|Year : 2011 | Volume
| Issue : 1 | Page : 501
Human Trafficking: An Evaluation of Canadian Medical Students' Awareness and Attitudes
JC Wong1, J Hong1, P Leung1, P Yin1, DE Stewart2
1 Faculty of Medicine, University of Toronto, Ontario, Canada
2 Faculty of Medicine, University of Toronto; University Health Network, Toronto, Ontario, Canada
|Date of Submission||17-Jun-2010|
|Date of Acceptance||10-Jan-2011|
|Date of Web Publication||29-Apr-2011|
J C Wong
200 Elizabeth Street, EN-7-229, Toronto, Ontario M5G 2C4
Source of Support: None, Conflict of Interest: None
Context: Human trafficking is a human rights violation prevalent globally. Current guidelines highlight healthcare professionals' key role in responding to human trafficking, emphasizing the importance of medical education in raising awareness of trafficking.
Objective: To assess pre-clerkship medical students' awareness of human trafficking and attitudes towards learning about
trafficking in the medical curriculum at Canada's largest medical school.
Methods: An anonymous, classroom-based questionnaire was designed, piloted and administered to first- and second-year medical students at one large Canadian medical school with a diverse student population. The questionnaire sought demographic data and information on students' self-perceived awareness of human trafficking and interest in learning about trafficking and other community health issues.
Results: 262 medical students completed the questionnaire (70.0% response). Most participants reported that they were not knowledgeable (48.5%) or only somewhat knowledgeable (45.4%) about human trafficking. 88.9% of participants were not familiar with signs and symptoms of trafficked persons. While students' responses indicated that they prioritized other social issues, a majority of participants (76.0%) thought that trafficking was important to learn about in medical school, especially identifying trafficked persons and their health needs.
Conclusions: These medical students of one Canadian medical school demonstrated limited familiarity with the issue of human trafficking but largely felt that they should be taught more about this issue during their medical education. This assessment of early medical students' awareness of human trafficking is relevant to medical educators and the organizations that could develop the required educational curricula and resources.
Keywords: Attitudes, health knowledge, human rights abuses, medical education, practice, questionnaires, undergraduate
|How to cite this article:|
Wong J C, Hong J, Leung P, Yin P, Stewart D E. Human Trafficking: An Evaluation of Canadian Medical Students' Awareness and Attitudes. Educ Health 2011;24:501
Medical education can play an important role in fostering future physicians’ sense of social responsibility and engagement with emerging community health needs1-4. Human trafficking is a significant social justice issue and an international human rights violation. The United Nations defines human trafficking as the recruitment, transportation or receipt of persons for the purposes of exploitation in forced labour, forced prostitution, or other forms of slavery, usually involving force, threat or deceit5. While it is not possible to accurately estimate the global prevalence of human trafficking due to its covert nature, the United States Department of State provides narratives for the prosecution, protection and prevention of trafficking in both developed and developing countries across Asia and Pacific, Africa, Europe, North and South America6,7. Trafficking is a truly global problem.
Current literature strongly emphasizes the unique role of healthcare professionals in responding to human trafficking8-12 and the healthcare needs of trafficked persons13-20. Healthcare professionals have a particular responsibility to identify and advocate for trafficked persons because healthcare professionals are often the only professionals that trafficked persons will encounter under captivity11. The United States Department of Health and Human Services (DHHS) provides educational resources for healthcare professionals about human trafficking, which emphasize that healthcare professionals occupy key positions for intervening on behalf of trafficked persons21.
As multiple governmental, non-governmental and academic agencies consider health needs of trafficked persons a priority issue, physicians should likewise consider addressing this issue in their educational and professional activities. However, few medical schools include the issue of human trafficking in their curriculum. Not surprisingly, one study reported that only 3% of emergency medicine health professionals had ever received training in how to respond to human trafficking22.
The purpose of this study is to assess awareness of human trafficking among pre-clerkship medical students of one Canadian medical school and assess their attitudes towards learning about human trafficking in the medical curriculum. These data from medical students are intended to inform medical educators as well as the organizations that are developing educational resources for healthcare professionals.
A questionnaire was designed to evaluate medical students’ familiarity with the issue of human trafficking and their attitudes towards learning about human trafficking. The study was approved by the Office of Research Ethics, University of Toronto.
The study was conducted at one large Canadian medical school. First- and second-year (pre-clerkship) medical students were invited to participate in a brief questionnaire administered in the classroom. Students received information sheets about the study along with the questionnaires, and participation was completely voluntary and anonymous. Students did not receive compensation for their participation, nor did participation affect their academic standing in any way.
Questionnaire Design and Data Analysis
No validated questionnaire existed in the literature to evaluate students’ awareness of and attitudes towards human trafficking. We designed a questionnaire composed of questions to target students’ self-perceived awareness of human trafficking and attitudes towards learning about human trafficking and other community health issues, for comparison (Appendix A). The questionnaire also collected basic demographic data. The questionnaire was piloted with a semi-structured focus group of four pre-clerkship medical students and was modified based on feedback from the group. Focus group participants individually completed full questionnaires and then the group reviewed each item. Items that were ambiguous or unnecessary were identified and either amended or eliminated. Time required to complete the survey was also assessed. The data were analyzed using SPSS Statistics 17.0 (SPSS Statistics 17.0, Release 17.0.0. 2008. Chicago: SPSS Inc.).
A total of 262 questionnaires were completed, for response rates of 77% in the first-year class (140 of 182 students) and 64% in the second-year class (122 of 192). Of the participants, 55.1% were female and 65.8% were born in Canada. The majority (71.4%) of participants were 21-25 years old and 21.3% were 26-30 years old.
