Developing Physician Educational Competencies for the Management of Female Genital Cutting: A Call to Action

Abstract

Female genital cutting (FGC), also called female genital mutilation, is defined as ''all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious, or other nontherapeutic reasons.'' FGC can have significant health consequences, including multiple physical and psychological complications, throughout the life course. Despite violating numerous human rights and existing legal prohibitions, the practice continues. In the United States, FGC is becoming increasingly prevalent, however, physicians are not routinely trained to care for these patients. Despite the evidence of the need, there is a woeful lack of training regarding FGC in undergraduate, graduate, and continuing medical education programs. Furthermore, many health care providers (HCPs) are unaware of their mandatory reporting obligations regarding FGC under current state laws. There are no established educational competencies or training guidelines for incorporating FGC into all levels of medical education. This article establishes the need to develop competencies and underscores that models exist for undertaking this work. It also aims to engender dialog about FGC education and calls for launching an initiative to develop educational competencies to train HCPs about FGC. By integrating comprehensive, evidence-based education and training at all levels of medical education, HCPs will be able to provide high-quality, team-based, culturally sensitive care to the hundreds of thousands of affected women and girls in the United States, and work to prevent the practice from being carried out on girls who are at risk but have not yet been cut.

Facilitating Factors of Professional Health Practice Regarding Female Genital Mutilation: A Qualitative Study

“…All of the people interviewed reported a lack of training in FGM, both in their academic education and after joining the workforce. This reality is shared with other countries where there is a significant number of people from at-risk countries [20,25,26].…”

Addressing female genital cutting among service providers in New York.

“…As Atkinson and Geisler (2019) have pointed out, "Education and training about FGC should be incorporated into American medical education programs, both at undergraduate and graduate levels, as well as offered as part of continuing medical education initiatives : : : " (p. 3). The findings of this study highlight a knowledge gap that extends outside the medical profession.…”

“…Finally, it is important to note that while numerous gaps in the field have been identified and acknowledged in the U.S.—ranging from the need for advocacy to the need for educational competencies and culturally informed practices (Atkinson et al, 2019; Atkinson & Geisler, 2019; Nour, 2015)—the main focus of the few studies conducted regarding health care professionals has been on the perspectives and practices of medical professionals in the U.S. (Hess et al, 2010; Lane et al, 2019; Moaddab et al, 2017). Until recently, the experiences of other professionals have been largely ignored (Akinsulure-Smith & Sicalides, 2016).…”

Diagnosis, Management, and Treatment of Female Genital Mutilation or Cutting in Girls

“…Data extrapolated from 2004 to 2008 East African regional surveys of girls and women 15 years and older revealed that 82% to 99% reported to have had undergone FGM/C, and of these cases, 34% to 79% were type III (Somalia having the highest prevalence of type III). [29][30][31][32] One recent US study revealed that of 79 general pediatricians surveyed, 73% had received no previous FGM/C education, 89% did not feel confident in their ability to identify FGM/C types, and frequency of performing external genital examinations on female patients at health supervision visits was inversely related to the age of the patient (with 75% performing examinations on infants, down to only 8% in 17-to 18-year-olds). 28 In literature from other high-income countries with immigrant populations from regions where FGM/C is prevalent, pediatricians have reported identifying FGM/C in pediatric patients, managing complications from remote and recent procedures, and, in some instances, being asked to perform FGM/C in children.…”