, standardized patient scenarios, learners can practice recognizing subtle red flags, applying trauma-informed communication, and balancing confidentiality with mandated reporting requirements. The debriefing sessions allow further reflection, knowledge integration, and discussion of best practices. Although standardized patients may be cost-prohibitive, faculty can serve as role players to reduce barriers to implementation. Through such training, healthcare providers enhance preparedness, empathy, and effectiveness in addressing the needs of trafficking survivors and contribute to broader efforts to combat exploitation.
Medical simulation, emergency medicine, human trafficking, sex trafficking, sexually transmitted diseases, abuse, non-accidental trauma, domestic abuse.
本模拟案例的目的是培训医学生、实习生、低年资住院医师、高年资住院医师、护士以及教员，使其了解如何在医疗环境中识别人口贩运受害者。该场景适用于急诊医学、门诊诊所环境以及院前环境，包括将急救医疗服务人员作为学习者。
人口贩运是对人权的严重侵犯，也是一个紧迫的地方、国家和全球卫生问题。受害者沦为商业交易的对象，助长了一个价值1500亿美元的产业，是有组织犯罪的第二大收入来源。在全球范围内，估计有4030万人是现代奴隶制的受害者，其中超过70%是妇女和女孩，四分之一的受害者是18岁以下的儿童。虽然人口贩运曾经被认为主要是一个国际问题，但现在的流行率估计显示，全球每1000人中有5.4名受害者，在美国，每1000人中有1.3名强迫劳动受害者。医疗保健提供者是少数可能接触到受害者的专业人员之一。多项研究表明，28%-88%的受害者在被贩运期间寻求过医疗护理。这些受害者最有可能在急诊科（63.3%）、计划生育诊所（29.6%）、私人诊所（22.5%）、紧急护理诊所（21.4%）、妇女健康诊所（19.4%）和社区诊所（19.4%）寻求医疗护理。尽管如此，只有一小部分急诊医生报告接受过关于人口贩运的正规培训。这凸显了急诊医学强化教育的迫切需求，因为医疗服务提供者常常是受害者的第一接触点。
在本案例结束时，学习者应能够：1）回顾在医疗环境中识别人口贩运受害者的警示信号；2）识别与人口贩运相关的常见指标和损伤；3）在询问潜在受害者时展示创伤知情护理方法；4）列出并向患者提供全国性的人口贩运资源；5）了解联邦和州的强制报告法律以及医疗服务提供者的角色；6）为医疗服务受限的患者确定最佳治疗方案，包括对性传播感染（STI）经验性治疗的咨询；7）根据当地机构政策和州法律，针对高年级案例回顾意外怀孕的管理方案。
本模拟旨在评估和提高在医疗环境中识别人口贩运受害者的知识水平。本次课程使用标准化病人来扮演患者和父亲/贩运者，一名教员扮演护士角色，另一名教员在控制室。控制室的教员调整显示的生命体征，推动病例进展，并在需要时可作为登记人员来推进病例。每个病例大约有四到五名学习者。在病例开始前，向住院医师提供了预简报，解释了与标准化病人互动的期望，并强调了安全和专业精神的重要性。每个场景结束后，进行了模拟后汇报，重点是呈现内容、鉴别诊断、体格检查结果以及针对性的社会和医疗问题的管理。这个病例场景也可以改编用作口试病例。
作者使用专门为本项目设计的模拟前和模拟后调查问卷对该病例进行了知识评估。这些调查测量了参与者在培训前对人口贩运的知识以及培训后的知识。在病例试点后，教员也向场景开发者提供了非正式反馈。在实施后对这些评估进行了审查。该病例在所有培训水平（PGY-1至PGY-4）的急诊医学住院医师中进行了试验。
使用线性混合模型比较培训前和培训后对人口贩运的知识，均值作为描述性统计报告，科恩标准化差异（d）作为效应大小的度量。对于有序问题，使用卡方检验比较培训前和培训后的回答。使用频率分布分析住院医师培训后对有效性的自我认知。使用SPSS v29进行统计分析。使用内容分析对开放式反馈回答进行定性分析，每位作者独立审查并对关键主题进行分类。参与者报告对人口贩运的复杂性有了更深入的理解，并且对识别和干预的能力更有信心。共有29名住院医师参与了所有四年的培训（PGY-1 = 9，PGY-2 = 4，PGY-3 = 11，PGY-4 = 5；51%为女性）。只有24%的人报告曾接受过培训，而94%的人认为他们将从人口贩运培训中受益。知识得分显著提高（培训前：59.2→培训后：65.1；科恩d = 0.39，p <.05）。自我报告识别受害者的舒适度从35%提高到64%（p <.05），管理受害者的舒适度从28%提高到69%（p <.05），不同PGY水平或性别之间没有差异。在调查后，100%的参与者同意模拟增强了他们的知识。定性评论通过与Smartsheet链接的二维码以数字方式收集，作为住院医师教学反馈的标准流程的一部分。住院医师的回答在不提供任何识别信息的情况下提供给病例作者，除了PGY年份。定性评论的提示是针对演示者的反馈和他们最有价值的学习点的开放式回答问题。定性反馈（n = 27）强调了意识的提高、人口贩运热线作为宝贵资源以及调查疑虑和提供医疗管理的策略。许多人还建议小组规模更小、增加模拟前培训以及更清晰地整合社会工作。总体而言，住院医师强调这个模拟不仅提高了他们的知识基础，还提供了在实际临床环境中支持受害者的实用工具。
急诊医学中基于模拟的人口贩运培训是使医疗服务提供者准备好识别和应对这些复杂病例的重要工具。通过参与高度互动的标准化病人场景，学习者可以练习识别微妙的警示信号，应用创伤知情沟通，并在保密与强制报告要求之间取得平衡。汇报环节允许进一步反思、知识整合以及对最佳实践的讨论。尽管标准化病人可能成本过高，但教员可以担任角色扮演者以减少实施障碍。通过此类培训，医疗服务提供者在满足贩运幸存者需求方面增强了准备、同理心和有效性，并为打击剥削的更广泛努力做出贡献。
医学模拟、急诊医学、人口贩运、性交易、性传播疾病、虐待、非意外创伤、家庭虐待。