Table 1 summarizes participants’ responses to questions about their familiarity with the issue of human trafficking. Many participants (93.9%) felt that they were either not knowledgeable or only somewhat knowledgeable about human trafficking. Less than 5% had learned about human trafficking through their extracurricular activities during medical school, and no participants had learned about human trafficking within the medical curriculum. A majority of participants (88.9%) felt that they were not familiar with the signs and symptoms that might help them identify a trafficked person. Furthermore, most (93.9%) thought that it would be either unlikely or only somewhat likely to encounter or identify a trafficked person in a clinical setting in Canada.
Table 1: Responses to questions about awareness of human trafficking (n=262)
When asked about their interest in learning about a variety of community health issues, participants selected child abuse, domestic violence and poverty as the three most important issues (Table 2). While human trafficking ranked lowest on the list of community health issues, a majority of participants (76.0%) still perceived human trafficking as important or very important. Specifically, when asked to evaluate the importance of learning objectives about human trafficking, over 85% of participants thought that it was important or very important to learn about the identification and health needs of trafficked persons (Table 3). In contrast, fewer participants felt that it was important to learn about legal and immigration issues, or lobbying and advocacy.
Table 2: Perceptions of importance of various community health issues (n=262)
Table 3: Perceptions of importance of learning objectives in human trafficking (n=262)
Medical students at the University of Toronto reported limited familiarity with the issue of human trafficking and with responding appropriately when encountering human trafficking. A majority of students thought that it would be unlikely to encounter a trafficked person in a clinical setting in Canada, which is a misconception. Human trafficking is an increasing problem that crosses international boundaries in both developing and developed countries6,7, and is thus relevant in countries across the world. Healthcare professionals are likely the only professionals that trafficked persons under captivity may encounter, and thus have unique opportunities to intervene11.
One study of 21 survivors of trafficking in the United States found that 28% of them reported having encountered a healthcare professional while they were captive; but none of these encounters resulted in appropriate identification or intervention23. Trafficked persons may fear reporting their victimization because of their immigration status, psychological dependency on and fear of captors, and distrust of local authorities, so it becomes especially important that healthcare professionals recognize signs and symptoms in a patient that suggest trafficking24,25.
Medical students should be aware of the complexity and severity of healthcare needs of trafficked persons15. Trafficked persons require immediate attention for acute illnesses and longer-term care for physical and psychological problems that stem from pre-trafficking abuse and from violence experienced while being trafficked16,20. Physical problems include sexually transmitted infections13,14,18,19, food or sleep deprivation, injuries and compounded physical symptoms15,16. Trafficked persons are also at higher risk of mental health problems, such as anxiety, depression, attempted suicide or post-traumatic stress disorder16,17.
Healthcare professionals can help care for trafficked persons as they are rescued and must make difficult legal and immigration-related decisions16, and over the long run when they reintegrate into free society and rebuild their lives. Furthermore, medical students and physicians can use their unique position as health advocates to educate young potential victims in both developed and developing countries about the hazards of trafficking. Curricular development can draw on existing literature8,10,11,21. In particular, the US DHHS offers a useful learning package on trafficking for healthcare providers21. The International Organization for Migration also presents detailed guidelines for healthcare professionals on caring for trafficked persons26.
Encouragingly, most medical students at our institution felt that it was important to learn more about human trafficking. Introduction of human trafficking into the medical curriculum can follow the examples of issues like domestic violence or poverty that have already successfully been included in medical curricula through novel educational programs27-30. At our institution, child abuse, domestic violence and poverty are taught in the medical curriculum, so it is not surprising that participants in our study chose these issues as the top three most important community health topics. Information about human trafficking can be integrated into the community health curriculum, especially when issues such as domestic violence and child abuse are discussed. However, education about domestic violence does not sufficiently cover education about human trafficking, as human trafficking is an issue with additional layers of complexity9.
There are several limitations to this study. Firstly, this study was performed at one medical school, which weakens its generalizability. While students and faculty at several other schools in Canada and the United States were invited to join in the study, ultimately no other schools participated due to lack of interest or logistical issues. Secondly, the overall response rate of this study was 70.0%. As 30.0% of eligible students did not participate, questionnaire responses could be biased, possibly with an overestimation of student knowledge and interest in human trafficking. Thirdly, the questionnaire used to survey medical students was created de novo and not validated, and may not have accurately measured students’ awareness and attitudes. Additionally, the fact that the survey focused on the issue of human trafficking could have biased students towards responding favorably towards questions about their interest in learning about this topic. Finally, the goal of this study was to provide evidence for the need for curriculum development, but development or evaluation of specific teaching resources was beyond the scope of the study.
This study provides an assessment of early medical students’ awareness of human trafficking at one medical school. Our study is the first, to our knowledge, to provide some direct evidence to justify and guide the implementation of human trafficking, a critical social justice issue, into the medical curriculum. Interestingly, surveys themselves are vehicles for raising awareness about social justice and community health. Medical school is a uniquely effective time to influence the attitudes and practices of future physicians and, in turn, physicians can be uniquely influential advocates for trafficked persons.
The authors would like to acknowledge Brian Li for help with data analysis; Delna Press, Christopher Yao and Darwin Yeung for help with survey design; Mary Wanca for administrative assistance; and Dr. Jay Rosenfield and Dr. Martin Schreiber for help with implementing this study at our institution.
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Appendix I: Medical Students’ Perceptions of Human Trafficking: Survey